Our provider does not offer Nxstage in this area, and the company that does is a good 150 miles away, so what do you do when you provider does not offer the system ?
The options are to use the machine the dialysis clinic uses, to advocate for that clinic to provide the NxStage machine, or to change clinics (and usually doctors) to one that offers the NxStage. You could look on the NxStage website (www.nxstage.com) to see what clinics use their machines to be sure that the closest is as far away as you think.
Second, how long does training take ? I know we’ll need to know about putting the needles in, but what about the EPO, Calject, Heprin, etc ?
Training time depends on the complexity of the equipment and how fast the patient and/or care partner learn. Training takes 3-8 weeks up to 5 days a week.
Then what about the monthly “lab draws”.
Some dialysis clinics want patients to have labs drawn at the clinic while others have patients get their labs drawn locally and get copies from that lab.
Then, what about the actual dialysis procedure ? will we need to chart, listen to the lungs, etc, etc, etc, contact the Dr. when there is a problem, get orders etc, etc…how much simular would we need to be than a regular dialysis unit ?
In the home setting, the patent or caregiver learns as much as a dialysis technician.
They learn not only what to do and how to do it but why they’re supposed to do it that way. They learn about kidney disease from the nurse, diet from a registered dietitian, and financing and coping with treatment/rehabilitation from the masters prepared social worker. For the treatment, the patient or care partner learns how to set up the machine, check the settings, check vital signs, insert needles, give medications, complete dialysis records, report symptoms, how to order and store supplies and medications, do water testing, and much more.
Then lastly, what about other equipment needed, other than the nxstage unit
and water making system.
In addition to the machine and water treatment system (or bags for the NxStage if not using PureFlow, its water treatment system). Patients may need a basic recliner that can be disinfected, a BP monitor, a scale, and various disposable supplies. Dialysis clinics are supposed to provide equipment for the patient to do home dialysis.
What about an AED or other such equipment, and what about lab equipment, There are simple units available for hemocrit and also INR, would all this be needed ?
Patients don’t typically do any labs at home. I’ve never heard of anyone who had an AED in their home. Patients are taught what to do in an emergency (health, disaster, equipment failure, etc.). They would be advised to call the dialysis clinic for health problems, to call emergency medical staff for urgent emergencies and to call the supply company (Fresenius or NxStage) if the home dialysis training nurse can’t help troubleshoot a machine problem. NxStage trades out machines that aren’t working correctly. Typically a biomedical technician is sent to the home to repair the Fresenius machine and the dialysis clinic is responsible for that cost.
We are in a basicly rural area, and the Kidney doctor is about 1 hour away. The local
hospital know nothing about dialysis.
The dialysis clinic will provide information on who to call when and phone numbers to use. If a patient needs inpatient dialysis or more than something that the hospital can’t treat, he/she would be advised to go to the hospital that the dialysis clinic refers patients to. If the need is urgent, the patient could be transferred from one hospital to another by ambulance (or air ambulance).
Another home dialysis option for your father would be peritoneal dialysis. You can read about that from the entry page for Home Dialysis Central. Just because he’s doing hemodialysis now doesn’t mean that he can’t change treatments as long as there isn’t a medical reason why he would not be a candidate for another treatment. He may also be a transplant candidate. The transplant hospital can talk with you and him and do an evaluation to make sure that getting a transplant wouldn’t create more problems than it helps.
If you’d like to get feedback from patients who are doing dialysis and may have a similar situation to your father’s, you might want to post your questions on the patient message board for HD or PD.