Pierre,
Again thanks, we have some closets that can be used for this.
Thanks
Good morning!
I am back at technical questions ( my curiosity I am sure that we will learn all at the training).
If daily nocturnal is better ( and it looks that it is) how we can convince ( in the long run) our hospital to support it. It is not a problem of night staff, they have PD nurse at phone24/7.?
From looking at the machines , it looks to me that NxStage is simpler ? It does not need therRO unit. It exist in Canada? It is supported by hospitals?
Short term daily hemo must be done at the same time evry day? I am teaching and some days I will be hoe in the afternoon.
I know that all these questions are premature, but it gives me confidence to know more, because sincerely I am terrified. Probably it is normal,and by aquiring knowledge and confidence it will dimminish.
I appreciate not ranting 
, I have enough sad thoughts as it is!
You know I’m not really one to argue in favour of any machine over another machine. Personally though, I think that unless you plan to travel with the machine and all its supplies in the trunk of your car, this thing about needing or not needing connection to water is really a moot point. In one case, you use the municipal water supply. An R/O is not a complex thing. You turn it on and off with one button. In the other case, you receive and store 15 lbs bags of dialysate. With treatments 6 days per week, that’s a lot of water bags. You have to store them somewhere, and you have to carry them from wherever they are to your machine, and lift them up on top of the pole. So there are advantages and disadvantages in either case.
To my knowledge, NxStage is not available in Canada at this point. I know that my program looked at both NxStage and Aksys and decided to stick with conventional machines for now. There were two reasons. One is reliability, and the other is that we need the ability to do short daily and nocturnal interchangeably. So, that means NxStage and Aksys were out. The other advantage for us is that, home hemo will not be viable if it costs more than conventional hemo. Government will not pay more for dialysis than it has to. There are cost advantages to standardizing on the same basic machine at home and in centres, since the parts and the service are identical, and the training is standardized.
Complexity is not a big issue in my view. Even the current Fresenius machines are highly computerized and simplified. Setting up the tubing is really dead simple once you know what you are doing. There are only two segments of tubing. Everything else is just a matter of pressing a button on the panel or on the display screen. Most of the learning process is more with learning about the dialysis itself, how to handle needles, syringes, sterile techniques, etc., and how to deal with various emergencies or technical problems that can crop up. The six weeks of training deal more with practicing what was learned rather than learning new things, because it only takes a day or two to learn, and certainly not more than a week. These are mostly things you need to know no matter what machine you use.
As I’ve said many times before, just being able to do daily hemo is a heck of a lot more important than what machine is used to do it.
A nocturnal treatment uses exactly the same amount of stuff as a short daily. So, it doesn’t really cost any more (of course, it might cost a bit more for water and electricity which the patient pays for). In my program, the nurses handle both PD and home hemo patients, so the on call nurse does both. You don’t really need the nurse much after you’ve had a few months experience anyway. Sometimes little things happen, like the machine won’t pass the alarm test, or maybe your conductivity is lower than you’ve seen it before - that sort of thing. So you call the nurse, find out how to deal with it, and next time you know.
Pierre
Pierre, I see the RO a whole lot different than you. For 1 thing it can cost between $600.00 to $800.00 dollars to put in the drain lines and run a water line to the room where it is needed. We are responsible for cleaning our own RO’s monthly. There is 1/2 a day gone. I don’t know what type of RO you are using but I haven’t had a Marcor yet that lasted 1 year. I had a Better Water once that lasted 2 years before repairs. Not to mention the testing each day. And by the time I get the jug full of water carry it to the utility room poor the water in the little container add the testing powder I have probably spent 10 minutes. Of course you have to include the backwashing required on the water softner and the changing of the carbon tank and the changing of the filters. It all adds up in time spent doing and thinking about dialysis. I think you mentioned that your bicarb came premixed. We mix our own. This takes 6 minutes to rinse the jug with RO water and other 6 to fill it with RO water. Summer a little shorter do to the temp. of the water being warmer. I stick with the Fresenius because I want a machine that will do both short and long treatments. I really wouldn’t want to give up nocturnal. If NxStage or a similiar machine comes out with a way to do either nocturnal or short treatments without using an RO I’d go for it. Plus the time spent with the Fresenius machine with the acid clean and heat disninfect and chemical rinse.
It’s true none of this is a big deal and acid clean and heat disinfect are just a matter of pushing buttons. It only becomes a problem when you need to be someplace else within a couple of hrs. on awakening. I can definitely understand why working patients and really busy people don’t want to add an RO to the mix.
Another drawback that I see, is when I take dad and return to the center for the buttonholes I have to find someone to run the RO every day and do a heat disinfect on the Fresenius. Then we get home on the weekend it will be backwash the salt and carbon tank and do a chemical rinse on the Fresenius.
I agree this isn’t any “real” big deal but if the machine comes about that does nocturnal without the RO I can give up the RO. I’d love to be able to get up in the morning take dad off the machine, turn the machine off and be done with it.
Part of my training time was learning how to clean the RO and I felt a little overwhelmed at learning how to to the dialysis, draw bloods etc. plus clean the RO all during the same training time.
I do feel as you do though at this time. Inspite of the RO it is still worth it to be able to do nocturnal and short treatments if necessary.
Thanks,
I was under the impression that nocturnal cost more because of the supplies. Our hospitalis doing now 3 day home, and one patient 4 days. We will be probably the first in short dayly (6 days), but as lon that this will go, we will try nocturnal.
