Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Sat Feb 07, 2004 5:34 am Post subject: Questions Answered
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Here is a run down of what I do. You can start anytime at night you want too. I usually start around 7:30 but for the past 2 nights didn't start until 9. We are allowed to do this because the program we are in has the nurse and tech available to us from 8:30pm until 7am so anytime in that frame will work.<
>Even this can be changed if necessary. Last night I had the machine set up and dad started on dialysis in 1 hour.<
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>I go over to my fathers home about 7:30pm Start the RO (Water Treatment Machine) Wash for 3 minutes. Put on the arterial line and prime it 5 to 10 minutes. Put on the venous line, start the prime<
>3 minutes. While the machine is doing the prime around 5 minutes I draw up the syringes I will need for the morning take-off. Prime is done hit the button for test. Test is about 5 minu tes get dad and soak<
>his catheter tips. Finish whatever syringes I didn't get done during prime. Test is Complete set up the machine for recirculation 3 minutes. Hit recirculation button, recirculation runs 10 minutes. 5 minutes before it is complete wash 3 minutes again. Recirculation done program weight etc. into machine takes about 3 minutes. Call dad into bedroom get weight and set in goal. Dad gets ready for bed and I draw<
>5cc of blood discard. draw 10 cc of blood and let it recirculate in machine 10 minutes. While this is going on a do a flush in the access. Connect the lines to dad turn on the Blood Pump and to desired speed turn on UF and your on.<
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>Dialysis over Stop the Pump Rinse back arterial line 3 to 5 minutes, Rinse Back Venous Line 5 minutes. Disconnect Lines from dad and put in Saline and Heparin syringes drawup when I started last night. this takes about 15 minutes.<
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>Tear down tubing 2 minutes, Put machine on acid clean. While machine is doing acid clean this takes<
>15 minutes I wipe down the machine and my work area with bleach and make the bed. <
>Put machine into heat disinfect. Depending on how the unit has the heat disinfect set up this can either be 20 or 40 minutes the machine is cleaning. We have the 40 minute one. 1st 20 minutes I get coffee, take care of supplies (if I need too) get the testing stuff around to check the water in bicarb jug and get the bicarb out. Last 20 minutes of heat recirculation I rinse the bicarb jug and draw water for that night treatment, check the water for bleach and hardness. If all OK put the cap on the jug. 3 1/2 years it has always tested OK. I draw bicarb water in morning after treatment as it allows it to warm up by night time and the bicarb dissolves faster.<
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>Dad puts Bicarb in Jug at 4pm this takes 1 minute.<
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>No you do not have to start at the same time everynight.<
>Yes you can skip more than 1 night. We took a trip one time and skipped 3 treatments.<
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>The only thing we mix is bicarb. <
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>You don't have to keep any records but I keep a log sheet of dad's BP, Weight, and my machine setting fluid removed and Blood Volume Processed.<
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>Our patients are give a detector to detect wetness. Being a catheter patient we don't use it as the line are connected by screwing them on and then locking boxes are placed over them so they can't turn. The machine will alarm you if anything is wrong.<
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>I have heard on the web a few patients complaining of alarms. Knock on wood for us we go months without an alarm. If an alarm should occur it does interrupt sleep because you have to fix it or it won't shutup. <
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>I am not sure what you mean by blood spurts we don't have any but maybe it is because we use a<
>catheter.<
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>We are given a sharps container to dispose of needles. Tubing goes into our regular garbage.<
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>There are patients in our program who take off 10 pounds a night.<
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>Patients are not required to by special scales to measure so precise. Your fluid is removed almost everyday your not going to run into trouble. However I bought a set of scales that do weight 10ths and they are accurate within 2 tenths. Around $100.00 as compared to buying a set at Walmart.<
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>Yes you can get up during treatment by disconnecting and put the machine in a recirculation mode. However they don't recommend going over 15 minutes. If dad wanted a snack I would set it up in the bedroom on a TV tray and let him eat it while he is connected. I also have a portable commode because I don't like the 5 to 10 minutes it takes to disconnect and hook back up.<
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>If dad is sick we quit treatment.<
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>If you need IV Iron we have 2 choices do it at home or we can go to the clinic and have them do it. <
>I prefer to do it at home its no big deal. EPO do it yourself.<
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>Other responsibilites: Draw our own bloods at start of treatment twice a month. Takes 2 minutes.<
>Clean the RO once a month. Takes about 4 hrs. But here again you are just pushing buttons and connecting lines and then the machine does the cycle and during the cycle you can go do something else. <
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>Dad sleeps on his side and goes from right to left all night long. He isn't aware of anything once he's asleep. He is so used to me tending to alarms these don't even wake him up.<
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>As far as Arm hurting I don't know from experience, but I do know there are about 26 patients in our program and only about 3 use a catheter the other patients all do their own needles and no one has complained or quit because of arms hurting. All the patients are taught to pull their needles and hold their sites. Hasn't been anyone yet that couldn't manage it.<
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>No you don't have to get off the machine in exactly 8 hrs. You can set the machine for the number of hours and if you want to get off early just do it. I usually set the machine for 8 1/2 to 9 hrs. If dad wakes up and wants to get off, I take him off. If he is sleeping good I let him sleep.<
