PD logistics: disconnecting, cycler & pets

[kickingandscreaming]

I haven't even officially begun doing PD, so these questions are in preparation for the near future (am I a control freak? Perhaps.) 
Here's the problem:

• I live with my dog who sleeps with me
• I will set up the cycler in my bedroom
• If I have to disconnect in the morning (before letting my dog out to pee) then my dog will be in the room with me. A no no.
• I think the distance from my cycler to my front door is about 25" so perhaps I could walk (while connected) to the front door and let her out. Is that distance possible?
• While she is out I could very quickly disconnect.  I don't even know how long that takes.

Do I have to be near the cycler when disconnecting? If not, I could sneak into another room and quickly do it.  I just don't know how this works out when you have a dog who sleeps with you.  Any help is welcome. Thanks.

[Simon Dog]

If you are using the Liberty cycler from Fresenius, you can order a cassette with a 20ft line.  Unless you live in a mansion, this should give you enough room to walk your dog to the bedroom door and lock him our while you do your work.  When I was on PD, the 20ft line would even let me get ot the bathroom sink to wash my hands.   You do have to order drain lines with the 20ft cassette, as the drain line is not integrated like with the 10ft cassette.

If you want to go 25 ft, you could make sure your cycler is on an extension cord, and roll the cart with the cycler a few feet to add to that 20ft limit (I used to do this to reach the kitchen).

Do not even think about "quickly disconnecting".  The key to avoiding infection is meticulous care, and that is inconsistent with hurrying.  Peritonitis sucks; damages the periotoneal membrane; and pushes you closer to hemo.

[kickingandscreaming]

Thank you, Simon Dog.  I will be using the Baxter cycler (if they ever get on top of their shortage).  Does that change things. I thought the extension cord added more length than that.  I definitely don't live in a mansion.  It's a one bedroom apartment on one floor.  But my bedroom is on one end and the front door is on the other.

I had thought about using an extension cord to add length from that end, but I think it requires a special cord.  Quite a while ago I called Baxter and asked about that but I can't remember what they said anymore.  I think it was a #14 extension cord.

I really hate to lock my dog out of the room as that is exactly where she is used to going when she comes in from her initial outing. And there are certainly times of year when I don't want to leave her outside while I go disconnect myself.  I think I can make it to the front door with extensions, it's after that that I'm concerned about.

How long does it generally take to properly and safely disconnect?

[Charlie B53]

I suspect you have not gone to training yet.  In training you WILL practice doing all this and more.  You will pick out the correct bags of solution, set up the machine and make 'connection' while wearing a 'dummy belly/vest'.  Your Instructor wil make SURE that you learn exactly how, and why, so you will have not just the experience, but the confidence that you CAN DO this at home, alone.

The actual time it takes to close your 'fitting', trist/disconnect the line, and put a NEW CLEAN CAP on is only seconds.  Getting ready to do this takes a couple three minutes.  Cleaning your hands, the place where you are going to set the new cap, opening the new cap and standing it ready.

Training will instill the life dependance of cleanliness of hands, connections, your catheter 'site'.  ANY contamination can cause a potential life threatening infection.

Yes, you can have your pet, but you will have to learn how critical it is to be sure not even ONE HAIR gets even near to be sure you minimize any and all possibility of infection.  It won't take long and it will become second nature to look twice, triple check everything just before twisting the connector.

Using the Baxter Cycler, like I do, the cassettes have different length of lines.  There is a 3 prong and a 4 prong cassettes.  The difference is the number of lines, 3 or 4, and the length of those lines.  The 4 is MUCH shorter and extersions are almost a have to unless you do not have any need to move much.  The 3 are almost three times as long.  I use a Patient Extension with the 3 and can roam nearly half my house.  With the 4 AND an extension I can barely reach the bathroom.

The #14 extension cord referrs to the gauge of the wire inside.  14 isn't very thick and is very common.  It may be fine depending on how long the cord is.  25 feet shouldn't be any problem.  If going to a 50 foot cord I would increase the wire size to compensate for 'line loss'.  Cheap insurance.  Then I would look for a 12 gauge.  Easy to remember, just like a shotgun,  but there is NO comparison between wire gauges and shotgun gauges, way different.  14 is fine for very light things like lamps.  Anything that draws more current, like a vacuum, power tools, etc., a 12 is far better as too small a wire can cause damage to the electrical tool.

