Whoops! I didn't think about that...

[Desert Dancer]

When I go on the machine I set the treatment clock for 10 hours. This is because 1) it almost always takes me about two hours to fall asleep (even pre-dialysis) and I can't function on six hours' sleep 2) it uses up all the bicarb that would otherwise have to be dumped, and 3) more is better!

I set my heparin pump for 1.2u per hour; it starts dispensing an hour after I start and dispenses the last 1.2u an hour before the treatment ends (hour 9). After 10 hours both my chambers are clear of clots and there's no streaking or clots in the dialyzer itself. But sometimes (not often), I'll shut off the machine when it reaches the UF goal and fall back asleep for another hour, giving me an 11 hour treatment. When that happens, there is usually a little ring of clotting in both chambers at the top of the blood levels and in the top of the dialyzer when I do my return but the dialyzer is pretty clear once the saline runs through it.

Then last night Andy said to me, "What happens if the clots in the venous chamber break off? The air detector detects air, not clots." Hmmm. Good question.  My assumption would be that even if that happened the clots would be too small to cause any problems, and if they were big (unlikely) they'd not clear the bevel of the needle and I'd get a pressure alarm.

Any thoughts?

[mcclane]

right now, i'm still doing hemo via cvc.

But I always thought that the filter in the venous chamber would catch all clots.

The hospital initially had me at 0.5 heparin per hour, and an initial 1 bolus.  I had to increase that to 0.9 per hour an 0.9 bolus.  I typically set my treatment time between 7 - 7.5 hours.  I don't pay for any of the dialysis supplies so if I have a huge amount of bicarb leftover, it really doesn't matter to me either way.

[Desert Dancer]

Yep, I'm an idiot. I completely forgot about the damned screen in the bottom of the venous chamber. I guess I've been doing it long enough that I just don't see some things anymore. That's not good. What an idiot I am. 

I can't stand waste of any kind, whether I'm paying (directly) or not. Waste is waste, and waste is BAD!

[MooseMom]

DD, I am hoping to eventually do nocturnal home hemo; I'm not on dialysis yet, but it's certainly in my future, so I am making preliminary plans now.  Since you definitely seem to be an old hand at this modality, can I ask you some questions?

Is there a particular reason why you use a Fresenium Baby K instead of NxStage?

How was your schedule decided?  I see you do 10 hrs every other night...is that the norm?  I've heard other people doing, say, two nights on and one off, so I am wondering how someone decides what schedule to follow.  What was your schedule when you first started nocturnal, and how did you come to the schedule you have now?

Thanks so much for any guidance you can give!

[Desert Dancer]

DD, I am hoping to eventually do nocturnal home hemo; I'm not on dialysis yet, but it's certainly in my future, so I am making preliminary plans now.  Since you definitely seem to be an old hand at this modality, can I ask you some questions?

Is there a particular reason why you use a Fresenium Baby K instead of NxStage?

How was your schedule decided?  I see you do 10 hrs every other night...is that the norm?  I've heard other people doing, say, two nights on and one off, so I am wondering how someone decides what schedule to follow.  What was your schedule when you first started nocturnal, and how did you come to the schedule you have now?

Thanks so much for any guidance you can give!

Hi, MM! I'd be very happy to help any way I can.

When I first approached my clinic to inquire about nocturnal they told me the NXstage wasn't FDA-approved for that purpose, and that they used the BabyK for their nocturnal patients. Frankly I never even inquired about the NXstage because I was under the impression that the NXstage relies on high blood flow rates (500-600) and that was unacceptable to me. I wanted low flow rates 1) to protect the life of my fistula and 2) to have dialysis that was easier on my body. I set my blood flow rate at 250 and my dialysate flow rate at 300 - nice and easy.

My clinic also said if I wanted to go with the NXstage, the most I could do at each treatment was 5-6 hours, and I wanted a minimum of 8 hours per treatment; this was mostly because I wanted to ensure I could clear as much phosphorus as possible to avoid binders and dietary restrictions. I also wanted to make sure that if I needed to take off a lot of fluid my UF rate would still be low and I would avoid crashing. So far, so good: I pretty much eat/drink whatever I want and I haven't crashed yet (knock wood).

When I requested nocturnal from them I was not expecting them to offer me anything other than 3 days a week, but they offered me every other day and I jumped at it. My prescription - strictly speaking - is for 8-hour treatments. I think I got into doing 10-hour treatments because one day I found I'd gained 3.4 kilos (my average is <2) and I wanted to get it off without putting my UFR above 350, so that's when I struck on the bright idea of just setting the machine for 10 hours. Then I thought, "Well, hell. It uses up all the bicarb, I don't have to use any more Heparin, my UF rate is super low and I can get a full night's sleep. Why not just keep on doing 10 hours?" So I have, and my clinic has never said a word to me about it.

Andy had expressed some resistance to the every-other-day scenario because he really wanted us to have the weekends off, to not have to deal with it for two full days. However, we've since found that that's a dicey proposition because if anything goes wrong (can't get the machine to pass tests or some other unforeseen circumstance) then I get pushed into a fourth day without dialysis. Also, going three days seemed like a great way to heal up my buttonholes and I found myself having to sharp stick too frequently, so we're back to sticking to the every-other-day regimen. So that gives me 30 hours one week and 40 hours the next; it's not 168, but it's a lot better than 12!

[MooseMom]

Thanks so much for that, DD; that was really helpful!

[mogee]

DD, your dialysis practices are nearly identical to mine.  I was on NHD for eight years, usually ten hours a night.  I liked to use all of the dialysate solution and all of the bicarb.  I rarely removed more than 2l and occasionally had to drink while on dialysis because my weight was less than a kilo over my dry weight.  Although I was meticulous and disciplined I regularly drank alcohol and used cannabis while on dialysis.  Last November I had a transplant.  To honour the gift of the kidney I discontinued drinking and smoking pot.  Such a life-altering event calls for a meaningful sacrifice.

[Rerun]

DD, your dialysis practices are nearly identical to mine.  I was on NHD for eight years, usually ten hours a night.  I liked to use all of the dialysate solution and all of the bicarb.  I rarely removed more than 2l and occasionally had to drink while on dialysis because my weight was less than a kilo over my dry weight.  Although I was meticulous and disciplined I regularly drank alcohol and used cannabis while on dialysis.  Last November I had a transplant.  To honour the gift of the kidney I discontinued drinking and smoking pot.  Such a life-altering event calls for a meaningful sacrifice.

Bless your heart... and kidney!   

[Simon Dog]

I'm in-center an d scheduled for BabyK @ home once my fistula matures.

My doc recommended the Baby K as he is not convinced daily short offers any benefit over every other day conventional or nocturnal.  The doc likes the idea of less use of the fistula, and I like the idea of every other day "off".   The key words to getting the most out of the Baby K @ home appear to be "nocturnal" and "every other day".