I need some help!!

[dialysis RN]

I just started a new home hemo program in my area.  My first patient to start is wonderful, her and her husband are fast learners and not having any major problems,  but the thing is  she is doing 20 l 6 days a week.  She normally will have to run 2:20 to 2:30 on those 6 days.  The total time to set up, run, then clean up takes 4 hours. This just seems like a lot to me, how do you cope, and does this get better?  We are at the end of our third week she does not feel better she is feeling worse.  She is being treated for a UTI her kt/v standard for the week is 2.20.  Please tell me this will get better or are we missing something??

[G-Ma]

I'm on my 2nd wk training for NXStage and on 20L for 6 days/wk and yes it is taking about 4 hours total a day for me at this time which I don't think is bad considering I got on the van at 8:30am and got home at 4:30 pm, 3 days a week before.................once I'm trained and home with R2D2 it should even go a bit better....anyone else on NX... how are times doing for you?

[dialysis RN]

G-ma how is your partner doing???And how are you feeling?

[lola]

Otto's time as long as no problems is down to 3.5 from the time he starts to set up to when everything thrown and wiped clean.

[G-Ma]

Oh man.  My post just got deleted by me.  I'm feeling better, thanks for asking.  Migraine Mon through yesterday, however nurse thinks I was dehydrated because I was not drinking enough...go figure.  I initially thought would have to drag family members to train due to their work schedules however my oldest son has decided who will train and when and he has memorized the nexstage and pureflow books and is training next week...and this was my I don't want to be a student son..his 14 yr old has been with me every day and knows the buttons, his 18 yr old is going next week and his wife is with me this week and cannulated me today and did a great job.  She stumbled on PureFlow..you know push hard on the NxStage so she did on PureFlow and accidently started drain.  Too bad there isn't a NO don't drain button or Stop the drain, so she then learned how to hang bags and then opened the wrong clamp on rinseback but nurse caught that right away.  Fortunately or Not several times there are 2 nurse trainers in the room talking at the same time and we have had the NXStage trainer trying to teach us at the same time so confusion reigns a bit but hopefully will settle down next week.  I noticed differences in the different training pamphlets we were given, so I have been working on my own steps.

[Meinuk]

I understand training taking extra time.  But by the time a person leaves the unit, I shouldn't take 4 hours.  (unless it is a really long run)

i think that organization of supplies really helps with time management.  I set up and prime my machine in the morning as I get ready for work.

Sometimes, I lay out my "cannulation station" a rolling flattop stand, with needles, bandaids, wipes, drawn heparin, 4x4's, tape  and sure seals  All prepped and ready to go, then I drape it with my chux that goes under my arm.

When I get home from work, I turn on the machine, eat some dinner, snap & tap then put myself on the machine for 2:27 (weekdays 20L runs x4)

Cleanup after my run 5 mins max.

Having a routine really helps, and I'll admit, I am seriously organized, but I have to be, I do this alone.

During training you are just learning, it gets smoother.  I was on the phone last night, and I managed to hold the phone and take myself off the machine, and tape up. I didn't even realize that I never missed a beat until my friend commented on the NxStage alarm going off again and again telling me that rinseback was over.  I couldn't have done that six months ago.

[G-Ma]

oboy...good for you....I feel like I'm lightyears from there meinuk but am further than I was last week so ok.  Yes, I'm anal about being organized or trying to as well and plan on having everything ready to go so when my helper gets here we are on.........

[Meinuk]

G-ma,  I was exactly where you are last year. 

I'd come home at night after my training and everyone here would talk me through everything with tips and tricks.  They are why things go smoothly for me now.  You'll be a pro soon, time flies.

[G-Ma]

Yes, thanks to all you pros.

[dialysis RN]

Thanks for quick responses!  You guys are great...I just want this to really work out for this patient.

[petey]

dialysisRN --
The home hemo time has always been a factor for me and Marvin.  He's been on NxStage since July of 2007.  Set-up, run time, and break down/clean up runs between 3.5 and 4 hours every day (6 x week).  However, when you really, really look at the time, we're only spending about an extra 2-3 hours per week total than we were when he was in-center (that time included drive to/from the clinic, wait time to go on -- and they were ALWAYS running late, etc.).  We think the extra 2-3 hours per week is WELL worth it because Marvin feels soooooooooo much better, has soooooooo much more energy, has better labs, has more flexibility, can travel with Hercules (his NxStage machine's name), has total control over his treatments and the times for his treatments, etc.

