For those of you that are not on the Aksys PHD, I hope that by reading all of the posts relating to the actual use of the Aksys PHD that you are really able to get a strong sense of how easy the Aksys PHD is to use when compared to most other dialysis machines.
(I know, the NxStage machine is also very easy to use. I don’t want to turn this thread in a fight between which machine is better.)
If you just look at the average times to do things, “easy” just screams out at you.
only 10 - 15 minutes to start a tx
only 10 - 20 minutes to end a tx and prepare it for the next tx
once monthly changing of the blood tubing set and kidney (even changing it only takes about 5 - 10 minutes)
no RO monitoring by the patient
no extensive water quality monitoring by the patient
…
I could go on, but I think I made my point. It really is the “next generation” in home dialysis.
I don’t necessarily disagree with you re the ease of use of the Aksys, but I wouldn’t want people who have to opportunity to dialyze at home with other machines to get the wrong impression about time and difficulty. Agreed, it takes longer to set up a conventional dialysis machine for treatment. I’m typing this as mine is doing it’s 15 minute recirculation, before I go on for the night. Altogether, it takes about an hour to set mine up - but it’s not hard to do. One hour for a 7 hour treatment isn’t that significant.
After a treatment, it only takes a few minutes to pull off the tubing, etc. and press the acid clean button. The machine does that unattended for about 15 minutes and it beeps me when it’s done, and then it takes a few seconds to put it in heat disinfect. Again, the machine does this unattended, and it even shuts itself off when it’s done after about 45 minutes total.
There is no extensive monitoring of water quality really. I only need to test the water from the carbon filter tanks before a treatment. It only takes a few minutes. I don’t need to monitor the R/O. In fact, it’s not even in the same room as I dialyze in. I don’t need to do much with the concentrates (acid and bicarb), because I get those pre-mixed, so, no rinsing of jugs, etc. I take them out of the box and put the wands in, that’s all.
True, it does take more time, but it’s not like it takes hours and tons of effort. I like the concept of the Aksys, I really do. But I wouldn’t hold back from daily home hemo just because it wasn’t available to me locally.
Estonb,
The time for set up and disconnect is even less after the amount of time I’ve been home on the PHD, not quite 2 years… in the time it takes me to put out my supplies and stick, I’m ready to intiate treatment about 9 min.
And I’ve already loaded acid and bi-card before ‘put-on’ so I close it up press the button a couple times and I’m done…
i’ve been pulling both needles out and holding them together for a couple years so when I get up …I’m still holding, and the machine is recycling and it’s been 7 min. since the end of treatment.
BTW, I use 5x heparin now 5 cc in the venous vent line, (then replace transducer protector) and I’m at 28 uses and 0.0 % decline which is fantastic compared to what I had been getting.
When I was training I asked the R.N. if I could just heparinize the lines after treatment through the venous vent line…they said “Nooooo, you can’t do that , you’d be opening the system, blah, blah, blah,”
Then the home nurse calls me about 8 weeks ago and said
“We’ve been having some very good results with patients heparinizing their lines post-treatment through the venous vent line!”
Well of couse the heparin cleans out the clots and blood and then is rinsed and disinfected etc. so it never impacts me… so it’s working like a charm.
Guillaume
Pierre, I agree with everything you said. We have been on nocturnal for 5 years and wouldn’t consider changing until? Just recently my father had some medical problems. The closest specialist are 2hrs away from our home. No matter how you cut it a doctors appt is going to cost me 5hrs a day. When you need the machine cleaning time to be on the road or the set up time to get home then it becomes a problem. It can be done as I have been doing it but it is exhausting. There are times when I can use the couple of hrs I put in setting up the machine and running through the clean cycles and getting bi-carb etc. ready. However, I would never consider giving up home dialysis if I couldn’t change machines.
I am glad for everyone on home-dialysis and them getting whatever they want and can, to be independant. The PHD works for me and whoever else likes it. This life is difficult and stressful. I don’t write to add to anyone’s burden. Anything I say about the PHD is meant for the PHD users and anyone who has questions about it. In the battle of the machine wars, I surrender.
Peace,
I certainly agree with Guliiaume in his statement that just the fact that you are able to do home hemo, regardless of the machine you use, is fantastic. Whateve works for you.
I was just trying to make it clear for those who are unfamiliar with the Aksys PHD that it does dramatifally reduce the amount of time needed to do a complete setup and tear down for each treatment.
Guillaume - I do have a question for you about the actual time it take for you to get on and off. I’ve only been using the PHD for about 2 months now and I am constantly trying to find ways to decrease my out-on and take-off times.
