Nocturnal Questions

I am finding out the my unit considers nighttime hemo to be for 7 hours. I am trying to figure out my timing so that I can sleep.

I am NOT a good sleeper, I am a very light sleeper (which I think is good for safety). Because of that I am very tired by bedtime. I hestitate to plan on putting myself on the machine at 11 at night as I will be so tired I’m afraid I might make a mistake. If I go on around 9, the time I think I feel comfortable, I’ll need to wake up at 4:30 to get off. I’m not sure after having to wake fully to get off the machine that I wll be able to go back to sleep. 5-6 hours of sleep is not going to make it for me.

So what do you who are on noctural hemo do??

Cathy We can run anytime between 8:30pm and 7am. I do my fathers nocturnal dialysis. I usually start setting the machine up at 8 to 8:30 pm and have dad on the machine 9:30 to 10pm I set the run for either 8 1/2 hrs or 9hrs. This gets us off at 6:30. I can’t go on 5 to 6 hrs. sleep either. Have you asked if you can run longer.

Cathy, Maybe they consider 7hrs. do to the bicarb running out. In our program the ones like us who want to run longer fill the bicarb jug to the 9.5 liter mark and add extra bicarb. I can’t tell you exactly how much now but if you need to know I can get the figure. I weight our extra amount and it is 122 grams. 1 carton of bicarb will cover the EXTRA required for 5 treatments. When we first started they had everyone make 2 batches of bicarb and dump from the one batch into the bicarb jug to fill it more. This was too time consuming and wasteful. It’s easier just to get little jars and measure the extra amount it takes. If this rambling has confused you let me know and I will try to explain it again clearer.

Thanks Marty, I do believe the problem is that the worry the bicarb will run out. I will bring this up to them next week and propose your solution if they haven’t come up with it yet.

Thanks so much, I will feel much better if they say 9 hours is okay, 7 is just too short!!

Cathy I experienced the low bicarb thing more times than I want to think about, tho now I can go for 8 hours, which is not as much sleep as I want but I usually go back to sleep after cleaning the machine which takes close to an hour.
the problem I see with this is I must to needle removal and fistula care while half asleep.
I handle it by caring for machine first, drain dialyzer and set up vinegar rinse before removing needles, that way I have a little more time to get myself alert. remove needles and hold until bleeding stops while acid rinse goes. then do heat disinfection which takes no attention except to turn water off when temp. is reached. then back to sleep.
wish you lots of luck.

Today I spoke with a nurse who trains patients to do nocturnal home hemo. I asked whether patients can sleep longer than 6-7 hours. He told me that their patients sleep from 7-9 hours. Patients learn how to turn off the ultrafiltration on the machine once the machine notifies them that dialysis is complete. As long as there’s enough dialysate, the patient can sleep longer with the machine running without doing anything else. Since the nurses at this clinic have figured out how to make it work for their patients, I would hope that your nurse could figure out how this could be possible for you. I’m not sure if the type of machine you’re using for nocturnal dialysis makes any difference on how fast dialysate is used, but that might be worth asking your nurse.

I guess I’m confused. I thought turning off the u/f simply stops the machine from removing more fluid, but “dialysis” continues. For example. When your b/p drops too much I need to turn off the u/f until my b/p rises (I need to give fluids too). But my understanding is that my blood is still being cleansed just no fluid is being removed. Now there is a switch to turn off dialysate, is that what you mean to press??

We use the Fresenius 2008H in order to run 9 hrs. we need to set our flow rate at 300. I start out with 9.5 ltrs. of bicarb and after 9 hrs. with a flow rate of 300 there is about 1/2" to 3/4" of bicarb left in the jug.

Cathy, I believe Beth means the UF. Sometimes if I get up at the same time the treatment is done. I turn the UF off so no more fluid is removed and let the machine run until I get my hands washed and feel awake.

I guess I am being dense. I believe I was taught that when you reach your “goal” that U/F stops automatically, but dialysis continues. Beth seemed to say that stopping UF also stops dialysis, but I was taught yesterday that dialysis continues just the fluid removal is stopped. In order to preserve dialysate I need to turn off the dialysate button, that will also stop “dialysis” although blood continues to circulate safely. From what I have learned stopping UF on the Fresenius will still require dialysate. Now I do agree that I can wake at 7 hours and turn off the dialysate and continue sleeping until ready to disconnect (or at least I will check out that option), but I do not think that stopping UF stops dialysis or the use of dialysate. FWIW my center was not up on the idea of adding extra water and bicarb, but they are looking into alternatives, including maybe doing 5 hours a bit faster since I don’t retain much fluid so b/p fluctuations do not appear to be a problem.

Hi y’all,

My understanding is that two processes go on, usually simultaneously, during dialysis:
1). Ultrafiltration removes fluid
2). Dialysis (diffusion across the membrane) removes wastes

These processes can be separated, though. So it should be possible to turn off UF and still have “dialysis” (= waste removal) with blood circulation continuing. This would require using dialysate.

Cathy, Next next you do a treatment watch. The UF doesn’t stop once the dialysis time is up. The light will stay lit and if you look at rmvd on the screen it will continue to go up. If your using a hi-flux dialyzer the rate will change to 300 when the time is up. I can’t remember for sure but I think if it isn’t a high flux dialyzer the rate will change to 70. You only have to look for a minute and you’ll see the machine is continuing to remove fluid unless you push the UF button to turn it off. Your not dense it just takes time to absorb it all.

You are correct, UF being turned off only stops fluid removal. You would still be using dialysate if you continued to run. Just curious but why are they objecting to running longer and just making more bicarb?

The post above this was by me and not Cathy, I was thinking of her and put her name instead of mine. Sorry.

Like Marty, I wonder why your clinic would object to you getting more time with the dialysate cleaning your blood. The more dialysis a person whose kidneys don’t work, the better. I was watching a video about NHHD last night and the doctor said that NHHD replaces about 50% of a patient’s kidney function compared with conventional dialysis that replaces only 15%. I knew about the 15% but didn’t know about the 50%.

If you get more dialysis, it seems like you’d replace that much more kidney function and would feel that much better. I don’t know what dialysate costs, but think compared to other disposables like the dialyzer, it’s negligible. If getting more of it allows you to be more rested so you could function better, so much the better. Like Marty suggests, I’d certainly ask how you could get more dialysate to use during your runs.

Thanks Marty for fessing up, I was sure I had gone crazy seeing a post I didn’t remember :stuck_out_tongue: !!

Dori I don’t know right now why they are reluctant. They are going to check it out. It could be because I am part of the NIH study so they want everyone pretty much equal. It could be because no one else is doing it. We will continue to discuss it as I train. Right now I have bigger problems, somehow I infiltrated or didn’t apply enough pressure when I removed a needle yesterday (it was fine all through treatment) and I have a major swelling/bruise etc. I just hoping I can get on since I am on my second arterial spot right now due to infiltrating the first spot due to being too close to the crook of my arm the first day.

I try to be “on” by 10:30 pm for my seven-hour treatment. I watch a little late night TV for an hour while I make sure that I, and the machine, are stable. That helps to keep the alarms and monitor calls to a minimum. At 5:30 am, I take myself “off” and try to get a couple more hours of sleep. Getting enough sleep has been one of the major challenges of NHD. Moderate doses of sleep medication have been helpful for me.

I have two bicarb containers and a splitter with a line to each container to plug the bicarb wand into. Although I am comfortable with seven hour treatments, I can make enough dialysate to last for much longer. Getting enough rest on treatment night… can be a much tougher issue.