Apologies if this has been asked before - I did a couple searches and couldn’t find an answer though.
My Dad is 70, and started at home overnight PD about 3-4 weeks ago. In addition to end stage CKD, he also has moderate alzheimer’s, and as a result when he’s woken up to use the restroom a couple times over the past few weeks, he’s disconnected his line because he forgot he’s not supposed to remove it. Aside from this, he hasn’t had any issues with the treatment, and has seen some improvement in his condition. His nurse is now talking about switching him to 3 PD that’s 3 x’s a day during the day, due to the risk of infection from improper disconnection of his line overnight.
Is there anything else we can do to help prevent him from disconnecting the line? Are there any kind of safety locks/clasps available that he couldn’t easily undo, or some other out of the box thinking that would allow him to continue the overnight treatments?
I am not aware of any locking device over the catheter, but perhaps a clinical nurse who works for the company (Baxter or Fresenius) that made his cycler knows of something if his home training nurse doesn’t. If he disconnects to go to the bathroom, does he reconnect following the sterile technique procedure he was taught or does he remain disconnected the rest of the night? How often does he do this?
Some possible options:
If he doesn’t wear a PD belt that secures his PD catheter around his belly, that might help to keep him from disconnecting. You can find where to get them on the Home Dialysis Central site under Life@Home > Helpful Products at https://homedialysis.org/life-at-home/helpful-products.
Does he have enough extension tubing to get to the bathroom and has he been shown how to do that more than once? Would a commode near his bed help? Does he live with someone who could make sure he goes to the bathroom before going to bed and who takes him to the bathroom before they go to bed if at a later time? If he lives with someone, a bed alarm could alert that person that he’s getting up. Here’s a website that lists some - https://www.aginginplace.org/best-bed-alarms-for-elderly-fall-prevention/.
Finally, if the clinic is suggesting for him to do manual exchanges, most people need 4 manual PD exchanges every day that are done around breakfast time, lunchtime, dinnertime, and bedtime). Is he able to do that safely remembering all the steps? If not, who can be trained to help him do manual exchanges during the day?
I also am on a 5 cycle 10 hr night time PD and have to get up go to the bathroom at times, but the big difference is that I have a 20 ft tube and don’t have to worry about disconnecting. Is there someone at home at night to help him?
Thank you both for your responses!
A little more info about his situation:
My mom lives with him and takes care of all the setup steps, and he does have enough tubing to make it to the restroom just fine.
Usually my mom wakes up in time to help him, but sometimes (2-3 times in the month he’s been doing this treatment) he unplugs it before she wakes up.
I don’t believe he has a PD belt and will check into it for sure. The wake up alert/alarm also seems like a viable option, will look at that as well. Thanks again!
I have had to address this situation with several patients and found a device that can’t prevent disconnection, but makes it difficult for the disoriented patient to do so. The device is called the Secure Way. You can Google “SecureWay” to take a look (this system will not allow me to include the link). It is a plastic device that snaps on to the transfer set-patient line connection. Once in place, the catheter works in the normal way. With the Baxter transfer set, the twist valve is covered, so it cannot be accidentally closed during the treatment - that was another problem I saw on occasion. It is available for both Baxter and Fresenius systems.
The device is available in 2 configurations - the Day/Shower device is worn like a necklace and minimizes the use of tape on the abdomen if used all day. Many of my patients use it that way. I do instruct all of my patients to use it when they shower so that the catheter is suspended, preventing dangling, and they can remove all the tape to properly cleanse the abdomen. The other configuration is
the above mentioned Night/Exchange holder. I recommend the $34.95 set that includes both devices. I have seen it in use for about a decade and never saw one break. Money well spent.
This system was designed, patented, produced, and sold by one of my former PD patients. I have no financial interest in the product. I just think it is a brilliant design and my patients love it.
Alan Falcioni MSN, RN, CNN
Our solution is a plastic urinal on the PD cart…sure beats leaving the bedroom.