More questions about nocturnal dialysis


I am in the process of getting ready for home dialysis training. I have been reading about nocturnal and would like to know more about what the set up is like. How do you keep the needles anchored? How do you prevent the tubing from getting twisted up when you roll over? What kind of ‘moisture detector’ is used? Is this something that you think someone can do by themsleves? If your needles are hurting, does that keep you awake? What about sleep - do you sleep well? What is a typical time that you hook-up and take off. Can I sleep in - turn the UF off and keep dialyzing until I decide to get up?
So many questions…

Thank you in advance,

I was trained for nocturnal but now choose to do 4 hours daily during the evening. It isn’t as good for phosphorus control, but works for me.

With regard to your questions.

You are taught how to tape your lines down for safety. I wasn’t given any moisture alarm but know that some people have them and some buy bedwetting alarms. You learn to keep your arms fairly still and the alarms will go off and wake you if you lay on them or kink them. I do self dialysis with no problem. My needles seldom hurt although my arm gets achy sometimes. I have never slept well which is why nocturnal hasn’t worked for me, but most do just great, you get used to the noise.

When I first got home it took about an hour to set up, now I have it down to 45 minutes, I don’t think I can get that down any further. Getting off takes less time, although I do stop bleeding very quickly. I would say it generally takes me about 20 minutes then I am waiting for the machine to finish up. It takes maybe a total of about 35 minutes before I can turn off the water and r/o and be truly finished.

You can’t really turn off the u/f and sleep in as you will run out of bicarb. If you use a standard mix you only have enough bicarb to last around 7 hours. Some people add bicarb and get enough to last around 9 hours, my unit did not allow this. I thought about turning off the dialysate flow and the u/f but you get an alarm after 10 minutes without dialysate flow. Honestly don’t know if it keeps alarming every 10 minutes or if that feature could be disabled. Something maybe to ask your training staff.

Hope this helped.

The alarm I use under my veinous needle, as provided by my home dialysis unit, is simply a standard bedwetting moisture detector. It’s simply taped up against the gauzes that support the needle. If the veinous needle came out, presumably, the blood pump would stop and the dialysis machine would alarm. The moisture detector might alarm before the needle actually completely pulls out, as it takes only a hint of moisture between the two contacts to set it off (like blood soaking the gauze under the needle).

Yes, it’s very possible to do this alone. I recently trained to do my daily home hemo alone. I trained to do it as nocturnal, but I have to do short daily for a couple of weeks at home first. So, I will let someone else answer your questions about nocturnal. I do tape my needles and lines up as for nocturnal, though. I use a burn net over my arm to facilitate taping. If you’re alone, once you’re on, you’re on. So, you have to be sure you have everything on hand that you might need (tapes, gauzes, scissors, scissor clamps, spare transducer filters, alcohol swabs, etc.).

I have a phone nearby, but my unit also provides me with free Lifeline service, just in case, I guess, I’m about to pass out and I don’t have the time or ability to dial 9-1-1. I guess it could be a lifesaver though under some circumstances, as Lifeline already knows exactly where I am, and that I’m dialyzing at home alone. I’m not really sure that I need this, but I guess it can’t hurt.

About fistula pain, just one comment. In my experience, the regular dialysis units let potential fistula problems slide, or simply don’t notice them, because you are only dialyzing 3 times per week, and you get a different nurse or tech all the time (there’s no continuity). When doing it daily, these problems are more likely to actually become problems that interfere with dialysis. I ended up needing to have a fistulagram and an angioplasty during my 6 week training period. In hindsight, the signs were there that I had a stenosis which needed attention, but nobody really cared to follow-up on it until I got to the home dialysis unit. If you have pain in your fistula during treatment now, it might be worse when dialyzing daily. I think it might be wise to find out why you have pain during treatment.

I’ll tell you though, I feel so much more independent now, plus I can eat more phosphorus and potassium. It’s worth the effort.

Standard 3 x week hemodialysis since Oct 2002
Recently started daily home hemo after 6 weeks training
Was hoping to get a transplant before I actually started, but no dice :slight_smile:

a moisture alarm did not work for me because my arm would perspire and set it off.
I had to mix my bicarb which took awhile and was lots of work. when the machine indicated it was finished I would remove my needles, run the machine through the disinfectant cycles, shut it off and sleep another hour. you don’t want to sleep with yur needles in following treatment.
while nocturnal had the big advantage of eliminating the need for phosphorous and potassium restrictions, it caused many sleepless nights so I went for the NxStage.
good luck in your endeavor.

Is it stressful to take out needles when you’ve just awakened in the morning?