I just want to mention that I do not do nocturnal for 8 hours 6 nights per week because I need more dialysis than other people do. I don’t “need” anymore dialysis than any of you do.
Everybody can use more dialysis. Daily nocturnal provides more optimal dialysis in a longer/slower modality, with minimum intrusion in the patient’s daytime. Because it’s long, it can be slower and more gentle, with a slower blood pump speed, much slower UF rate, slower dialysate pump speed. That’s the whole point of it. This minimizes the unphysiological aspects of being on dialysis. Short daily hemo provides more frequent dialysis, but not as many of the physiological benefits as daily nocturnal (since it’s limited by time). I know Bill will be thinking that dialysis need not be nocturnal for this. This is true. If a person wants to do longer treatments every day during waking hours, then of course, it will end up more like daily nocturnal than like short daily or conventional.
Since our natural kidneys worked 24 hours a day, you can’t really get too much dialysis. Less treatment time is simply a compromise which allows you less time on dialysis while still providing “adequate” dialysis by the numbers. The difference between “adequate” and optimal is like night and day.
A unit which provides home hemodialysis but not 5 or 6 nights per week is simply a dialysis unit which has not been convinced of the long term savings which are realized when patients are healthier. There are no savings to the health care system by providing dialysis at home only 3 times per week. If they can provide that, they can provide daily hemo (either short daily or daily nocturnal, or both).
But we are totally missing the point of home hemo if we just assume that some people need less dialysis.
hello amba_79 and queenie, thanx for your replies, the dr. has told us that he can do 5 hr’s per session if he wanted to, seeing as the kidney’s work 24/7 you’d think that they’d want you to do as many hr’s as possible, but we were told by a nurse that the reason people only do it 3 times per week is due to cost, but it’s o.k to up the hr’s each session, but you would have to get the dr.s o.k first. the nurse has said that they dont want his pump speed to go higher than the 400, he is on 300 at the moment, but next week it will slowly get pushed up.
I will re-word my last post. Some people may get the same benefits doing 8hrs as someone doing 10hrs. I am an example of this. Most people at our unit do 8hrs every second night without problems. I do 10hrs. When I went on 8hrs it still didnt stop my potassium going too high, therefore I have to do 10. You can do too much dialysis really. Again Im an example lol I did 5hrs 3 days in a row, and on the 3rd day my potassium went below normal. It probly would of been alright if I had of used a higher K dialysate on the third day.
I actually do nocturnal because I do need more dialysis. I would of kept going down hill otherwise.
helen, if you are allowed to do 5hrs then I definitely would. I know its only an extra hour, but it should make a difference. You shouldnt need any extra supplies to do 5hrs instead of 4.
hello again,yes, i would think that 5 hour’s per session would’nt hurt and the dr. has said that it will be o.k so hopefully when we get home, the hr’s will go up. i dont know about the pump speed though,we’ll have to wait and see. at the moment i’m concentrating on taking the needles out of hubby, then i will have to move onto the inserting, amba i will ask about the buttonhole technique, and see what they say. every one take care.
Helen, the blood results will help determine what pump speed will be adequate and if the dialysate needs altering. Hopefully they run regular blood tests when you first go home. I ran at 250 on 6hrs and it was ok, had a few hiccups but thats just me.
hi all, amba, they put the pump speed up to 325 today, alarms went off every now and then because the venous pressure kept going over the limits, so i dont know what that means, the nurse said that tomorrow the pump will go down to 315 just to see what happens. but all went well. take care.
If I have good needles, I will usually get a pump speed of 350 (I beleive it’s ml’s per minute)eg ml/m
usually it will be my arterial that plays up, if I don’t get the needles right & the needles is against the wall of the blood vessel in the fistula.
Im not surprised the pressures were playing up Helen. Sometimes putting a wad of gauze under the tubing just behind the needle, can help lower the pressure. If its really high, it can sometimes mean the needle is stuck on the wall of the vein. You can usually feel it when this happens, and its just a matter of repositioning the needle. You need to stop the pump, remove tape, and reposition. It needs to be done quickly, as you have the pump stopped. The nurses can show you how to do this safely.
usually it will be my arterial that plays up, if I don’t get the needles right & the needles is against the wall of the blood vessel in the fistula.
Double up some gauze to make a pillow (pillow must prop the needle up high enough) and place it under the art needle at put on before taping down. It will keep the needle off the wall, give it a good pressure and you won’t have to remove the tape and reposition into the tx. You will get a better clearance, too, since you wont have to stop the pump to fiddle with it. Do this every tx and the problems will be over.
hello all, with the pump speed and all the alarming, that day the pump speed stayed at about 300, the next day it came down to 220, because we had our original nurse and she knows andy’s fistula better, the other nurse had never needled andy before and he went into a new site also, he did have to rotate the needle alltogether, and put gauze under it, but guess what, the alarms kept going off. anyway,at the end of the dialysis, the needles came out, andy went to the loo, came back out with blood everywhere, the needle was not in a good spot to start with, today his arm is so sore and it is purple as anything, the nurse could’nt believe it {the good one} she tried to go back to the original site, got the first needle in then tried the next, while she was syringing back the heparin, andy felt pain in the vein, so she tried to re position the needle, and tried to syringe again, again pain, so she had to pull it out altogether, she rang the dr. and told him what was happening, he said not to worry about dialysis today, thankfully his blood test yesterday was good. so over the weekend andy just has to rest his arm, and we go back in on monday, hopefully it will be better. take care all.
It’s very easy to tape down a little too tightly, which makes the angle too flat.
Yes, this is right. The pillow must not be smashed down with the tape. Tape securely, but do not flatten the pillow. Pillow must be high enough to give the needle the correct angle. If the pillow is not thick/high enough, use more gauze or bunch up gauze better.