Types of at-home dialysis

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Types of at-home dialysis

HealthyRockford.com Staff Reports
Posted Jul 02, 2008 @ 10:00 AM

Home hemodialysis
A machine pumps the patient’s blood through a dialyzer or filter to remove waste, extra chemicals and fluid.

To provide a regular access point to the blood vessels, a doctor does minor surgery in the patient’s arm or leg. Sometimes the access is made by joining an artery to a vein under the skin to make a bigger blood vessel called a fistula. If the patient’s blood vessels are not adequate, the doctor may use a soft plastic tube to join an artery and a vein under the patient’s skin. This is called a graft.

The patient receives several weeks of training from a registered nurse at the dialysis center on monitoring the machine, placing the needle in the access point, checking blood pressure and pulse, keeping treatment records, ordering supplies and keeping the equipment clean.

Patients should have a helper who trains with them and who will be there during home at-hemodialysis.

The machine is provided by the dialysis center. Patients order supplies which are covered by insurance as part of treatment.

The risks of at-home hemodialysis are the same as for in-center hemodialysis, including low blood pressure and infection. Most serious are the potential for an air embolism, in which air accidentally gets into the bloodstream, or blood loss if a catheter separates during the procedure.

At-home hemodialysis can be daily for two or three hours per session. Or it can be done at the same frequency as in-center hemodialysis – three times a week, for about four hours a session. It can also be done during sleep, three or four nights a week for six to eight hours a night. The pattern depends on the patient’s needs and the physician’s orders.

The portable NxStage brand machines DaVita uses for everyday at-home hemodialysis come with their own water purification system and work in a regular electrical outlet, said Rockford DaVita Regional Operations Director Mary Anderson.

Those who choose a less-frequent at-home hemodialysis option may need a larger Fresenius brand machine that requires a 220-volt outlet and portable reverse osmosis system for water purification, she said. Insurance would not cover the cost of any home modifications, but DaVita covers such needed costs up to $3,000, she said.

Click here for more information about home hemodialysis

Peritoneal dialysis
A soft tube called a catheter is inserted surgically in the patient’s abdomen by the doctor and extends outside the body. It is held in place by polyester cuffs that merge with the patient’s scar tissue.

The catheter is used to fill the patient’s abdomen with a cleansing liquid called dialysis solution. The walls of the patient’s abdominal cavity are lined with a membrane called the peritoneum, which lets waste products and extra fluid pass from the blood into the dialysis solution. Then the dialysis solution is drained and thrown away.

The process of draining and filling, called an exchange, takes about 30 minutes to 40 minutes. The period the dialysis solution remains in the abdomen is called the dwell time. A typical schedule calls for four exchanges a day, each with a dwell time of 4 hours to 6 hours.

One form of peritoneal dialysis allows the patient to walk around with the solution in his or her abdomen, draining and refilling it every 4 hours to 6 hours of dwell time.

Another form uses a machine called a cycler to fill and drain the patient’s abdomen for three to five exchanges a night, usually during sleep, and then begin the morning with a dwell time that lasts the whole day. The choice is determined by the patient and the doctor’s orders.

The patient receives several weeks of training from a registered nurse at the dialysis center on germ-free techniques for connecting at the beginning of the exchange and disconnecting at the end, as well as training on ordering supplies and operating and the cycler if that modality is used.

The cycler is provided by the dialysis center. Supplies, ordered by the patient, are covered by insurance as part of treatment.

Infection is the most common risk for people on peritoneal dialysis. Peritonitis, an inflammation of the peritoneum, is a common problem that sometimes makes it impossible to continue peritoneal dialysis.

Click here for more information about peritoneal dialysis http://kidney.niddk.nih.gov/kudiseases/pubs/homehemodialysis/

Sources: National Institute of Diabetes and Digestive and Kidney Diseases, DaVita.

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