[Simon Dog]

14 gauge wire is used for 15amp circuits, which are common household circuits.   12 gauge is for 20amp circuits, but is also totally safe to use on 15amp circuits, and probably a good idea as well, particularly with a long cord.  The instructions for dialysis equipment typically says "no extension cords", but you should be safe with a 12.

As to relations between wire gauges; shotgun gauges; steel thickness gauges and needle gauges - there is none, except that a smaller gauge number generally means "bigger" (hemo types see this in the difference between 15, 16 and 17 gauge fistula needles).   The exception is the 410 gauge shotgun which is a caliber, not a gauge (even though the term gauge is misused).

[kickingandscreaming]

Thank you again.  You're right.  I have yet to begin actual training, but it should start very soon, maybe this week if my PD nurse can schedule it.  I'm surprised to hear you talk of doing PD in the present tense.  I thought for sure you were doing HHD (NxStage).  Am I totally off?

I found the information in the Baxter online manual and it says to limit the length of the extension cord to 12 feet and to use.  Here's what it says:
– Use only heavy-duty extension cords rated at 1200 watts (10 amp for 110V systems).
– Use only extension cords less than 12 feet (3.5 meters) in length.
– The extension cord must have the third grounding wire that mates with the grounding plug on the HomeChoice/HomeChoice PRO APD System power cord.

[Simon Dog]

Reasonable requirements, but I would still suggest a nice 12 gauge cord (easily available at Home Depot) even though a 14 will handle 10 amps.  And, definitely make sure it's a 3 wire cord, and that nobody breaks the ground pin off the male end.

[kickingandscreaming]

Will do. Thanks again.

[Charlie B53]

Wire has a resistance to electrical flow.  A crude parallel can be made to a garden hose.  Hoses are available of different diameters. For any given length the larger the diameter the more 'flow' you can get through the hose at a given pressure.  The hose has a resistance to flow, so the larger thie diameter the more flow possible.  Sort of the same with wire having resistance to electrical flow.  The fatter the wire, the smaller the gauge #, the less resistance, the easier to flow electricity.

Both wire and hoses, adding length adds resistance, increasing diameter reduces resistance so as to enable flow.

Generally bigger is not always better, with the exception of wires and hoses.

It's a simple concept to compare the two but it gets the point across.

[kickingandscreaming]

Sorry.  I'm still obsessed with how I will orchestrate doing PD safely using the cycler (which I don't yet have) in a way that can coordinate with the care of my dog. 
To reiterate:
I sleep with my dog in the bedroom where I also will keep my cycler and main supplies.  My concern is that first thing in the morning I let my dog out (while I am still connected).  After she comes back in she heads right back to the bedroom.  I could lock her out close the bedroom door and disconnect  but I'm too much of a softy to do that to her (she's 14 and is used to a certain degree of consideration and inclusion from me).  Or i could go into a second space where she isn't to disconnect.

I have a walk-closet quite close to the bedroom, but it is a separate space with it's own door.  (See attached drawing) I was thinking of setting up a "satellite" PD station strictly for connecting and disconnecting in the closet.  And then I can walk to the bedroom where my dog will undoubtedly be all of this time.  The closet is a space where my dog doesn't go, so it's relatively dog free (as much as any place in my house is).

Does this make any sense?  Thanks.

[Shaks24]

Discuss it with your training nurse while you train on the cycler. Also they typically will make a home visit to check out your setup before cutting you loose on your own with the cycler so you could take suggestions at that point. If it comes to your safety and well being vs hurting the pups feelings....well I hope you know what you need to do as far as the pup goes during connecting and disconnecting. Throughout your time on the cycler you will go through continued monthly education on your treatments. A big part of it is about avoiding infection through best practices. At least its that way with Fresenius. Just today at my Lab day I got a handout on preventing peritonitis. Been doing this over 2 years now.

[Charlie B53]

Actual time to connect or disconnect is merely secoonds.

