Hospital researching dialysis service

12/21/2007
Hospital researching dialysis service
By Christy Welch
Southwest Iowa News

Crawford County Hospital is again researching the availability of providing dialysis service to Crawford County. Adding the service to the hospital has been researched previously; however, no company was willing to provide the service at that time. The process was discussed at Monday's hospital board meeting following a question posed during the public hearing by Rick Newland, who he said has been a dialysis patient.

Mark Rinehardt, administrator, has contacted two companies that provide dialysis service in this area, DaVita and DCI (Dialysis Clinic Incorporated).

"DaVita was not interested," he said.

That company will absolutely not even consider providing the service because of the locations it already has throughout the area.

However, DCI gave a little better response.

"DCI was hesitant in saying they were interested," Rinehardt said. However, he continued, DCI did leave the door open a crack.

According to Rinehardt, properly trained nurses would need to be found and capital equipment expenditures would need to be made.

"With the numbers we have, it would be a financial loss in their unit," he said. "We are still looking at it, but it may take a financial subsidy to make it work."

Steve Vary, board president, continued, "At least we have a crack in the door."

The hospital administration and board is looking at what they would need to do to make it work, which could possibly mean assisting a clinic until it could operate in the black. However, it would take time before the clinic would begin making money.

Vary also reminded the public that enticing a company to come in and run a clinic in Denison might be difficult, because the hospital would have to take clients from other clinics in the area.

Dr. David TanCreti added that the Crawford County Memorial Hospital may be able to capture patients from outside the county.

"If ours is a better unit, people from Carroll would come here," he said.

Newland asked if a cost estimate could be made on running a clinic.

Vary responded that because they now have a company that may be interested in running a clinic, they could put together some numbers.

TanCreti reminded the board that the clinic would also have "spin off" money from labs and other hospital services, which would be brought back into the hospital. He also said that the impact on the family of a person in need of dialysis is large, time wise and financially. He added that the costs are horrendous.

"If it is close, go for it," he said.

Newland agreed, saying that when he used a dialysis service, most of his money went to traveling to the Council Bluffs/Omaha area, food, and other costs. Not a lot was left from his paycheck after dialysis, he said.

He added, "I'm trying to be enthusiastic about what you are doing. If it is possible, go for it. Hearing that you (the board) are considering doing it in the red is honorable."

Vary explained that attracting these types of services are one of the reasons the hospital board is considering constructing a new facility.

"This facility will not work for that," he said.

Deborah Knowles, who previously had spoken against building a new facility during a public hearing, asked if a dialysis clinic could be placed in the existing hospital.

The hospital staff responded that the peritoneal dialysis probably could be done with very little remodeling, but the hemodialysis needs a totally clean environment and extensive renovations would need to be completed. (See the sidebar on this page for an explanation of the two main types of dialysis.)

Rinehardt reminded the public about the chances of hiring a company to provide the service, "DCI was very hesitant, but the door is at least cracked a little."

The hospital staff and board will continue to do research on providing the service.

What is dialysis?

Dialysis is a method of removing toxic substances (impurities or wastes) from the blood when the kidneys are unable to do so. Dialysis is most frequently used for patients who have kidney failure, but may also be used to quickly remove drugs or poisons in acute situations.

This technique can be life saving in people with acute or chronic kidney failure.

Two main types of dialysis can be performed: Peritoneal dialysis and Hemodialysis.

Peritoneal dialysis is the easiest method, which can be completed by the patient's family at home, or in a hospital setting. It works by using the body's peritoneal membrane, which is inside the abdomen, as a semi-permeable membrane. Special solutions that help remove toxins are infused in, remain in the abdomen for a time, and then are drained out.

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

Hemodialysis is the type that most people think of when they hear the term dialysis. It works by circulating the blood through special filters outside the body. The blood flows across a semi-permeable membrane (the dialyzer or filter), along with solutions that help remove toxins. Temporary or permanent large-size catheters are placed in veins that can support large blood flows. Blood is diverted from the access point in the patient's body to a dialysis machine. Here, the blood flows counter-current to a special solution called the dialysate. The chemical imbalances and impurities of the blood are corrected and the blood is then returned to the body. Typically, most patients undergo hemodialysis for three sessions every week. Each session lasts 3-4 hours.

- Information taken from the Internet site Medline Plus and from the National Kidney and Urologic Diseases Information Clearinghouse's Internet site.

http://www.zwire.com/site/news.cfm?newsid=19137227&BRD=2703&PAG=461&dept_id=555123&rfi=6