Supplies

Hi all!

My husband Michael will be starting training for home hemo on Monday. His new unit has been great, but I’m left with one question…

Michael’s been on dialysis for four years–the first two on PD, the second two on in-center hemo. When the nurse and the tech from the unit visited our house today to check things out, they told us that we’d need about as much space for supplies for every other day slow nocturnal as we did for CAPD. I have to admit I was kind of surprised. I mean, with PD, we were storing all those boxes of fluid.

So I was wondering, in your experience, how much space are you using to store supplies for home hemo?

Thanks to all for your responses.

Deborah

P.S. I also want to thank all of you for your wonderful board. You’ve been a wonderful source of encouragement and information in our decision-making process in all of this!

Hi Deborah,
How often will your unit resupply? I did daily/short home hemo on a standard machine for a year. I was resupplied about once a month and reckoned that each month’s supplies were equal to about half a cord of wood. Half a cord would be a cube 4’x4’x4’.

I would think that for three times a week treatments the amount of supplies would be somewhat less than for CAPD. The main space hogs would be saline and acid. Am I correct that you’ll use two bags of saline and one bottle of acid per treatment? Then that is only two and one box respectively per month. Then you’ll have 12 blood tubing sets and dialyzers but that is less than a case a month. Is space an issue? If you end up having some issues post them to the board and I am sure the people who post here can come up with some ideas.

So how long will Michael dialyze each run? Do you/Michael have any thoughts for the age old question - which is better pd or hemo? - since you’ve done both. Keep us up to date on how things are going.
Bill

Hi Bill! Thanks for your rapid reply!

Space isn’t really a problem, but I was kind of hoping I could fit most of the supplies in our walk-in closet. I’ve managed to clear about four to five feet up to a height of about six feet plus a couple of shelves up to about four feet. Or maybe in my home office. (I work at home as an editor, but to tell you the truth, I use my laptop and work in the living room more than I’m behind my desk.)

Anyway, from what you described it doesn’t sounds so bad. On PD we had an entire wall of our garage lined to a height of between four to five feet with boxes of fluid and other supplies. Plus overflow in our closet!

You asked about PD vs. Hemo. That’s really a tough question. In some ways, Michael (and I) absolutely loved PD. It was so flexible, and we loved doing dialysis at home. We even went on vacation both summers Michael was on PD–not a single destination, but true road trips–having supplies delivered to hotels where we were staying along the way. But there were drawbacks too. Mostly, because Michael is a Type I diabetic (for 37 years since age 13) he found it very difficult to manage his blood sugar on PD. (This was before the new protein-based fluid was available, sorry I don’t remember what it’s called.) Another problem was that he was slowly but surely gaining weight which he wasn’t very happy about. Overall though it was a positive experience, and he’d probably still be on PD if he hadn’t developed a perforated bowel which required him to have an emergency (and unreversible) colostomy. We’ve been told a colostomy is considered an absolute contraindication to PD because of the risk of cross-contamination causing peritonitis and because there’s almost a 100 percent chance of developing a severe hernia in the stoma.

As for in-center hemo… Well, I now that I think about it, I can’t think of that much positive to say! LOL Michael goes to a very warm, friendly unit where we really like the people. That’s a positive. However, after doing dialysis at home for two years, it was very, very hard to relinquish that much control to someone else. And he pretty much feels lousy all the time–no energy, severe fatigue–on in-center hemo. In all fairness, he has several serious co-morbidities (besides the diabetes, he has heart problems, vision problems, and has broken his ankle and knee a couple of times in the last year). But a huge issue has become that his adequacy stinks. Even on 3X a week four hour runs, he’s running at around 65% URR–which his doctor attributes to the fact that he’s a big man–6’3" and 220 pounds.

We’re hoping against all hope that every other night slow nocturnal home hemo will make a huge difference in the quality of Michael’s life. His doctor seems to think it will–and so does the head nurse at his current unit and the nurse at the new unit. We feel sooooooo fortunate to have the chance to do this. I’ve been searching for a program in our area (north-central Arizona) for two years now, then suddenly everything fell into place. Truly, we think it’s an answered prayer.

Sorry to prattle on so! Promise to keep it shorter next time!

Deborah

when I got my initial shipment of supplies I was near tears, where was I going to put all that stuff? seems whoever filled out my requisition did it for 3 months, not one. it took quite a while to whittle it down to a more manageable amount.
figure out what you need for each treatment, multiply by the number of treatments then add a little just in case. there are sometimes problems and things must be discarded.
a large closet with shelves should hold everything nicely.
wish you luck.

