Four In-Center HD Treatments per week needed - Help !

[TheGrandson]

Our Nephrologist recommends my grandmother to receive four treatments per week, instead of the standard three, due to heart failure. (Dilated cardioMyopathy)

She is tolerating well, but I'm having a really hard time getting any of the centers to agree to give her the one extra treatment per week, presumably over the two day break that we all face on in-center HD.  The push back is coming from DaVita, because they don't want to give up a chair once a week, when it could be filled with a regular, thrice-weekly patient.

For the last five weeks, we have been suffering from Grandma feeling great all week, but on day two of her two- day break (Monday's in this case) she gets Shortness of breath and requires an ER visit, followed of course by Inpatient HD and a night or two of observation.

We want to avoid the emergencies by just implementing the doc's recommendation - one extra session per week! 

Does anyone have experience with this dilemma, or suggestions to cut through the red tape I am facing?

[Fabkiwi06]

Sending love to Grandma! Hope she's able to hang in there!

My first thought is to ask the Doctor that prescribing the extra treatment. They might have some authority to pull at the clinic to make it happen, or know of a different clinic that can accommodate her.

[Simon Dog]

Most clinics tend to leave the chair in the isolation room unused unless they have a Hep-B positive patient (Hep-C and HIV get treated in the regular chairs).    Perhaps her MD could find out if there is a day in her 2 day gap when that chair is open.  I was having a problem with my home unit on a Friday and the contingency plan my full clinic made if I needed an in-center treatment was to let me into the isolation room for a run (turned out not to be necessary)

It doesn't have to be the same time of day, as long as she does an AM treatment followed by a PM one (PM followed by AM would be counter productive in regards to fluid management).  I would avoid AM-skip-PM, but AM-PM-skip should work.

Also, if she is on MWF find out if the extra is more easily scheduled  by moving her to TTS (or vice versa).

And finally - is her neph the clinic medical director?   If so, he should be able to throw some weight around.

[kitkatz]

If the doctor prescribes a fourth session she must be given it

[TheGrandson]

 Thank you guys, the isolation room is a great idea-we just have to find a clinic that has one. 

[Simon Dog]

Thank you guys, the isolation room is a great idea-we just have to find a clinic that has one.

All clinics have isolation rooms.   Its required so the clinics can meet medical standards when treating any patient of theirs that gets Hep-B.

The other issue is staffing.  There is a formula for the number of RNs and techs based on the number of occupied chairs.  If your clinic is at capacity for the staff on duty, adding one more patient could mean adding a tech and/or RN to the shift to meet the required ratio.  In other words, "follow the money".

[Michael Murphy]

 In New Jersey Dialysis clinics have sprung up every where.  My center was closed form2 months to be rebuilt.  Fresinius shifted us to a new center that only was used Mon. Wed. And Fri. The Tu. Thu. Sat. Sessions were empty.  Perhaps there is a newer clinic that is not full and can handle the extra session. If all else fails I would schedule a session per week with the travel  group for your dialysis company even if you have to go to another town they should be able to accommodate you.

[TheGrandson]

Thanks, everyone for your kind input. I actually have some developments - due to a fluke; we ran her pump speed at 200 mL/min, instead of the normal 350 speed she is used to. I also asked the staff to challenge her estimate dry weight - and to my surprise her BP never bottomed out and we removed almost 2K - which is a lot for her.

I am now wondering if ultrafiltration is gentler and better tolerated (from yalls experience) with the pump running slower ? I am thinking nocturnal dialysis of sorts.

[Hootie]

Absolutely from our experiences. Lower the better...