I read that there are quite a few Fresenius units which offer in-center nocturnal txs. It would be nice to hear some first hand accounts from the professionals or patients in these programs. Any ideas for how we might accomplish this?
I’ve heard about this.
One of the big advantages of daily nocturnal, as with short daily, is that you don’t have to go to a dialysis centre. Of course, I think the Fresenius in-centre nocturnal would only be 3 nights per week. I don’t think that would be as good as daily, but certainly better than conventional thrice weekly.
I do know that some dialysis units in Canada are considering self-care short daily in-centre.
Actually, it’s not very expensive, because they do use the regular daytime machines, but at night when they’d usually be just sitting there. The staffing level is lower than during the day, since patients are sleeping and the treatments are so slow that there are vew “crashes,” etc. Basicallly, this type of treatment allows the clinic to get another shift out of its existing capital investment–while offering a treatment (generally 3 to 3.5x/week) that is double the dialysis of usual in-center care.
My understanding is that there are about 60 of these Fresenius programs in the U.S. right now. I think it’s terrific, because not everyone has a partner or a home that is suited to NHHD. Also, these centers could be great resources for folks who do NHHD but want to travel & not switch to conventional treatments. In-center nocturnal is also a work-friendly treatment.
We’ll add those 60 clinics to our database in a new category if I can get someone to pass along the information to me.
Oh, I heard a presentation from one of the Fresenius docs from Texas who ran one of these programs. He said there was a bit of a “sleepover party” atmosphere; people got to be friends and would talk & such. They had to institute a “lights out” policy so people would get some sleep. The only downside he mentioned is that one patient who was doing in-center nocturnal went on a vacation and did conventional treatments–without adjusting his diet to compensate. Unfortunately, he died from a potassium overload. So, it’s very, very important if anyone normally does nocturnal 3, 4, 5, or 6 nights a week to be sure they’re familiar with the standard in-center hemo diet (potassium limits especially) if they have to switch to conventional treatments for any reason.
When I visit my Mom in the Chicago area I dialyze at an FMC unit on the nocturnal shift. Here is a post I wrote to the D_S listserv back in December of 2003:
I was the second nocturnal patient to go on last night (Tuesday) at the Fresenius unit in Evanston Illinois. The unit has 18 stations and runs three mostly full shifts during the day. It’s one of those mirror image units with the nurses station at one end and 9 stations on either side of a central counter that hides the plumbing. Each station has individual TVs (small ones on swing arms, with cable) and a mix of beds and chairs, used based on consumer preference, it looked like the mix was about 50 / 50. Clustered towards the back of the space away from the nurses station, there were eight machines with beds ready for nocturnal runs.
I expected some formalities, I don’t know what but something to distinguish an eight hour run from a normal incenter stint but there wasn’t anything other than in addition to the normal washing and weighing I made my bed with some unused sheets that they provided and the extra pillows and blanket that I had brought from my Mom’s house (which I had with me thanks to Carla’s post last Friday. Her questions made me realize that there were some details I needed to know. I may be getting too lackadaisical about dialyzing in strange ways, in strange units but that’s another post). I think it’s weird that they would just let a visitor blow in and jump on the machine for eight hours. I have dialyzed here I think twice before but there was never any indication that I was remembered or that I was offered the nocturnal run based on my previous visits.
I was trying hard to be a good patient - I didn’t want to spoil it for the next visitor who would like to try nocturnal - I wanted this to work out. I wanted nocturnal to be a good dialysis option for when I visit my Mom who lives about twenty minutes from the unit. I made my bed, tore my tapes, found the supply cart and set up to go on while one of the staff, Ella, drew my syringes. I brought my own button hole needles and got them in without any trouble. Victor the other half of the nocturnal staff got the lines together and I settled in for what I hopped would be a restful night. The bed was okay, a small (single) hospital adjustable style, with a too soft vinyl covered mattress. About what I expected and on par with what you would find in a Rick Steves recommended Italian pensione – which is to say it was good enough for me, for one night.
I got on at 8:15 right after the guy at the adjacent station and for the next 90 minutes or so everyone else showed up and hooked up. I thought there was a no-show but he arrived at midnight. I think this was an expected occurrence because his dialysis bag included a bright personal light source - like a bike headlamp - so that he could get his needles in without turning on the over head fluorescent high beams. I forgot to look at his machine when I left to see if he was running the full eight hours. I’ve often wondered why eight hours? Why not seven? or 9? Why six days out of seven? I run four days out five at home but I can understand the calendars influence on incenter day of week options but you never hear about 9 hour runs anymore. But that is another thread… back to the nocturnal shift.
