I’m sure it seems like this is the end of the line for your ward. However, it doesn’t have to be. A PD nurse told me that unless his peritoneal membrane has been damaged too much by the infection to transport wastes, if the staph can be treated and cleared up while he’s on HD, it may be possible to reinsert the catheter and try PD again. However, it is essential to clear up the infection and be sure that he doesn’t get reinfected because staph is in someone’s nose or on someone’s skin.
Did the dialysis clinic ever test to find out the kind of staph infection he had? Knowing the type of staph infection would help the doctor and PD nurse know where it came from and what to do to prevent it from happening again. It’s possible that if others were doing his exchanges for him, they may also be staph carriers too.
Did the clinic swab the noses of everyone who did PD exchanges for your ward? If anyone was found to have staph in his/her nose, there is an antibiotic ointment that can be put in the nose to control staph infections and reduce the chance that the infection can get on the catheter or in the peritoneal cavity.
Another thing that may increase his risk of getting infected is a low albumin level. It’s hard for PD patients to keep their albumin level at 4 or above. If someone on PD doesn’t eat enough protein to overcome the extra protein that PD removes, his/her protein level can drop below 4. Having an albumin level less than 4 increases the risk of infection. The lower the albumin goes, the higher the risk of infection. Increasing protein intake can increase the albumin level and reduce the risks of infection.
So far as financial help if you want to learn how to do home hemodialysis, if your ward is on Medicaid, state Medicaid agencies provide financial help to pay for transportation to/from dialysis (including home dialysis training). Years ago I had a Medicaid patient who lived some distance from our clinic and Medicaid helped to cover lodging. I don’t know if this is a covered service in your state (or any state) now, but it’s worth asking. Also, it’s possible that the clinic has made arrangements with a nearby motel for a special rate for families training for home dialysis. That’s also worth asking about. As Dori mentioned, the social worker at his dialysis clinic may know or be able to track down information about local resources to help cover costs that you would have while learning how to do his home dialysis. Some National Kidney Foundation affiliates offer emergency financial help, the American Kidney Fund offers financial help (social workers have applications for both of these), sometimes churches or local community organizations can chip in to help pay part of the costs. Since you and your husband probably already know the basics about kidney disease and treatment, documenting treatments, reporting problems, it may not take you or your husband as much time to train if all you have to do is learn how to operate and troubleshoot the machine, emergency procedures, and how to do needle sticks. You might want to ask your tax advisor if the expenses you have while he’s in training would be tax deductible as medical expenses. That won’t help you this year, but it could help next year.
I have talked with a few nurses that train patients for home hemodialysis who are willing to go to people’s homes to train patients. I don’t know if there’s anyone that offers this in your area. There are also some dialysis centers that offer “staff-assisted” home hemodialysis, so you might ask clinics if they offer this service. Medicare doesn’t pay for the person who does the dialysis though so that would be something you’d have to pay for unless he has insurance or Medicaid that would cover it.