I’ve been able to get my total put-on time pretty close to being as short as possible. But I am having a problem with my take-off time. My access is in my leg, so I am not able to get up and things while I am holding my access sites. My hold time is strictly 10 minutes. Technically, I can go for less time but if I do that I run the risk of my clotted access popping open when I put my body weight on that left, and then having excessive bleeding because of that. I have found that 10 minutes of pressure will always guarantee that my clotted access won’t start bleeding once I get up and walk around. So the 10 minutes are a given. The parts that I can’t figure out how to speed up are the post tx items. Things like sitting/standing blood pressures, post tx weighing, cleaning up my area to make it as unobtrusive as possible between treatments, putting away the things that I use duing my txs like my computer, anything I may have been eating or drinking while on the tx, and anything else that needs to back where it came from that is not part of the actual tx.
Do you have any tips for me that I may be able to use to decrease the time it takes for me to get everything completey wrapped up after a tx?
I would look at my situation very diffently if I were able to do nocturnal dialysis, too. However, when only doing short dailly I have found that the total time from the very start of getting ready for a tx through the very end of cleaning everything up after a tx has a huge impact on my schedule. When I first found out that my clinic was going to offer short daily with the Aksys machine I thought “Great - I can go from about 6 hours total time, 3 days a week down to only 2.5 hours total time for 5 days a week.” I was conjuring up all of the extra time I would have on my hands once I got the PHD home and was using it regularly.
As I described in my earlier post, the time required to start and end a tx on the PHD is a whole lot less than the time it takes on a more traditional machine. However, all-in-all it definitely takes more than simply 2.5 hours. I was not really thinking it though and I forgot about the time it takes to access my fistula, the time it takes to decannulate and hold my site, and the time it takes to clean everything up once I am completely finished.
Now that I am on my PHD full time, I have found that it averages around 3.5 hours for each tx from the very beginning to the very end. That’s a lot of time spent on dialysis over 5 days! I don’t tend to dialyze until the mid-afternoon, and I need at least a couple of hours after I wake up in order for my brain to really become functional (my personal, quiet time). Between the 2 of those chunks of time (wake-up time and dialysis time), I don’t find that there is a whole lot of time left for me to be leading a “normal life”.
If that time were significantly increased by my having to use a different machine then I don’t know if I would feel that the physical benefits of doing SDH outweighed the time commitments of doing SHD.
Luckily for me, I was able to start my SHD on the Aksys PHD instead of the other, more time consuming machines. If I had started my SHD on another machine I really don’t think that I would have decided to stay with SHD.
Do you have any tips for me that I may be able to use to decrease the time it takes for me to get everything completey wrapped up after a tx?
Well my setup in the breakfast nook of the kitchen means I’m 5 steps from the sink and a LARGE trash can is 3 feet away under the window cat hammock. When I get off other than pressing buttons a couple times and closing the doors, I put needles in the empty Red Acid bottle even the lines and Y connector which then goes in the trash along with paper plate, chuck or blue underpad, whatever, and syringes all the use-agains go in a zipper flowered bag that women use for secret things and sits on the TV/ medical cart i.e. swabs, tape 1", 1/2’, tweezers, glasses, Billy-the-kid-ney hand grip, the indispensble ‘auto- tourniquet’ strap thingee, heparin, post treatment pills and everything else is in a 4 ft tall med-drawer cart. The floor is linoleum, easy clean. I’ve loaded my acid and bi-carb prior to Tx so i’m good to go in minutes. I have good blood pressures so I don’t monitor ‘overmuch’…also I’ve come to know the physical and don’t feel the need to weigh after …if the Aksys doesn’t remove my target I will know it sooner rather than later. I treat every day sometimes I take a day off or not. I treat 2 hrs. If I want to watch the TV at some time I’m not on Dx … I sit in my breakfast nook and set up my supplies for the next morning and come in, sit down and get on.
hope there was something in this that helps,
Guillaume
Okay. I give up. I’ve been thinking about it ever since I read your post last night, but for the life of me I cannot figure out what “Billy-the-kid-ney” is!
How does your clinic allow you to get away with not taking all of your stats every 30 minutes, or with not logging your pre and post wieghts?
I have to supply every bit of info that is blank on my flowsheet for each tx. That means pre weight, pre blood pressure, then blood pressure and acccess pressures at a 200 rate of blood flow before I can actually start my tx. Once I start my tx, I have to get another blood pressure and access pressures at my target blood rate. Then for the rest of my tx, it is blood pressures and access pressures every 30 minutes in the tx. After my tx, I have to give them my sitting blood pressure, my standing blood pressure, my post weight, the amount of fluid that Bertha took off, and finally the “Clr” or “Not Clr” status of my chlorine test.
I guess I would be able to get done quicker if I didn’t have to do all of this monitoring.
