Things That Go Bump In The Night

I am often asked why I do dialysis at night. When I started dialysis in Oct 2009 I was still working fulltime and wanted to continue. Doing dialysis at night meant that I had my days free. Of course not finishing until about 1.00am and getting up to commute to work at 5.15am left me rather tired by the end of the day. Anyway, after 18 months of that I am now only working two days per week and neither of those days follows a dialysis night. I still prefer to do my dialysis at night because it leaves me all day to do as I wish during my semi retirement.

Doing dialysis at night has an added difficulty because the phone support by the nursing staff and the technicians is after hours and no one likes being woken at say midnight to answer a question. Home dialysis does have some complications and apart from the telephone there is just me to resolve any issues. Here is a list of the things that go bump in the night and the list is still growing:

1.       Most problems occur when getting started. Often the machine will get confused when doing its rinse then won’t complete the testing. This requires the “Windows” solution, reboot it and start again.

2.       If the testing works then the next point of failure is the Prime. This is where the machine flushes the air out of the blood lines using saline. Sometimes it won’t start the Prime and sometimes it won’t stop. I can usually overcome this by starting or stopping the pump manually.

3.       By far the biggest problem is the operator. Yep that’s right when I forget to do something or get distracted. Like failing to connect the water hoses, or forgetting to disconnect the saline after it has finished Priming.

4.       Assuming that the machine works correctly and I don’t forget something the next issue is to get the cannulas correctly inserted in my arm. This is probably the biggest single issue and the one that puts many people off home dialysis. There are endless mistakes that can be made here but the one that hurts is when I put the cannula right thru the blood vessel (either the artery or vein) and then it bleeds into the tissue and leave a big black bruise. Fortunately I have only done that once.

5.       Once the cannulas are in, the next step is to flush the tube attached to the cannula and it is very easy to forget to clamp the tube which results in blood everywhere. It only takes 2-3 heart beats to pump enough blood to require a major clean up. Apart from the mess it doesn’t do any harm but you have to learn not to panic.

6.       The final step of connecting to the machine pumps the blood thru the blood lines and replaces the saline which is pushed into a bag for disposal. The machine often stops with an alarm and the only option is to just keep restarting the pump until all the saline is gone. This is annoying and usually means the machine needs a service.

7.       Only when all the setup is completed and the machine is running can you determine if the pressures in the blood lines are correct. A wrongly inserted cannula will not allow the blood to pump and the machine stops with alarms. Having to fiddle with a cannula or reinsert it at this stage is complicated and not much fun. Twice now I have had to stop the dialysis altogether and retry the next day.

8.       Once the machine is running the next 5 hours should be uneventful but possible problems include; power failure, water failure, twisted blood line, blood leaking from a connection, a cannula moving or heaven forbid a cannula being pulled out.

9.       I have experienced a power failure during an electrical storm and while the machine continued on battery until it was restored (only seconds) the water pump also stopped.

Well I guess that’s about it for now. For all the above problems I would still highly recommend home dialysis rather than going to a hospital. It is much more flexible and more comfortable.