We do not intend to travel with the machine, if and when will be able to travel,will do in center.
Again thanks a lot for info, the hospital will stick with the known machines ( they have a lot of technicians d=working with them).
again thanks Pierre, and hopefully the our Hockey willl win
One for Marty, and one for Sadsam…
Hey Marty…
Boy, you sure have a lot of work there that I don’t have at all. I’m not posting this to gloat or anything, but there has got to be an easier way to get nocturnal hemo. The only thing I do for my R/O is that every Saturday morning (only once a week), after getting off my nocturnal treatment (ie. after the heat disinfect is finished on the Fresenius), I put peroxide in the R/O for the off day. All I have to do is to unplug the water hose, replace it with the rinse hose, put 30ml of disinfect in the machine using a 60ml syringe, and turn the R/O on for 30 seconds. That’s it, and it only takes about 5 minutes. Then, before my next treatment, I simply let the R/O rinse for 15 minutes, and then check that there is no remaining peroxide with a little test strip. Once I know there isn’t any, I just unplug the rinse hose and plug the water supply hose back in. In terms of a major cleaning, the tech guys come in every 3 months to do the scheduled maintenance on the Fresenius, and at the same time, they change the filter in the R/O. I don’t have a water softener, and the two carbon tanks get changed every few months, automatically. I don’t have to do anything, and since I also don’t have to mix my dialysate concentrates, I guess that’s why it seems like a lot less work to me… it’s because it is a lot less work 
I do a heat disinfect right after each treatment, except on Wednesdays, when everyone is expected to do a chemical rinse instead. The heat disinfect is good for 72 hours, and the chemical rinse is good for 24 hours. If more time than that has elapsed, then I have to do another heat disinfect before I can run a treatment.
I don’t have to do anything at all on off days.
The plumbing for the system was ordered and paid for by the hospital, so I had no expenses whatsoever for that. I just had to be there to let the plumber in. Same thing with the electrician who came in to install two special outlets with GFI. My home program seems to make it as easy as they can for the patients. It’s not a private company or corporation though, it’s a public hospital.
If I had to do all that you do, I think I would be rooting for a NxStage too!
Hi Sadsam
Yeah, you would think that nocturnal being like 4 times as long as short daily would use more, but no, as I do it anyway, it uses exactly the same supplies. The only difference is that an 8 hour treatment uses up almost the whole jugs of acidified and bicarbonate, whereas a short daily uses only half the jugs. But it makes no difference, since the jugs can’t be reused anyway. I just empty what’s left over in the toilet bowl after each treatment. It ends up the same. The only thing more I use on nocturnal that I don’t need when doing a short daily treatment is to add a little bottle of phosphorus to the bicarbonate jug, and a little container of calcium to the acidified jug. The cost for those is negligible.
Good luck. I hope you can start soon.
Pierre
Hi Pierre!
It looks more simple that I imagine.
Now we wait for the surgeon call for consult and then fistula. Your info helped a lot, in the knowledge and in the confidence. Also we will have arguments to go to nocturnal in the long run. We will try to convince thehospital, but first fistula, training etc.
Again thanks, will keep you informmed and will continue reading the postings. We have abetter idea what is involved, and yes the hospital will do the modifications to plumbing, provide the machine, substances etc.
Hmm, different ways around the world!
The first thing I would say about RO’s is some of them are NOISY!
We have had 3 in 5 months , the first 2 sounded like wasps and the on/off noise of the water being pumped drove us crazy on Nocturnal ( even with the thing shut in a closet). We are fortunate to have a very good technician ( we call the guys that service the machines “techs”) who went out of his way to get us machine No 3 which is whisper quiet . I count my blessings every time I turn the little angel on.
In my program we heat disinfevt before and rinse after. And I don’t do anything with the RO. I do have to change the fliters (1 and 5 micron) and the tech does the rest. 8)
Pierre, What RO are you using? Our center has been looking for one that didn’t require so much cleaning. They have tried the (Aquaboss?) by Fresenius but were discouraged by the weight. Thanks for the info on how long a heat disinfect and chemical rinse are good for. I think maybe backwashing on the water softener and carbon tank has alot to do with the water coming into the home. We aren’t on municipal water so our incoming water isn’t treated with anything other than chlorine and no filtration before coming into the home. Today wasn’t a real good day to talk RO’s when I got up this morning ours had sprung a leak during the night and needless to say I had a flooded closet to clean. This is the 2nd time this has happened to me.
Mine’s an old Baxter unit. Newer patients get a Gambro. I used an Aquaboss in training, but it broke down. Man, it’s so simple there’s nothing they can’t fix or replace on that old Baxter.
Potential messes are the biggest problem with these things. I have a leak alarm under my R/O, but of course, it wouldn’t help if I wasn’t there to hear it. I sympathize with you.
I know people who live outside the city need a bit more complicated setup sometimes.
Pierre
Pierre, Thanks for the info.
You’re welcome, Marty. By the way, they picked the Gambro even though it’s otherwise an all Fresenius centre, apparently because it’s one of the simpler models of R/O out there (Baxters are no longer being made) - but I have no experience with it myself. The real experts, like the man I know who has been a machine tech since the 1970’s, have learned to appreciate analog simplicity over digital complexity when it comes to reverse osmosis.
Pierre