Is it possible to dialyze at home? The risk is not small
Recently, Jiangsu uremic patients Hu Songwen 13 years at home in the home homemade "blood dialysis machine" for dialysis news, once again, the plight of China's uremic patients, has become a hot topic of public opinion. Is self-help dialysis feasible? Why is there a huge difference in cost between self-help dialysis and hospital treatment? Is hospital dialysis hiding profiteering? To this end, the People's Daily "proof" column reporter interviewed the news parties and doctors, experts.
Did Hu Songwen dialyze at home for 13 years?
Investigation? Was in the hospital dialysis 6 years, nearly 13 years of basic home treatment
January 14, the reporter came to the town of Qutang, Haian County, Jiangsu Province, to see Hu Songwen and his mother. In the bathroom on the first floor of his home, Hu Songwen sat behind a pile of instruments, his left arm inserted with a needle, "self-treatment".
"This is the blood pump, is the driving force of the blood circulation outside the body, the blood through the dialyzer, through the semi-permeable membrane and the dialysis fluid for material exchange, to remove the body's products of metabolism and regulate the electrolyte disorders and acid-base balance; this volumetric flask is used to measure the configuration of sodium chloride and bicarbonate of sodium and other dialysis fluid; dialysis fluid should be heated to a slightly higher than the temperature of the human body at 38 degrees! Around, which contains a variety of salts, stainless steel pots are not easy to rust and contamination ...... "Hu Songwen, while pointing to the side of the size of the instruments and bottles and jars, while telling reporters that such dialysis, from the beginning of the two times a week, to the current three times a week, has been carried out for nearly 14 years.
According to Hu Songwen, in January 1993, he was found to be suffering from uremia in his junior year at Nanjing Meteorological College, and the first six years were spent in the hospital on dialysis.
Hu Songwen said, at first by the school reimbursement of one year's medical expenses, dialysis in the Nanjing Military Region General Hospital; a year and a half later, he returned to the county hospital with the community and friends and family donations ***45,000 yuan treatment. With the cost of treatment stretched to the limit, he had the idea of treating at home from 1995, bought Blood Into Chemistry and began to study. "The book talked in detail about hemodialysis technology, and I thought it would be feasible to treat at home, and spent 5,200 yuan to buy back a blood pump in 1996. The family was against it until 1999, when they had to agree because they couldn't think of any other way." Hu Songwen said.
Hu Songwen's mother, who is 81 years old, recalls her son's first at-home dialysis and remains impressed. "It was the first time on the afternoon of March 31, 1999, on the second floor of his house. I was very nervous and scared, afraid that he would have an accident. Now I'm not afraid anymore." Hu Songwen's mother said as she helped pour pure water into a stainless steel pot to heat it.
Wang Yixin, deputy director of Hu Songwen's neighborhood committee, told reporters that their group of neighborhood committee cadres came to the post in 2002, and after they came, Hu Songwen has been at home on his own for treatment.
According to Hai'an County nephrologist who checked the medical records after 2005 (the hospital's computer has records that can be queried history), there is indeed no Hu Songwen's medical situation. Doctors from other departments also told reporters that they did not have the impression that Hu Songwen had visited the hospital in recent years.
Can blood dialysis be done at home?
Investigation? Higher hygiene and technical requirements, home dialysis risks
Hemodialysis refers to the use of diffusion, ultrafiltration and convection principles to remove harmful substances and excess water from the blood, is one of the most commonly used renal replacement therapy.
According to experts, there are medical risks in the process of hemodialysis, which may cause serious consequences and even life-threatening: first, hypotension, heart failure, myocardial infarction, cerebrovascular accidents; second, air embolism; third, allergic reactions; fourth, dialysis imbalance and electrolyte-acid-base balance disorders; fifth, hemolysis, hemorrhage; sixth, fever and infections; seventh, liver function abnormalities, etc.; eighth, viral hepatitis and other infectious diseases .
According to the requirements of the Ministry of Health, medical institutions to set up hemodialysis room, must have the health administrative department approved nephrology professional diagnosis and treatment subjects, hemodialysis room should be distinguished between clean and contaminated areas, each hemodialysis unit using an area of not less than 3.2 square meters, at least two practicing physicians and a technician, and each hemodialysis machine is equipped with at least 0.4 nurses.