You could do it in your walk-in closet as long as you have a flat shelf sort of, that you can clean with something like a Clorox wipe so you can be pretty darn sure there will be NO bugs, bacteria, etc.  And maybe one of those pump bottles of hand sanitize r..

When it s time to connect or disconnect step into that space, shut the door, re-clean your hands, pull the cap off the patient hose without dropping the hose twist the cap off of your cath, twist the connection together.  If disconnecting and after re-cleaning your hands and making SURE your table surface is CLEAN, open the new cap package and stand the cap making it ready and easy to pick up, untwist your cath from the patient hose, pick up the cap and twist it into place.

Easy peasy.

NOTICE:   Put your mask on BEFORE cleaning your hands then do not touch anything other than your cath, the hose, and the cap.

You will go over these steps EVERY day at training until each seems second nature.

[kickingandscreaming]

Discuss it with your training nurse while you train on the cycler. Also they typically will make a home visit to check out your setup before cutting you loose on your own with the cycler so you could take suggestions at that point.

Unfortunately. my PD nurse is NOT an animal person at all! and she is totally freaked out that I have dog who, god forbid, sleeps with me.  I wear a lot of black polar fleece clothing in the cold Northeast winter, and my pale colored dog's fur clings to it even when straight out of the washer.  Every time my nurse sees that she re-freaks.  So I don't expect to get real unbiased advice from her about orchestrating my life around my dog.  She'd prefer I just got rid of my dog.  Only problem with that is that my dog is really my only reason for wanting to live, at this point.  So it's kind of moot. She's 14 and won't live for very much longer (I suspect), but then I'll have to decide if there's any reason for me to keep going.

[Simon Dog]

If you think your pups feelings are going to be hurt by being locked out of the bedroom for a few minutes, consider how she will feel if you are in the hospital for a week recovering from peritonitis.

[Shaks24]

I understand. I'm a dog person too. The pup in my picture passed away last year of cancer. I rescued him and had him for fourteen years. I thought I could never go through that again but low and behold I rescued two more. Both females. A hound dog and a Great Pyrenees. I have a designated room in our house for my treatments. Pretty much no one goes in there but me. My wife used to come in to sleep with me on occasions but that pretty much stopped after a few nights of multiple alarms. lol. I hook up 5 nights a week so on my off nights I sleep with my wife in the master bedroom. Dogs are so loving and understanding. I think your pup will understand if you keep her away for a few minutes during hookup and disconnect. You will have to be very careful with the dog hair. One hair in the catheter tip could cause you much harm and if you have to go to the ER like Simon Dog posted, it would be even more challenging for both you and the pup. After you go through training you will understand this better as you see the mechanics of the process. I hope it goes very well for you as you train and go on the cycler.

[Charlie B53]

I learned long ago that some things are better left UN-said.  Especially those things that your PD Nurse won't necessarily agree with.

My dog, AND cat, are often in my bed.  Almost day and night.  They love me, I think.

Your Nurse is rightfully concerned that there IS a possibility for a serious infection, IF, even one pet hair should somehow touch against your UN-capped catheter.

Take steps to make double sure that doesn't happen.

During training your Nurse will impress on you the important of STILL air.  No moving air like from a running furnace, air conditioner, open window, anything that can cause air to move around.  If the air is moving the dust, bacteria, HAIR, can be carried around and very easily can be contacted by your catheter during those moments that it is exposed, uncapped.

This is the reason she is so adamant about still air, NO pets, etc..

I cannot advise you different.  Just remember her reasoning and make double sure that all your actions are strictly done to reduce all possibilities for contamination as well as you can.

Your plan to use the closet seems likely, and can work fine IF there is no air movement in there. 

Stop telling your Nurse that you foresee a problem with your pet.  He will be in a different room.  No problem.

Keep a second bottle of hand sanitize in that closet so you can AGAIN sanitize your hands before touching your cath.

Take Care,

Charlie B53
Moderator

[Deanne]

I was on PD for six months and had two small dogs and three cats in bed with me. One of my dogs was special needs and often needed to go out at night NOW. If I felt him move during the night, I was out of bed in an instant. He didn't / couldn't wait. If I didn't feel him move, I'd wake up to a wet spot in the bed.

