A problem regarding the puncture order of patients at the start of hemodialysis is commonly experienced in most maintenance dialysis facilities. Various strategies have been used, but an overall approach has not yet been established. We began using a time-fixed puncture system 20 years ago and continue to successfully carry out this approach. In this study, we report practical methods for using the time-fixed puncture system (TFPS) and compared our experience with other various puncture order systems. Patients were also surveyed by questionnaire.
The basic rule of TFPS is as follows. (1) Time interval of the puncture procedure is settled within a 5-minute frame. (2) Two staff are always engaged for the puncture procedure of one patient. (3) Patients are given precedence, by the following criteria: long-term hemodialysis history, long-time hemodialysis per session, travelling a far distance from home, a history of difficulty in being punctured, requiring additional care. (4) Time of puncture and patient names are posted in a prominent place.
Analysis of characteristics of other puncture systems: when puncture is performed in order of the time of arrival to the clinic, patients compete with each other for puncture turn. As a result, many patients come to the clinic off-schedule in the early morning in order to get an early turn. Using the bed placement order system, a simple line of work flow is effective for the staff, but patients usually complain about the simple fixed puncture order by bed number. However, TFPS improves off-schedule arrival at the clinic in the early morning and efficiently shortens the interval until puncture. Staff can concentrate on puncture procedures. The ending procedure can be also smoothly performed. The satisfaction rate (total % of satisfied and rather satisfied patients) using TFPS was 97% on a patient questionnaire survey. However, rather dissatisfied patients comprised 10% on a questionnaire regarding fixed time frame among patients with a hemodialysis durations less than 10 years. Limited choice of a time frame for new patients is a disadvantage of TFPS. We have to consider changes in the time frame appropriately. In conclusion, it is very important to select a suitable puncture order system for each condition.