Lu Ming, director of the medical administration department of the Beijing Municipal Bureau of Health, said Beijing stipulates that hemodialysis can only be carried out in hospitals above the second level, and there are more than 230 hospitals in the city*** that can carry out hemodialysis. As technical conditions mature, Beijing will relax the hemodialysis qualification standards, where qualified first-class hospitals and community medical institutions can also carry out treatment.
Hai'an County People's Hospital nephrologist told reporters that hemodialysis should have very good hardware and software, Hu Songwen's case is just a special case, and does not represent the whole, the patient in his own home to do dialysis there are a series of problems, the risk is very high. Wang Shixiang, director of the blood purification center of Beijing Chaoyang Hospital, believes that self-help dialysis is feasible, the condition is that there must be formal equipment, can achieve the operation of the required sterile environment, and technical support from medical staff. But self-help dialysis there is a great risk, hemodialysis, the human body through the dialysis pump blood flow of about 300 milliliters per minute, in case of poor control, easy to cause blood loss, will cause or aggravate cardiovascular and cerebrovascular diseases, and even life-threatening, if this time is not in the hospital, it is difficult for the patient to be rescued in a timely manner.
Wang Shixiang introduced, self-help or mutual dialysis, to meet the health operating conditions, especially independent room as a dialysis room; at the same time, the need for patients and their families to master dialysis technology, it is best to have a health care provider to guide; if an accident occurs, to be able to ensure that timely assistance.
Wang Shixiang introduced, foreign countries have home dialysis room. First, they have a perfect family doctor system, the patient dialysis at home, can get the guidance of the family doctor. Secondly, in developed countries, patients have a better living environment and can have a separate dialysis room, which can meet the hygienic conditions needed for operation. In Australia, home dialysis units have become more common.
Is hospital hemodialysis hiding profiteering?
Investigation? The cost of medical equipment is higher, the price of treatment is determined by the Price Bureau, profit margins are limited
Many patients feel that the hospital hemodialysis price is more expensive, the reporter visited a number of hospitals to understand the situation.
Wang Shixiang said that in 2002, the Beijing Municipal Bureau of Prices pricing for each 420 yuan, allowing fluctuations of 15%. Many hospitals in Beijing dialysis charges 480 yuan, of which, the total price of consumables is more than 300 yuan, the rest of the cost of labor costs, water and electricity, housing, depreciation and maintenance of equipment. Wang Shixiang said the high standard of equipment hygiene and technical level required for hemodialysis also makes it difficult to reduce the cost at present.
Hai'an County People's Hospital nephrologist told reporters that patients needing dialysis need to register for the first visit to the hospital, the ordinary number of 2 yuan, blood tests and other costs are generally about 500 yuan. After the first treatment, the patient then go to the outpatient blood dialysis, no longer charge registration fees, material fees and so on. According to state regulations, patients need to do a blood test every six months.
At present, the treatment of uremia patients at the Hai'an County People's Hospital mainly includes blood purification (hemodialysis), and various medications (anti-hypertension, improvement of cardiovascular function, regulation of endocrine function, and fight against anemia, etc.). It costs 400 RMB to do a hemodialysis, which is charged according to the unified fee standard in Jiangsu Province, including drugs, dialysis solution, dialysis tubing, heparin, etc., as well as the cost of acquisition, wear and tear, and daily maintenance of some equipments. In addition to the hemodialysis machine, dialyzers, tubing, etc. are all disposable, the state does not allow reuse; hemodialysis room doctors and nurses are all through the unified training, get a certificate of induction before the hemodialysis post work. Hundreds of thousands of blood dialysis machine with five or six years on the scrap, and there are daily maintenance costs; for water treatment machine a to hundreds of thousands of dollars, 3 to 5 years to replace once.
Jiangsu Province Price Bureau staff told reporters that 400 yuan a blood dialysis cost is the province's uniform pricing, with reference to the neighboring Shanghai, Zhejiang and other places is also this number, and the national scope, the price is similar.
While most hospitals have no room for profiteering on blood dialysis, the 400 yuan per dialysis cost is a huge burden for many people. How can the right to live of the critically ill be guaranteed? How can the huge cost of treatment stop crushing ordinary families? The next installment of "Evidence" will focus on the protection of health insurance for uremia and other major diseases.