Unlike your patient, Marvin felt better (much, much, much better) after just the first week of training.  He continues to feel very, very good.  We're in a routine for set-up (he does all of this), and it's quite easy for him to do (being very organized helps).  While he's running, he watches tv, answers the phone (which I hate doing), and has visitors.  That passes the time.  While he's running, I'm doing chores around the house, cooking, "talking" on IHD -- and going in to check on him every 30 minutes.  He can just call my name, and I hear him, so it works for us (though I know some partners stay in the room the entire time with their "patient").

Yes, it takes a four-hour chunk of our day -- every day in the week except one.  But, it's become a part of our daily lives, and it doesn't seem like an extra burden at all.

[G-Ma]

I agree with petey as with me it was such a frustration sitting in the waiting room when I was early for my appointment and then didn't get on for over an hour after my time and this was fairly consistant.  Yes, I know there are things that happen in center but I sometimes thought it was a scheduling issue also.

[silverhead]

Sharon is the patient and I am the caregiver and I do all the set up and so forth, I admit I am quite anal about my routine in regard to each step of the set-up, but it works for me and we haven't had any problems or that dreaded aw-sh** moments because of something I missed in the set up, we recently started running 25 liters (up from 20) so our total time is about 4 hours total, and like Petey I can be in the kitchen cooking or cleaning and so forth while she is on, I can hear any alarms throughout the house and get a lot done during her sessions, but it sure beats the 3X trips to the center every week, we also like that we can choose what time to go on,  and in this summer heat it sure is nice to go on in the cooler part of the day, (no one in the Northwest has air conditioning), we both feel that this is one of the best moves we have made in her care and cannot comprehend going back to the old way......
Tom

[jbeany]

The order of steps that we are taught in training doesn't help with the time issue.  We were taught to organize every last supply before touching the machine and starting priming.  At home, I start priming immediately and organize while it is running.  The 15 minute prime cycle is more than enough time to lay out cannulation supplies, etc.  I also found out that it's even easier to start priming and leave the machine in a 23 recirc for a while.  Most of the bubbles clear by themselves that way, and snapping and tapping only takes a few minutes that way.  

So for my schedule - Start priming.  Layout all supplies, draw heparin, hectorol, etc.  If necessary, e-mail my nurse with updates, reorganize any supplies that need to be restocked from boxes into my tubbies, call in my inventory to NxStage, etc.  This takes up the 15 minutes, sometimes less.  Leave the machine in recirc while I make dinner or do other chores - anywhere from 15 minutes to several hours, depending on what else I have to do.  Then, when I'm ready to start, I can snap and tap, get weight and bp measures, etc and be ready to start in under 10 minutes usually.  My run time averages 2 hours, 20 minutes, and another 20 to hold.  My partner does the breakdown while I hold, then I finish with a weight and a few minutes to wipe it all down with bleach.  Total time spent actually dealing with the machine is about 3 hours and 10 minutes, 5 days a week.  That doesn't count being available for deliveries, but that doesn't usually take too long.  So I'm spending about 16 hours a week, maybe a bit more.  Given that my center is an hour from home, I actually spend less time dealing with dialysis than I did when I went to in-center.

[dialysis RN]

I think that once she gets a routine down all will be well.  The problem is she live 5 minutes from the clinic, we are organized most days of the week, so she gets on on time most days. Her labs are excellent already.  Since starting she has developed a UTI and feels awful- She is just wondering when will she have more energy, like everyone said? 

[G-Ma]

We all know a UTI is an animal all by itself...    I just finished my 2nd week NXStage training, came home yesterday and today and cleaned house, ran errands etc with no washed out feelings or headaches.  Nurse came yesterday and got water sample and I believe plumber is coming next week for PureFlow and on we go.

[Wallyz]

Check her Bicarb level, RN,  When I was using the 40 Lactate, I was staying acidic, and sill felt bad, even with good clearance. I switched to the 45 lactate (SAK001) and it worked great.

[dialysis RN]

thanks Wallyz will do!!