As you probably know, I am on nocturnal home hemodialysis. I dialyse every night for seven to eight hours. That gives me very good clearances, my hemoglobin is good and I live a close-to-normal life.
However, there are certain risks associated with nocturnal home hemodialysis. In my opinion, the biggest risk is that of blood loss during dialysis. Blood loss can happen in the dialysis center as well. The big difference is that in the center, you have people observing and monitoring you and it is day, after all. Everyone is wide awake. So, should there be any blood loss, it can be immediately noticed and corrected.
In nocturnal home hemo, both you and the tech, if any, are asleep. So, any blood loss can go undetected.
So, should you not do nocturnal home hemo at all? Far from it. The benefits far outweigh the risks. Do you stop flying after hearing the reports of hijackings or air crashes? Do you stop driving a car after hearing about fatal car accidents? By taking proper precautions, you can easily minimize the risks and get all the benefits of good, optimal dialysis.
I am a member of Home Dialysis Central and there I got some very good advice from home hemo veterans about the precautions to be taken on nocturnal. There are two possible scenarios that we need to be careful about. Blood leaks from the arterial and venous sites is the first and blood leaks from the dialyser itself is the second.
What I do is to make sure that the needles at the arterial and venous sites are taped really securely so that they do not come out of the sites at all. For both the needles, I use an 'X' pattern by using two half-inch wide transpore tape pieces and tape them across the needles and make the tape stick against the wings of the needles on both sides securely.
For the venous needle, since it is usually horizontal almost, I put a small cotton ball below and then tape it around. This gives a good angle for the flow and also secures the needle well.
The arterial needle is the one that gave me a major problem one time. This was mainly due to the primary tape in the 'X' pattern coming off. Ever since, I have been putting a half inch wide transpore tape around the wings so that the primary tape does not come off at all.
In addition, I have a blood leak sensor which basically has a sensor that is connected to an alarm and the sensor goes off should any blood touch it. I tape this sensor to the side of my arm just below where the arterial needle goes in. So, despite all this, even if any blood leaks, I will know soon enough.
The other place where a blood leak can occur is the dialyser itself. Now, the dialyser has two openable caps on both ends and after reuse processing, it is possible that the caps are not closed securely enough. This can cause a blood leak. Another possibility is the arterial and venous lines that are connected to the two ends of the dialyser are not screwed properly. This can cause a blood leak to occur as well. So, what I do is to put an empty, dry bucket right below the dialyser and put a blood leak sensor there as well. This will cause an alarm to go off if there is any blood leak.
So, you see, with proper precautions, it is possible to minimize the risks of blood loss during nocturnal home hemo. It is important for us to understand that this modality is the best there is today among hemodialysis modalities. It is the only modality that offers us a chance to live a life as close to normal as possible.