Working through the checklist for home dialysis

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Working through the checklist for home dialysis

By GEORGE A. DOUGLAS
Special to the Journal Tribune
Published:
Monday, February 22, 2010 12:09 PM EST

The initial step in my training for home dialysis – peritoneal dialysis – was to check my catheter to see if it was if it was working and once the test showed it was operational, my nurse/instructor , Connie, told me I was scheduled to start training the next Monday, Feb. 15.

I arrived at 9 a.m. and Connie, with another nurse, Sarah, who also is in the other clinic, started my training in how to administer my treatment at home. My last clinical treatment after two years – needles in my arm – was on Tuesday and then I would be on peritoneal dialysis at the Home Dialysis clinic. As soon as I proved my ability to go through the procedure, I would be on my own in my apartment. All my equipment and supplies were delivered on Friday, the 19th.

As I sat in a small room, Connie handed me sheet entitled CAPD Exchange Procedure, with underlined, “Supplies needed: Solution bag, cap, and mask.” She warned to keep the sheet me as I followed the steps at home. Follow the steps, she said, religiously, don’t miss one. There were 16 specific steps.

A white, plastic machine, with slots, which is round in construction, is attached to a metal pole. It’s called an organizer and the solution bag is hung on it as well. . The organizer is marked to aid in the various steps during the exchange procedure.

Connie, a native of Minnesota and certainly “Minnesota Nice,” went through the steps, explaining the importance of each and the vulnerability, such as a critical infection, if you do not careful to follow instructions. .

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When you start, the first step is to cover your mouth and nose with a mask and wash your hands for three minutes. Second is to open the bag, check the dextrose, volume, expiration date, clearness and to make sure there are no leaks. Third step has you move the blue piece counter-clockwise and remove colored cover.

Placing the disc in the organizer is the fourth step, followed by placing the drain bag on the floor (shiny side up) – the fifth step. The sixth has you break the cone and hang the new bag and next, you put the new cap in the organizer, with the clear end in the new cap slot for the seventh step.

After these preliminary steps, you are ready for Step eight. You get the catheter, which is attached to your stomach, out, making sure the white clamp is closed, and you place it in the slot “extension” in the organizer.

After completing the eighth step, the ninth warns “make sure the mask is on and hands are washed. It also adds that it’s OK to use hand sanitizer.

Untwist middle cap in the organizer and then untwist catheter and move it to the middle. It is vital that in this move, you do not allow the catheter to touch anything except the middle slot. If it touches anything, your sleeve or another part of the organizer in the move, it becomes contaminated and the procedure cannot go forward.

The 11th step has you unclamp the catheter and you drain the fluid in your stomach for 15-20 minutes. Then you turn the organizer to flush – to clear the air bubbles in the caterer – and after a second or two, Step 12 is completed. You then you turn to fill until the bag is empty, which is the 13th step.

You turn the dial all the way around to PIN/Close, Step 14, and then close the white catheter clamp, making sure mask is on and hands are washed, Step 15. The final step, Step 16, instructs to untwist new cap, untwist catheter and move to the new cap.

I realize this is technical, but I wanted to accurately report the steps required in home dialysis. Connie and Sarah had me repeat the procedure three times (or was it four) and by the final trial run, my confidence started to build. And on Wednesday, we are on our way.

Once I’m allowed to be on my own, I have another goal. I will start training to have dialysis while I sleep. And Connie assures me I’ll be on the first tee of the Cape Arundel Golf Club in Kennebunkport on opening day in April after a good night’s sleep and a treatment.

— George Douglas writes regularly about his experiences as a kidney dialysis patient. He is the former editor of the Boston Post. He lives in Kennebunk and can be contacted via e-mail at gadoug23@earthlink.net.

http://www.journaltribune.com/articles/2010/02/22/columnist/doc4b82a8de7b5d0629942582.txt