The Examination of a vascular access of home hemodialysis patients in our hospital

[Purpose] Recently, home hemodialysis (HHD) has become common in Japan. However, vascular access (VA) is difficult in some patients. To perform stable HHD, it is important to achieve favorable VA. With respect to VA for HHD patients in our hospital, we analyzed VA maintenance/control before and after the introduction of HHD. [Subjects/Methods] The subjects were 4 patients undergoing chronic maintenance dialysis in whom HHD management had been conducted in our hospital (42.8±7.1 years, male-to-female ratio: 2: 2, duration of HHD: 20.8±20.5 months) (mean±SD). We retrospectively examined VA orientation as guidance before HHD introduction and the management of puncture/problems after HHD introduction based on interviews on consultation at the outpatient clinic and reports/records regarding the treatment course on each session. [Results] The mean frequency of guidance before HHD introduction was 27.3±10.9 times (mean±SD). Of these, the frequency of guidance for puncture was 21.5±9.0 times. VA problems after HHD introduction consisted of mis-puncture-related internal hemorrhage (11 episodes), pain/swelling at the puncture site (6 episodes), puncture-position switching related to an increase in the venous pressure or pain at the puncture site (7 episodes), PTA selection (1 episode), and additional guidance for puncture (2 episodes). Sharp needle-related problems caused swelling/pain, markedly influencing the patients' stress. On the other hand, buttonhole (BH) puncture reduced stress. [Conclusion] As a specific interval is required to learn self-puncture, it may be necessary to start guidance for puncture in the early phase. BH puncture may lead to a decrease in the number of puncture-related problems, and should be utilized as a puncture method to put patients' mind at ease. However, guidance for puncture with a sharp needle must be performed in patients in whom BH puncture is difficult or as a strategy when it is impossible. For VA management in HHD patients, it is important to accurately acquire puncture methods matched to individual patients and continue regular observation with dialysis staff.