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>The common things you see go wrong would be the same common things you see in-center. In 3 1/2 years I don't think I have detected a common thing. The biggest aggravation I have is the machine screwing up. One time I couldn't get my machine in conductivity and the repair was done the next day the acid pump needed a new spring. One time I was getting foam in my venous drip chamber and the the arterial module was replaced the next day. One time my machine wouldn't come on and some new was installed the next day. One time my RO pump went and I had to get a new RO the next day. One time I had a pin hole in my acid wand and got a new one the next day.<
>None of this could be missed or do dad any harm. Because the machine will alarm when something is not working right and it will NOT RUN.<
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>My tip would be set up a routine. If you set up the machine and take yourself off the exact same way every time you won't make mistakes. If you don't make mistakes you don't have to waste the time fixing them to get done doing what you are trying to do. Set up a routine for cleaning your machine and mixing your bicarb etc. You won't forget to do it and it will go faster.<
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>Get yourself organized. You will have to let someone know what supplies you need for the month. Keeping things in the same place all the time and you can get the supply sheet filled out fast and when you want something you won't be running around looking for where you put it.<
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>My dad is lucky in the fact he has to do nothing but be a patient. If you have someone at home to help you at all; you will spend even less time than I do. Also keep in mind if your still uncertain; if you don't like it you can always go back in-center and you can change your mind anytime during training.<
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>At 1st I felt totally overwhelmed at learning the machine, how to draw bloods, how to do the Iron, and cleaning the RO. but I muddle my way through and now it is a piece of cake. Once you get home if you have forgotten something you were taught all you have to do is call the nurse who trained you and they can walk you through anything at home. <
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>This reminds me you have to culture the dialysis machine and RO at home once a month takes about 5 minutes. The 1st time I had to culture the machine I forgot how. So just called the center and they walked me through it.<
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>I have always seen the work involved like doing laundry or dishes. I don't think anyone wants to do this stuff everyday either but it has to be done. Not everyone wants to go to work everyday but if there working that is what they do.<
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>Hope I have helped and given you some insight if you have anymore questions just ask. <
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>Another Tip if you have room when I did the water connections I bought a plastic
sink at home depot and put it over a drain line we installed in the bedroom. Cost about $20.00 and it sure comes in handy.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Sat Feb 07, 2004 2:48 pm Post subject: Different schedules
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I just wante to mention that when I looked into home hemo the program where I live was run three times per week, nights. I guess each center must be different. Lin.
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Tim
Joined: 08 Feb 2004
Posts: 1
Posted: Sun Feb 08, 2004 5:36 am Post subject: 6x Nocturnal vs 3x
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Why are some nocturnal programs 3x a week while others are 6x? Can one feel decently well with the 3x? Are there diet and fluid restrictions with the 3x?
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Sun Feb 08, 2004 12:16 pm Post subject: 3vs 6
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More than likely the reason some programs go 3 nights instead of 6 is because Medicare pays for 3x a week. If you are in a program that permits more they pickup the cost of the other treatments. I have heard the patients on 3x a week say they feel better than they do on in-center dialysis and this is probably true as you are still getting twice as much dialysis. 24 hrs per week as compared to 12 and slow fluid removal. A couple of the elder patients in our program run 5 nights instead of 6. They just don't eat as much and don't need as much dialysis for clearance. They feel good. You would still have some leeway with fluid and diet as you have more dialysis time for clearance and more time for fluid removal. The goal is not to put more fluid on than you can comfortable get off.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Feb 09, 2004 2:26 am Post subject: Fluid removal
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A lot of people on dialysis either have, or will develop heart problems due to fluid removal. For them in particular I would think that even a three tx. per week, at a slower longer rate would be very beneficial. crashing and cramping, and too damage to the heart from quick and large amt. of fluid removed happens during the incenter txs. because they are shorter with high pump speeds, and ufr rates. Home hemo for a lot of people would protect their heart from such risks. I'll bet that years from now they will find that home hemo pts. suffer from less LVH. Lin.
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jfwag
Joined: 11 Jan 2003
Posts: 140
Posted: Mon Feb 09, 2004 4:08 am Post subject: Re: Fluid removal
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Marty would be correct about Medicare only paying 3X's so the way around this is to obviously dialyze for longer times which I don't beleive are regulated. In other words, if in center is three hours, do six hours at home 3X's if your neph. permits it. Lois and I were working up to 5 hour runs. And like Lin says longer runs will mean slower speeds and thus knock out cramping, low BP's etc.
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jfwag
Joined: 11 Jan 2003
Posts: 140
Posted: Mon Feb 09, 2004 10:08 am Post subject: NN&I
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Nephrology News and Issues has an excellent article in this months edition on home dialysis therapies.
