Tuesday, October 14, 2008

My home hemo journey - Part 3

I did some research about the dialysis machine and the RO plant, the two main pieces of equipment required for home hemodialysis.

The best option would have been a portable hemodialysis machine, something akin to the NxStage System One that many people used in the US with great results. I for one, love to travel. And travel would be restricted to short weekend trips with hemodialysis. But the NxStage machine was not yet allowed to be sold outside the US. Moreover, even if I bought it there and brought it here, servicing and repair would be an issue.

So, I decided to go with the Fresenius 4008 S, a sturdy machine used widely in India. I also bought an Ion Exchange RO 100 liter/hour plant. The hemodialysis machine was setup in my bedroom. The RO plant in the terrace of my two storey house. The necessary electrical and plumbing work was done. An RO water connection was given to my bedroom for the HD machine and in my bathroom for the cleaning of the tubes and dialyser after dialysis.

Everything was finally ready by May 13th, 2006.

I decided to go for short daily to start with and then when things settled down to switch to nocturnal.

My first short daily session was good. The tech did everything. I dialysed in the evening for two hours. I continued short daily (except Sundays) for about 20 days. I then thought things were going well enough for us to switch to nocturnal.

The tech would come in around 10 in the night. He would start me off and he would sleep in the same room to take care of any alarms and any other problems that came up. I slept fairly well.

There were hardly any alarms from the machine. Most of them needed a ‘Reset’ button press to take care of.

There were however some other problems. Sometimes, blood would ooze from my arterial and venous sites. The tech was very well equipped to handle these emergencies. These incidents were due to my moving my hands in my sleep that would cause the needles to move around and cause the oozing. We then decided to tie my finger in a manner that would allow some movement of my arm but not enough to cause any oozing.

Once we did this, the oozing stopped completely.

One important thing we did was to use the buttonhole technique. You can find a lot of information on the buttonhole technique on the internet. But in this technique, the regular sharp needles are used for four to five days in a row. Cannulation is done at exactly the same sites (as opposed to the step ladder method) and the same angle. This causes a tunnel to develop. Once this tunnel has developed, we switch to blunt needles. And then cannulate at the same sites using the blunt needles everyday.

This helps in two ways. One - the pain during cannulation is reduced greatly. Two - the needles cannot puncture through the artery and vein in case the arm is moved too much and this protects against bleeding etc.

Part 4

3 comments:

Anonymous said...

you do have a backup power-source to last you through a rainy night such as today's - right?

and did you explore this link to detect any blood loss? (I'm sure you did but just in case you did not, here is a link)
http://www.nocturnaldialysis.org/faq_pages.htm#20

Regards,
Santosh

Kamal D Shah said...

Yes, I have a UPS that provides three hours of backup. Till now, I have never needed it beyond that.

About the blood leqk detector, I have a DRI sleeper that is mentioned in the link. However I have stopped using it because I ohave never had a blood leak after I started tying my hand to the bed.

Thanks Santosh for your comment and links! If I may ask, how are you connected to dialysis?

Kamal

Anonymous said...

Hello Kamal,

My dad is on dialysis for the past 6 years due to his CKD. Over the past 6 months, the doctors said he was developing an infection but were unable to pinpoint the source of infection (the location and/or the bacterial strain). Frankly, I'm surprised it took them well over 6 months with no results. Since he was infected, they also stopped his erythropoietin injections. So his haemoglobin count was between 6-7 and he needed blood transfusions once every week or so.

One fine day, about a month ago, the doctors decided he needed 2 units transfused. They did the fast 4 hour dialysis, transfused 2 units and sent him home. within about 2 hours of reaching home, he complained of shortness of breath and was rushed to ER. His doctor decided it was a case of fluids overload and they put him in Apollo ICU and gave me 48 hours to fly home. Thats when I truly started my research on CKD/dialysis. Your site has been very helpful - thank you very much and keep up the good work. You're a true pioneer in this region in NHHD.

Regards,
Santosh