Personally, I think the monitoring is important as a way to pick up if there were any mistakes along the way with the UF, either miscalculation or a machine problem that needs to be taken care of (it can and does happen). There’s also the fact that real weight can change up or down, and that can mean that you end up either taking too much or not enough off. The first and really, the only practical sign of this is blood pressure. When I did short daily, I logged every 30 minutes. With nocturnal, you only log at the start and then you log weight, BP and temp after tx. Logging simply ensures you pick up on these things, and it can be useful at the clinic appointment. I don’t think I would look at that to cut time.
Pierre
How does your clinic allow you to get away with not taking all of your stats every 30 minutes, or with not logging your pre and post wieghts?
o.k., I will try not to be sarcastic, I am on self-care home hemodialysis, I have dialyzed for nearly 25 years and I know my body very well and I also accept the consequences of all my actions. Even in center, I refused to take more than 1 pressure an hour. I rarely let anyone tell me what to do that doesn’t have an awful big stick. I just do what I do, I ask no one to do as I do. I was anwering a direct question not giving advice. I look forward to the day that dialysis is over, I do not resist it. I do not try to hasten it, either. I think, as much as possible, my medical staff know this and do not hastle me with ‘inconsequentials’. If they did, they might ‘win’, and they may or may not want to.
P.S. Billy-the-Kid-ney is a red sqeeze grip in the shape of a kidney that says “Billy-the” on it. I have had it for years, you grip it while you stick, gives you something to hold on to, it used to be for pumping up a vein for a better stick.
Oh, that is what “Billey-the-kid-ney” is. I get it. Thanks for the explanation.
That is great that your clinic “allows” you to forgoe the constant monitoring. My clinic is very strict about those things. They freak out if I don’t fax them my weekly flowsheets as soon as the week if over. Once they get my flowsheets, they then have to enter all of the info into the program they use to track sll of that stuff for every patient that dialyses with their clinic.
They have told me several times that they have to have this information from me, and everyone else, in order to pass the audits they get on a regular basis.
What clinic do you dialyze through? My clinic is a DaVita clinic.
I do 4 hour daily (6x/week) treatments on a Fresenius 2008. I do have to log pre and post b/p standing and sitting, temp, pulse and weight, and log treatment info, however I only log one check, generally in the first hour, I did more in the beginning but am a very stable client so this is allowed.
It takes me 45 minutes to get on, including all the water testing, logging and cannulation. Getting off is quicker, I leave my needles in until I get the machine rinsing, pull my needles and hold (I stop bleeding extremely fast, generally 2-3 minutes), and then finish cleaning up during heat disinfect. It takes maybe 20 minutes total.
I think as you get more experienced and maybe learn so ways to speed up your set up it will get faster as I believe setting up the Fresenius is the slowest.
Same here, reporting every 1/2 hour is required…I believe that we all should do this as a compliant patient. This data is very important for research which benefits other patients as well. Without research data we’re not taking part in helping the renal community…
On the other hand am trying to come up with a way to record my reports digitally without using pen/paper…
One example I thought would be using a tablet PC where the patient can write over the screen and all data is recorded on a flash memory card which later you can print nice printed reports or even sent over internet to clinic…no more stacks of paper to handle around and of course a nice database of all your reports, easily tracking how your doing since home dialysis initiation. This streamlines how we care for oursleves as patients and makes life easier on making decisions.
Same here, reporting every 1/2 hour is required…I believe that we all should do this as a compliant patient. This data is very important for research which benefits other patients as well. Without research data we’re not taking part in helping the renal community…
I’m wondering what changes every half hour that will provide data to support research. My b/p maybe varies 3-5 points during my treatment, and my v/p and a/p maybe vary 10-20 points during the entire treatment. U/F remains the same so is meaningless and tmp varies seldom, sometimes 10 points but that is is.
It’s not just the vitals, there’s alot more involved but really you can’t say much about vital without other data…for us it seems meaaningless but for those proffessional researchers who are working hard to improve dialysis it means alot…they need full reports, not partially completed repeorts…
It’s not just the vitals, there’s alot more involved but really you can’t say much about vital without other data…for us it seems meaaningless but for those proffessional researchers who are working hard to improve dialysis it means alot…they need full reports, not partially completed repeorts…
But what other information do you log, all I log is time, b/p pulse, ap, vp, rate, rmvd, tmp and bfr. The only thing that varies would be b/p, pulse, ap and vp??
I am in the research program and they certainly don’t ask me for more frequent logging, and remember, in nocturnal you only log getting on and getting off.
To me, it seems the important information is the blood work.
Every state has different requrments as to how frequently you need to do you data and then the other factor is your paticular dialysis facility has it’s guidlines. It is really best to follow those. The other nice thing about the PHD Aksys is that there is very little supply storage since you do not need saline bags and the ultrpure dialysate is actually more pure than saline.