Home Dialysis risks question

I do dialysis at home on the NxStage, and am 31 years old, doing my own dialysis, with my husband nearby to help in emergency situations.
What are some of the common risks/mistakes to watch for?
I have a catheter, so bleeding isn’t a major issue
How much air can you really tolerate - estimated?
What are the signs of too much air (in case I did get some air somehow).
What will happen if I get air in my catheter?
I am very careful, but when a nurse has done my dialysis, they don’t seem to be as careful, and DO push air with meds, etc.

I rarely cramp during dialysis, I can tell before it happens, and my blood pressure is usually high, never drops suddenly, so I don’t pass out.

What is this Lifeline button for emergencies that I have heard others talk about??

Thanks for any input

Anything can happen really, from machine troubles to a disaster…I tend to prepare myself mostly for distasters…have an emergency light handy, for practice try doing a few manual blood returns…

As far as air problems the machine suppose to alert you on that but always keep on the lookout for unusual problems…read the manual ofter to memorize the alarms…

For instance, one time my machine was taking out more than what I wanted, so basicly the machine alerted me the problem so I followed the steps to determine whether it was…I then discontinued treatment. That only happened once since starting home. Rarely you will have problems and your training will keep you on the safe zone.

LifeLine


On two different occassions in-center I have gotten air. The symptoms are unmistakeable- tightness in chest, sputtering cough, pain travelling up right arm and into neck. The even scarrier part was that both times, the alarm did not go off. Both times the nurse was unable to find where the problem was coming from. My doctor said I probably got a few air bubbles. I can tell you it is very serious when this happens.

Each time this happened to me, and it happened shortly after put on, my lines were clamped and it took about 30-45 minutes for me to recover while the nurses looked over everything to make sure there was no evidence of air. It was really scary to continue tx, but there were no furthur problems each time. So, apparantly a loose fitting or something in the machine set up led to this very serious problem.

I would hope that in the training for a home program one would be trained very thourougly regarding the prevention of air. Maybe an expert can join this discussion and shed some light on this very important subject.

I have run into several problems with air in lines, but was able to spot it, and successfully remove it.
I just wanted to know the risks, you never know what can happen, its best to know the signs too.
Thx

Hi Terri, I got air in my line one time when I took myself off during a run to go to the bathroom. I was able to get it out but it sure is a hassle. I got one of the men’s urinals from the PD nurse and now I don’t have to worry about that. Also, if you suspect small air bubbles you can run an alcohol wipe down the blood line below the air dectector and if there is air it will show up silver.

Thanks for the advice, also, thanks for the lifeline info, I am looking into that.

Don’t forget that if you do ever get a large amount of air to your blood stream you need to lay side-ways on your left side heart facing against the ground for 45 minute or more…doing this prevents you from a risk of a cardiac arrest…

I’ve only been doing this since the end of February, but, in my opinion, on short daily, the biggest risk on a daily basis is a significant air embolism. Proper attention to setup and to connecting the lines should prevent it though, unless there’s a serious machine malfunction. I don’t know how it works on the NxStage, but on my more conventional baby K Fresenius, the air detector and clamp on the veinous bloodline is the last thing on the machine before the blood comes back to me. It would detect any air bubbles that managed to get past the two air chambers and clamp down instantly. There are many safeguards on the machine before this would happen without an alarm stopping the machine though (and the metal clamp on the veinous bloodline closing). I’m sure there must be something equivalent on every dialysis machine. On a daily basis, the biggest risk for an embolism would be from something I might do, like an improper connection of the veinous bloodline with the veinous needle line, or having a lot of air in the veinous bloodline before even starting treatment (it’s just a matter of checking it, really). Because of that, I’m extremely careful about this. Whereas air on the arterial side would have to go through the whole blood circuit, any air that’s in the veinous line will go directly into me, so, I check the whole veinous bloodline very carefully before I even connect. When connecting it to the veinous needle line, I find that it’s sometimes virtually impossible not to end up with some very tiny air bubbles at the connection after the connection is made - even with the utmost care in squeezing both tubes so that saline come directly into contact with blood. This doesn’t seem to have been a problem so far. During training, I forgot to close the clamp on veinous bloodline at the end of priming/recirculation once, and as I was connecting the bloodline to the needle line, my nurse stopped me to show me that there veinous bloodline was full of air. So, I felt stupid for the rest of that day, but I learned my lesson. I know the symptoms of an air embolism, and I’ve been taught to lie on my left side with my head down and my feet elevated if I suspect one, and call the paramedics. Lying like this prevents the air from getting to the brain or the lungs.

I guess hemolyzed blood would be the next thing. There are many safeguards against this, and all would have to fail, but it could happen, just as it could in a dialysis centre. The machine would alarm and stop if either the conductivity or the dialysate temperature were to go beyond the established limits, but, I keep an eye on them to spot any trend ahead of time. It would also stop if there were a kink in the lines somewhere. So, as far as hemolysis goes, you just have to trust the machine and know how to recognize it by appearance in the veinous line. You also have to be careful about checking the quality of the water supply post carbon filter before each treatment (for chloramine, in my case, from the city water), but I gather that doesn’t apply to the NxStage.

A blood leak in the dialyzer would stop the machine, but my biggest fear, really, would be one of my needles coming out when I’m sleeping. I’m fully awake and aware when doing 2 hours short daily, so, even if it happened, I would simply do the same thing I did when it happened to me in the dialysis centre twice: put my finger on the hole! If it happened while on nocturnal, it could be a problem though. I have a detector on my veinous needle for that, but, I would have to be sure I woke up. This is why I was taught to use a large Tegaderm to tape my needles. It’s taped at the needle with the Tegaderm, and the needle line is again taped at my wrist, over a burn net. It seems pretty secure. At the dialysis centre, they only use paper tape at the needle, in case they have to reposition the needle a bit after treatment has started. I don’t have that concern since I use the buttonhole technique and dull needles. As long as the needle is in, it’s in the same place as it always is, so, it’s predictable.

I was on hemo for 2 and half years in centre before switching to home hemo. The only difference between now and then is that now, I’m the one who has to be aware of the risks, rather than a nurse.

Pierre

I have had center staff reverse needles for various reasons and have done it at home on the advice of dialysis nurse.
DON’T do it on the NxStage unless you re-reverse needles before rinse back.
on one occasion I had to stop at the beginning of dialysis and disconnect and when I reconnected I accidently reversed needles. I thought my pressures were strange but within limits so I continued and did not run into any problems until rinseback when the saline bag filled with blood.
fortunately my sig other was there and squeezed ALL the contents of the bag back into me. I felt better to take extra saline than to lose all that blood.

I reverse my lines on the NxStage, but I have a catheter. I cannot dialyze otherwise due to low pressures. When I was in training, they also reversed the lines, and did not reverse them back before the end of treatment. So, I have been doing that every time I do dialysis. I have not had any problems, I don’t think, and no blood in saline bag either. I wonder if I should reverse them back before ending treatment, or just do it how I have been doing, since I haven’t had any problems. I wanted to keep the risk of infection down by not opening the connection unless absolutely necessary.Maybe its OK with tessio catheters??
Maybe a nurse or doctor will read this, and reply their advice too.