I know exactly how you felt! Michael was doing hemo in-center on a short “bridge” while his PD catheter healed when they delivered our first batch of supplies. I had bought a large cabinet when the truck arrived, I told the drive to just put the stuff in there. He laughed and said, you’re new at this aren’t you? Then he backed up his semi and unloaded what looked like an entire warehouse full of boxes! Most of them ended up in our living room (temporarily) because I hadn’t worked out a place to put them! So I guess at this point nothing will surprise me, but I’m really hoping it’s not THAT much stuff this time! LOL

Thanks for your response.

Deb

I’ve just received my second monthly supplies for 6x week dialysis. I do believe Bill made a calculation error at 1 box of dialysate (4 bottles per case) and 1 box of saline (12 per case).

I usually get 4 weeks of supplies, at every other day you will do 14 treatments per month. I use approximately 1.5 bottles of acid per treatment, so that would be 21 bottles or 6 cases. This would take up approximately 4’ by 2’, dialyzers come 12 to a case so you would need 2 cases (each case about the size of a case of paper, and light), tubing comes 24 to a case so one case of that (a slightly bigger box, but also light), bicarb comes 12 to a case so 2 of those (they are small, maybe 12x12 or so), saline comes 12 to a box so you will need 3 boxes (again about the size of a case of paper but heavy).

Other misc supplies will be the vinegar, they will send a case at a time so 4 gallon bottles, I take these out of the case to save room, and bleach, they sent me a case of 6 which should last all year, again I took them out of the case and stored separately.

I keep my needles, heparin, tapes, syringes, reagent strips, drapes, blood tubes, alcohol, etc. in a couple of cleared dresser drawers right by the machine. I also keep my culture oven and centrifuge in a cabinet.

You will have the monthly Renalin and accompanying holder to store.

I believe the amount of space you have cleared will be sufficient. BTW this is for the Fresenius machine which is the only one approved for nocturnal so I assumed it was the machine you will be using.

Hope this helps, I am just finishing up my 4th week of home dialysis and 8th week of dialysis, so am very new to this my self.

Hi Deb, I also have just started doing home hemo. I am on the Aksys machine and supplies are a lot less with that system. I do have a little suggestion that I have for some supplies that you might use everyday. Things like needles, gauze, alcohol wipes. syringes, or other small items. I found a cart made by “CLOSET MAID”. It has 4 wire draws that can pull out and being wire you can see exactly what your looking for. The cart is bought with different options, like a wooden top or plastic, with wheels or without. I purchased mine at a local LOWES. It costed about $60.00 but it’s the best purchase I could have made for my supplies. For all those small items, I don’t know how I would have stored them without it. You need them close by and handy so this works great for me.
I wish you and Michael all the best. Keep us posted on how things go.
Deena

I am on the Aksys machine and supplies are a lot less with that system.

I’m curious about what supplies are different. I understood that the Aksys system used very similar supplies to the Fresenius, ie bicarb, acid, and saline , but reuses the lines and kidney, saving those 3 boxes a month. Not a lot of space. I do like that the Aksys doesn’t require the time to do all the water testing everyday, but then again it runs all day and can’t be used for slow dialysis due to the lack of a heparin pump. However, I thought that reusing the lines and kidney were the main differences supply wise.

Cathy

hmmm, I use to better at math :oops:

One thing with the Aksys is that is does not use saline under normal operation. Also the acid bottles are more along the line of 16oz soda bottles as opposed to the gallon sized bottles I used when I dialyzed on the B Braun.

[quote="“Bill Peckham”"]

That would be significantly fewer supplies, the acid bottles for the Fresenius are also gallon sized. Still curious though, how do they return your blood to you without the saline??

The AKsys uses Ultra Pure Dialysate (UPD) in place of saline. The machine makes someting like 50 liters of UPD during its preperation for treatment. When I begin treatment the lines are primed with UPD then when I hook up the lines and press ‘go’ the machine draws the UPD out through the F-80 kidney until my blood meets in the middle of the kidney (you could also set the machine to give the prime, I set my machine to discard the prime).

If you need fluid during treatment the machine infuses UPD through the F-80. And it uses UPD to rinse back the blood - again through the F-80 which is nice because there is no need to disconnect the lines until the treatment is over.

Here is a link to a good article on how the Aksys PHD works:
http://ndt.oupjournals.org/cgi/content/full/18/1/19

PHD®: the technological solution for daily haemodialysis?
by Zbylut J. Twardowski

here is Dr. Twardowski’s account of the Aksys PHD’s operation:


Preparation of dialysis solution for each dialysis
The system is filled with RO water, including the blood compartment of the dialyzer and the bloodlines. The dialysis solution is prepared by dissolving the powdered chemicals and diluting the concentrate in water in the main tank. The temperature of the dialysis solution is regulated by a thermistor, and the proper dissolution of chemicals is checked by the first conductivity meter (CM 1). The dialysis solution fills the dialysate and blood compartments of the dialyzer.

