Fresenius setup in a nutshell

I’ve posted about this a few times as part of other threads, but here is an abridged version, for anyone who might be interested in short daily or daily nocturnal hemo but might be put off by misconceptions of great difficulty and time:

When you have a conventional dialysis machine, you really have two main components at home: a water purifying system consisting of a small reverse osmosis water purifier (we call it the R/O), and as necessary, a couple of small carbon tanks used to remove chlorine or equivalents from the city water, and the dialysis machine itself.

When you have a treatment, first you check the water from the carbon tank with a little test strip. Then you let the R/O rinse for 5 minutes (it depends on the R/O).

To dialyze, you need a bicarbonate jug and an acidified jug. This is what makes up your dialysate. In my program, we get these jugs delivered already mixed, so it’s just a matter of taking the jugs out of the box. Some people need to mix concentrates with water in their own empty jug, which adds another step.

You can get the water system ready before you get the dialysis machine ready and keep watching TV or whatever. So here’s a typical evening setup for nocturnal:

9PM Check water with test strip (10 minutes waiting for strip to complete), then let R/O rinse (5 minutes). Done by 9:15 or so. Watch TV or whatever until ready to start dialysis machine later. Usually I gather up tubing, dialyzer, saline bags, heparin, syringes, etc. so it will save time later.

10:00 Turn dialysis machine on. Once you have installed the two tubing segments and the saline administration line on the front of the machine and prepared the heparin syringe, you have basically four separate procedures to go through:

10:00 Set in dialysis mode, and install tubing.
10:10 Set machine in Prime (and at same time, start preparing needle tray)
10:20 Set machine to alarm test (and finish with preparing needle tray)
10:27 Check that conductivity on machine matches conductivity on standalone meter (with 0.5)
10:29 Connect dialysate to dialyzer and then let machine recirculate saline for 10 minutes.
10:39 Visual check of lines, then a final rinse of each segment with saline (5 seconds for arterial segment and 1 minute for venous segment).
10:50 Cannulate needles and connect.
11:00 Start treatment.

Other than getting the water checked and the R/O ready, actual setup takes an hour if you don’t waste time, which includes the time needed to put your needles in. It’s slower when you are new and you have to follow the checklist word by word, but it gets faster with experience.

My treatments are usually 7 hours, so, on by 11PM off by 6AM. Treatments can be anywhere from 6 to 8 hours. Sometimes I start earlier, sometimes later, and sometimes I do 6 or 8 hour treatments.

In the morning, with any dialysis machine, it takes about 30 minutes to complete taking your needles out. Then, pull blood circuit off machine and throw away (about 5 minutes altogether), put machine in acid clean and while that’s going on, first clear off your treatment table and then go and make the coffee. After about 20 minutes, the machine calls you back to remove the acid jug (it’s just an ordinary jug of vinegar), and set the machine in heat disinfect. You don’t have to do anything during this time, so you can go and get your coffee and answer messages on this forum. At the appropriate time anytime during heat disinfect (after machine finishes the initial rinse), you turn the R/O off, and then you’re done for the day. The machine turns itself off and it requires no more attention until the next setup.

The big payoff of all this compared to conventional 3 times per week and also short daily is complete freedom of diet and much relaxed fluid (to the point that you can pretty much drink whenever you’re thirsty or feel like it). You can eat all the salt and phosphorus you want. Hemoglobin normalizes with decrease or discontinuing EPO, and blood pressure completely normalizes without medication.

If you are starting dialysis for first time, in my opinion, there is no big rush to get into home hemo. You will likely still have some significant residual kidney function and so hemo 3 times a week may be quite satisfactory. Let a centre take care of you for a while and relax. Once you feel better and you feel ready, if home hemo is available to you, start considering it. Being able to see how much better you feel on daily nocturnal compared to conventional in-centre is great motivation to continue doing it day after day.

During my 25 years with kidney disease and then my 2-1/2 years on hemodialysis 3 times per week, I lost much of my exercise tolerance. Before I started daily nocturnal, I could hardly walk a couple of city blocks without getting worn out and short of breath. Now, I easily walk a mile or two every day, and I could even do more. Whereas before I could ride my bike for a short time, now I can go for long rides. It’s great, almost like having your life back.


Another big payoff is the time spent on dialysis is done while your sleeping.
You don’t have to figure out what your going to do to occupy yourself while your on the machine. As a partner to a dialysis patient, I am not tied up as much doing nocturnal on the Fresenius as I would be doing a daily program with either the Fresenius or NxStage. As I not only would be there during the set up and tear down but also during the daily treatment time. I am there during nocturnal but doing what I would do anyway sleep.

Nice work Pierre
Good to hear exactly how it is done somewhere else in the world. i do things fairly much the same although I don’t do the conductivity checks until I am on and recording (using good old pen and paper). I don’t think my machine has all the read out that yours has.

I do an acid rinse at the end of run and a heat disinfect before I go on. We have a large carbon filter with a 1 and 5 micron smaller filters attached (downstairs under the house ) 1 and 5 are changed monthly. I have the Part A dialysate already in a bottle (jug?) to go and the bicarb in a sealed plastic bag (larger bag for Nocturnal) which you just plug into machine so we don’t make that up either. Tonight I am manually turning my sodium down to 138 from the default 140 to see whether that helps my blood pressure which is a little bit higher than we would like (no meds) now I am “weeing”(can i say that) a bit less and still drinking what I like ( still doing 29 hours tx week) Finding I am now needing to take off nearly 3 litres some nights. So less sodium might help with fluid retention. I don’t have much salt in my diet at all but do feel thirsty…well its hot here!

It is all nearly becoming second nature but took longer for me than I expected to feel relaxed about it all. It felt like an alien had moved into our little nest and was taking over our lives and spent the night sucking on my arm for its nourishment!! :lol: