With in-center dialysis we have to rinse the dialyzer with at leaste 2 bags of saline in order not to react to the fibers inside the dialyzer. Do you have to do anything similar with daily dialysis txs?
For me, there’s no rinsing step as such, but the priming does rinse the whole blood circuit with about 800ml of saline which ends up in a drain bag.
Pierre
Not at all, …however, I did have major problems with reactions in-center and once I started training those reactions came along with me which lasted for the first 3 months…so I did rinse for a while, but now I don’t. The reactions vanished at home. I also don’t use heparin…
Wow-whoa! Whenever I see mention of rinsing &c., I find it really scary!! :shock: We do NOT re-use anything here! I didn’t even feel wholly comfortable leaving the lines & dialyzer connected until next morning to use after failing to cannulate on Wednesday evening. With 210H dialyzers at $100 a pop, you don’t want to waste them, unused.
But the thought of people (I saw one U.K. guy’s posting talking about using lines up to 30 times!!! :shock: :o :? ) re-using gives me ‘the willies’ !
Geez I didnt realise dialysers were that expensive, holy crap!! How on earth is that justified :shock:
I never ever reuse anything. If for some reason I cant hook up, I chuck everything out. It would cost more if I got an infection and ended up in hospital. As far as I know, you are supposed to throw out unused lines anyway. Might be different with other machines.
There is NO re-use of anything in my case. When we talk about “rinsing”, we mean running some saline through the blood circuit to clear it of any manufacturing residue. I used to itch all through my in-centre treatments until they changed my dialyzer to one not sterilised with chemicals. No problem since.
Pierre
In the U.S. we have both reuse and single use units. Also, most patients do not know this, but they can request to do single use since Medicare pays for them to have a new dialyzer every tx. I did this in 2 reuse units and they gave me single use no questions asked. Or I should say, they asked, and I told them I heard Medicare gives me the option and from there they did not hassle me about it. They may try to give the patient a cheaper quality single use dialyzer. It so often is about the $$$. They did this to me and when my clearance dropped I spoke up to my nephs and they ordered a better model. One has to always speak up- education is power- they will walk over you if you are silent.
When I was initially on resuse, before I knew what it was, I had terrible itching on the tx, external and internal. I told my then neph about it-he had no answers for me. He could not blame it on phosphorous as my phos. was in range. But most of the nursing staff said it must be your phos. :roll:
I didnt know there are “cheaper” dialysers. I think that is appauling, money should be no option when it comes to health. By using cheaper quality equipment, I guess you are more likely to get ill, thus costing them more money in the long run. I guess that is why alot of people are coming to australia for treatment. There are a fair few on dialysis. It does annoy me though, as you can come here and get on medicare at the drop of a hat, yet if you go overseas, youve got fat chance. I dont think we should be allowing foreigners easy access to medicare, we dont need more people to clog up the already overloaded public system.
A:
By using cheaper quality equipment, I guess you are more likely to get ill, thus costing them more money in the long run.
We need help understanding this. Cheaper equipment, disregard for infection control and other unit protocols for safe care, patients wind up in and out of the hospital- how do the companies profit when they shortchange patients? If they kill the patient another patient fills the chair, but don’t they lose money when the patient has to go in hospital?
I meant it would cost the government more. Well it would here anyway.
When home or in-center patients are hospitalized, hospitals are paid for dialysis treatments that are performed in the hospital and doctors are paid for seeing patients each day they see them in the hospital. The dialysis clinic must report these days separately and only bill for days dialysis has been performed in the clinic. Actually the test of whether the treatment is billable to Medicare is whether blood entered the dialysis lines.
It is not in the dialysis clinic’s best interest to undertreat patients so they are hospitalized more. Dialysis clinics do lose money every time a patient is hospitalized. If hemo patients are hospitalized signicantly more than the average number of days for hemo patients, it shows up on a report that state survey agencies receive about clinics. Enough red flags and the clinic will get an unannounced visit from a surveyor to find out why. And when the surveyor visits, he/she won’t stop with why more patients are hospitalized. Many times surveyors are at dialysis clinics for several days going over the clinic with a fine tooth comb to find problems.
Right now hospitalization rates are not publicly reported – only dialysis adequacy, anemia management, and mortality are. However, that doesn’t mean that it won’t be reported in the future and clinics are well aware that eventually their reimbursement will be tied to how well they take care of patients under the pay-for-performance method of reimbursement that is being discussed now.
How does pay-for-performance work?
hi all, we dont as such rinse the dialyzer, we have a rinse back which rinse’s 200ml’s of saline back through the lines into my hubby at the end of his cycle, which is just to rinse the blood back and to give him fluid. there is no re-use of anything, it all get’s thrown out.i dont think i would like to use anything that has been rinsed.
HI Helen, Here in Australia, no one reuses anything and I don’t think it would be right to do it either.
What is meant by Rinsing the dialysers is when you set up the machine, you actually ‘prime’ the machine by running a bag of saline through the lines and the dialysers before going on the machine. This is done to rinse out dialyser from the chemicals used to sterlize it and also to clear out all the air from the lines before going on the machine.
hope this helps. cheers Queenie.
They run an extra bag of saline through my dialyzor to prevent a reaction. I would run a low grade temp. after going home from txs. and feel flu like. No one was willing to say it was the dialyzor, but the rinsing helps. This is the second unit I’m at and it was supposed to be done all along, however was not noted on my flow sheet or chart! Eventually they stop doing it and then we’re back to square one. I will continue to use a long rinse when I go to home hemo. I would imagine. Lin.
yes, queenie, we do the priming of the line’s then after hubby is finished he will get a rinse-back of saline {200mls} , but yes like you said, nothing is re-used at all, it’s all single use.
Lin wrote:
They run an extra bag of saline through my dialyzor to prevent a reaction. I would run a low grade temp. after going home from txs. and feel flu like. No one was willing to say it was the dialyzor, but the rinsing helps. This is the second unit I’m at and it was supposed to be done all along, however was not noted on my flow sheet or chart! Eventually they stop doing it and then we’re back to square one. I will continue to use a long rinse when I go to home hemo. I would imagine. Lin.
Were you on single use or reuse when you had the reaction?
Remember when you read about people reusing their lines 30 times they are using the Aksys PHD machine. What the PHD does, does not have an incenter equivalent in the US or anywhere else.
One reaction (the pyrogenic one) was on reuse, the other three single use. Whatever happened (staff refused to talk about it, except for one tech.) involved their water system. Two other pts. were affected. The three I strongly suspected were backfiltration because of the problems with the tmps which staff said were related to my low uf; they wanted to take more fluid off of me. Lin.