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.