Dialysis
Discard prime and start of dialysis. The patient changes the transducer protector, attaches the arterial and venous lines to the blood access, injects heparin to the arterial line and touches the start button to activate the system. The blood and UF pumps are activated. Negative pressure in the dialysate compartment pulls dialysis solution from the blood compartment and blood enters the blood compartment of the dialyzer through both the arterial and venous lines. Once the compartment is filled with blood, the blood pump speed increases and the UF pump speed automatically adjusts to create appropriate transmembrane pressure for the desired UF. The dialysis solution is heated to 37°C, flows through the dialysate compartment of the dialyzer and returns to the top of the main tank (Figure 1).

Backflush and solute infusion
Every 15 min, if desired, the directions of blood and UF pumps are reversed to create negative pressure in the blood compartment and positive pressure in the dialysate compartment. The fluid from the UF tank flows to the dialysis solution line through the bypass. The reversed transmembrane pressure gradient filters dialysate through the membrane into the blood compartment dislodging proteins and other molecules embedded in the dialyzer membrane pores. After a bolus of fluid passes through the membrane, the direction of pumps is reversed and dialysis continues. Backflushes are intended to preserve the efficiency of dialyzers for up to 30 reuses.

If infusion of fluid is necessary, ultrapure dialysis solution may be infused during dialysis in the same way as during the backflush.

Rinseback
At the end of dialysis, the direction of the blood pump is reversed. Dialysate from the main tank flows through the heater and ultrafilter 1 to the dialysate compartment of the dialyzer, creating high pressure in the dialysate compartment. The blood is returned to the patient through both the arterial and venous lines, pushed by the dialysate transferred to the blood compartment due to the reversed transmembrane pressure gradient. This method allows for almost complete return of blood with minimal delivery of fluid to the patient. After the blood is returned, the patient disconnects lines from the blood access and attaches the lines to the connectors in the dialyzer module, changes bottles 1 and 2, tests the quality of pre-treated water and gives information through the touch screen that the machine may start preparation for the next dialysis.

Preparation of the machine for the next dialysis
The machine first determines the clearance of the dialyzer by measuring changes in conductivity. The blood pump pulls RO water to the blood compartment of the dialyzer through the ultrafilter 2 and the dialysis solution flows countercurrently through the dialysate compartment. Based on the changes in conductivity measured by the second conductivity meter (CM 2), the conductivity clearance is calculated by the machine’s computer. If clearance is within an appropriate range, the dialyzer is accepted and the machine continues with the heat disinfection and dialysis solution preparation for the next dialysis, as described above.

Hey, Bill, any chance that you could post a photo of your supply storage for the Aksys machine? Marty posted her dad’s set-up for a Fresenius machine (under Marty’s dad, stories), and it’s very helpful to actually see it. : )

Also, those of you using the NxStage machine–love to see those supply storage/set-up photos, too. Please share your stories with us!

Dori

Okay I finally took some pictures of my dialysis storage and I will try to post them. My dialysis room is 12.5’ x 8’. It use to be a bed room that I would rent out. Here is the supply shelf above the machine. I installed shelves around the perimeter of the space. You can also see my attempt at decorating. When I first set up the room I painted it to look kinda clinical. When I visited a holiday unit in Edinburgh ( here is a link to a trip log: http://members.dancris.com/~dalee/listpics/billp.html )
I decided I needed a less clinical look for my home unit. This is my attempt at a sort of rural Italian look.

Hmmm that picture is pretty big. Hey Gus how did you post pictures without the border? Here is another one that shows the area where I sit - the top of my chair is visible in the bottom center of the pic, draped in a red blanket.

Here you can see the bicarb and acid storage on top of the dresser. I can store a two month supply on the dresser top. One drawer is for dialysis supplies - heparin, paper work stuff, saline for the arterial syringe, test tubes for blood work, etc. the other five drawers are for clothes. My dialysis room doubles as dressing room.

You can also see a flat metal sculpture I bought on Ebay that I have yet to hang. The room is a work in progress. I have a new light to install - you can just see the blades of a ceiling fan that will go. Behind the door is a large trash can that I empty once a week and you can see a shelf that needs to get hung behind the door.

Here is what I have behind the curtain on my main stiorage shelf: Needles, water filters, more needles, Myron L test water, syringes. You can also see my supply cart next to the scale. It holds my paper work, tape, band-aides, y-conectors.

You can also see my portable heater that I can use so I don’t have to heat the whole house when I am dialyzing in a back room.

I have my pics hosted on a little private webspace I have…then use the IMG tags to embed it…

Btw, nice pics! you sure got i nventory nicely organized![/b] :smiley:

Jane does this thread answer your supply question?

Yes, great. Thanks for directing me here. Really like your set up too : )