Thankfully, my PD nurse loved animals. The suggestion she gave me was to jump out of bed, pull the plug on my dialysis machine and wheel it to the door with me when I had to. My bedroom is at one end of the house, the door at the other end. My house isn't large, but a 20-foot extension still wouldn't have gotten me to the patio door to the back yard. It was awkward and difficult to wheel around, but it got the job done. I plugged it back in when I got back to my bedroom and everything continued without a hitch.

Putting them (him) out of the room to connect / disconnect wasn't a good option, either. This dog had an infinite bladder and would have been so nervous that I'd've had puddles all over the house from his being so anxious about being locked out of a room I was in. Instead, he stayed on his side of the bed and I kept my body between him and the connections. I was only on PD for six months before transplant so I can only hope that this would have worked long-term. I didn't have any infection issues during those six months though.

Hindsight being what it is, I should have just considered turning my family room into my bedroom so I'd've had a 6-foot walk to the door to let him out.

[Charlie B53]

............... Instead, he stayed on his side of the bed and I kept my body between him and the connections. ........................................ I didn't have any infection issues during those six months though.
.................

I would otherwise never admit to this, and in no way am I advising anyone else to do it.

BUT...............................

Two and a half YEARS so far, and NO infection. (Yet)

I am more worried when the young Grandson is over for the weekends.  He is too smart and has to be right there, up close, so he can watch, and learn, everything.  Of course he is in grade school , in a classroom with umpteen other kids, all coughing and sneezing and sharing every bug imaginable, then carrying these bugs around, home, here.  So far so good.  You just have to be very careful in keeping your hands clean.

[kickingandscreaming]

Thank you all for taking the time to comment.  My brain is processing all of it.  Can anyone think of some kind of outer clothing I could get that would make the threat of a hair falling off on the catheter less likely to happen?

I hook up 5 nights a week so on my off nights I sleep with my wife in the master bedroom.

Is this even legal??

[Deanne]

Would your dog tolerate being under a sheet for a few minutes?

[kickingandscreaming]

Would your dog tolerate being under a sheet for a few minutes?

She does, sometimes.  But she's old and has more trouble than she used to in regulating her temperature.  She would probably at least pull her head out for air.   But even if she would/could, would that actually protect anything?

[Charlie B53]

Since I do PD on the Cycler all night, I am usually wearing but a T-shirt and underwear.

And take the T-shirt off as I crawl into bed.  I'm a guy.

Works for me.

Ladies may feel otherwise.

Then again, some may feel 'clothing optional'.

Whatever feels most comfortable for you.

Charlie B53
Moderator

[Deanne]

Would your dog tolerate being under a sheet for a few minutes?

She does, sometimes.  But she's old and has more trouble than she used to in regulating her temperature.  She would probably at least pull her head out for air.   But even if she would/could, would that actually protect anything?

The only times she'd need to be covered is when you're connecting and disconnecting. Those are the only times anything can enter the system. If you're concerned about fur and dander floating around in general, you might want to run an air filtration system in your room. Turn it off while connecting / disconnecting.

[Shaks24]

I hook up 5 nights a week so on my off nights I sleep with my wife in the master bedroom.

Is this even legal??
[/quote]


Yes. That is my current prescription. I used to do 7 nights but I had very good clearance levels so as long as they hold and I feel well my Neph has me on 5 nights a week.  I take Mondays and Thursdays off and really enjoy a good night of sleep those 2 nights.

[kickingandscreaming]

Well, I wear clothing (pajamas) when I sleep as I turn the heat down to 55 overnight and sleeping nude or near so would be mighty chilly if I have to get up in the middle of the night.  It's barely a bit warmer than that when I wake, so I do have clothes on and they could have hairs on them.

I ordered what's called a "scrub warm up" which is a jacket-like piece of clothing with snaps up the front and knit cuffs on the sleeves.  I'm hoping that I can slip that over whatever I'm wearing when I connect and disconnect so that any hair that is clinging to my clothing will stay where it is and not fall on my catheter.  Does that make sense?  I ordered this: http://amazon.com/gp/product/B014LJGH8Y?psc=1&redirect=true&ref_=oh_aui_detailpage_o01_s00