About 10:00 the lights started going out first on my side and once the last patient was on all the lights were turned off. That is not to say it was dark. The machines in use, the Fresenius 2008k, has a computer screen and once my eyes adjusted I could see well enough by the glow of eight screens to make out the time on the opposite wall. When one of the patients began to shine a flash light on the ceiling I realized that there were no call lights. My home unit has a call light at every station, until I traveled I thought they would be standard dialysis station features and certainly in this situation I would have thought they would be available, however, that is not the case. The Bat Signal system is a good idea because if you need attention you don’t want to wake everyone up by shouting, so it’s about 11:30 I’ve got four hours and forty five minutes left to run and I’m thinking “they should give visitors souvenir pen lights”, nope I’m not going to be sleeping much. Speaking of not waking everyone up the machine alarms were the least intrusive I’ve ever been around. I have to ask on Friday if they somehow turn them down for the nocturnal shift. It also helped that the handful of alarms through out the night were answered within a minute but the alarms did not have that incessant, grating quality one so often finds in alarms.
So how was my personal nocturnal experience? It was brutal. I’ve dialyzed for eight hours at home during a study I did for the Aksys PHD so it wasn’t just the length of run - it was that my conductivity was 13.5 for the first five hours. At 1:00am I got Victor to go to a sub menu and there I saw they had my sodium at 138, once that was reset to 142 the conductivity came up to 13.9. I think for Friday I’ll ask that my sodium be set at 144 so that the conductivity can get above 14 closer to my home conductivity that I am use to. I should have been watching closer, sooner but when I first noticed and then waited, without a personal Bat signal, to bring it up to Ella when she made her 12:00 rounds it didn’t help because she gave me the “the machine sets it” answer which is true for some machines but the Fresenius 2008K looked like it had a lot of options. At least Victor was willing to go into it further and I was able to see the sodium setting.
So I can’t really say how incenter nocturnal would fit with me and my life style because I didn’t get any sleep. However, glutton for dialysis that I am, I decided to try again Friday. I hope with the machine set properly I’ll get some rest and come away with a better feel for the modality. The way the program is organized it is a hybrid of what I’ve come to think of as a standard incenter run and doing nocturnal at home. The main thing is that you are not monitored very closely you are just suppose to sleep. You can see the push and pull when it come to checking blood pressures- is it incenter?- is it home? The protocol is to check blood pressures every hour, I put the kibosh on that as it made no sense to me and Victor trusted me when I said I was a stable Dialyzor. In the event, my pressure was checked at the beginning, end and once during the run at my request. It was a long night, I was cooked by the end but you know - live and learn.
That was my report after my first run. After that first experience I did two more incenter nocturnal runs and posted the following:
Happy New Year to All. I write from Miami where I have just finishe dmy treatment and am in the down time between dinner and when all the clubs open. South Beach is pretty crazy but the Davita unit here makes setting up visitor dialysis easy. They run three days a week - MWF - and both my runs went smoothly. I’ve had a cold since arriving in Florida but I think I am finally shaking it off.
I wanted to tell you about my second nocturnal run in Evanston the day after Christmas. It went much better. My sodium was set at 142 so my conductivity stayed right around 14 through the run. I’d do it again. I’ll be in my brother’s wedding this summer and plan to ask for the nocturnal shift during my stay. If nothing else the nocturnal shift is quiet, without all the hubbub of the day shifts and - my pet peeve - on the nocturnal shift there isn’t a bank of fluorescent lights shinning in your eyes the whole time.
I talked to two other nocturnal dialyzors - one was there because she wanted the best treatment available to her, what she really wanted was home hemo and was interested in my experience with the Aksys PHD. The guy I talked to ran the nocturnal shift because “it’s quieter” which I totally understand. I asked if he felt better, he said he had been on dialysis for 13 years, same as me, but he just shrugged so I am not sure. The program has only been going for two months so maybe the effect of dialyzing for 24 hours a week hasn’t been felt yet. …
Since this first experience in December 2003 I have gone back a few times and can say I much prefer dialyzing incenter at night. It is my first choice whenever I travel and would be my choice if I had to dialyze incenter for three days a week.
If it’s in-center on the same machine, one thing you have to be aware of with the Fresenius 2008K is that you have to manually adjust the dialysate speed to 300 for a proper nocturnal treatment. They may not do that in a centre for nocturnal, i don’t know, but this seems to lower the conductivity a little for some reason. As far as I know, some of these machines can’t go as low as 300 for dialysate unless they have been modified or they are fairly recent. The temperature adjustment may also be affected. For example, my prescription temperature is 36. When I do short daily, I get a temperature of exactly 36. But when I do nocturnal, I have to set the temp to 36.5 in order to get 36 degrees Celsius. The slower dialysate speed affects this. Not a big deal, and I’m sure Fresenius has all these bases covered, but these would be things to look for.
Edited to add:
I forgot to mention, this apparent lower conductivity is just because the indicator is thrown off based on the original machine adjustment by the technicians. There’s actually no change in conductivity at all according to the technicians I’ve spoken to who work on my machine.
Davita Omni in houston texas offers 3x weekly nocturnal dialysis. :lol:
Davita Omni in houston texas offers 3x weekly nocturnal dialysis.
Is that in-center or home?
Is that in-center or home?
It is In-center
I work for Fresenius and we are starting a new Nocturnal Incenter Dialysis program this Sunday, Feb. 19th!! I am very excited about it, I will be the nurse working in the clinic and it is on Sunday, Tues, and THurs nights!!! We are in the Kansas City, MO area, based out of our Raytown, MO clinic!! Spread the word!!