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  • #16
    Re: Nocturnal Pros and Cons

    I agree 100% with checking on you guys more than just every 30 mins .. I tend to keep my eyes on my 4 pt's and still be able to be a productive teammate withi my clinic. I think the hardest thing is the age old battle of keeping your access arm uncovered so I can see the access/needles/lines & make sure everything is running smoothly. The venous & arterial pressures only tell us so much. It is also helpful when my pt's tell me if their needles hurt/sting/pressure/pinching amything that is out of the norm for that pt. Anyway .. things happen in dialysis but I try my hardest to make sure my pt's have a good tx with no complications.
    Happy TX's everyone ~ Becky

    Comment


    • #17
      Re: Nocturnal Pros and Cons

      Becky - It is awesome to know that someone, like you, out there that cares about the patients so much.

      Hangpilot - If you do not mind, I would like to know which center you go as well since I live in Houston.

      pal

      Comment


      • #18
        Re: Nocturnal Pros and Cons

        I have heard from people who have done Nocturnal that they feel so much better than in and out dialysis. As Jester of Canadian Kidney Connection says, in center is more like McDialysed. Nocturnal I heard is better because it is slower, easier on the body, not so harsh, and more like real kidneys are.

        Is that right? I was offered Nocturnal Dialysis but in Canada I would have needed plumbing alterations as we do not have NxStage.

        I recently attended a webinar by a Nephrologist from Australia who was talking about the benefits of this. But I was wondering .. can Nocturnal Dialysis only be done with buttonholes? What if you have been unsuccessful at establishing them?
        Angie
        Kidney KornerDialysis Ethics Forum Kidney PixAwareness Shirts KidneySpace Donor Search
        I will be walking a Kidney Walk in Ontario Canada Sept 18th 2011
        • Peritoneal Dialysis = 4 yrs
        • Hemo Dialysis (in center) = 2 yrs
        • 2 kidney transplants = 1990 - 2001 & 2007 to present

        Comment


        • #19
          Re: Nocturnal Pros and Cons

          Originally posted by angieskidney View Post
          I have heard from people who have done Nocturnal that they feel so much better than in and out dialysis. As Jester of Canadian Kidney Connection says, in center is more like McDialysed. Nocturnal I heard is better because it is slower, easier on the body, not so harsh, and more like real kidneys are.

          Is that right? I was offered Nocturnal Dialysis but in Canada I would have needed plumbing alterations as we do not have NxStage.

          I think thats a fact, the longer and more gentler the better outcomes, though there has been significant research studies showing its imressive result there are many un-answered questions about Nocturnal and Daily-Short and I think much more data is needed to determine whether Government entities in the United States will be willing to fund to establish wide use throughout the nation. Will we succeed? Will we fail? Who knows but the number of patients doing home dialysis at home today has made a BIG jump compared when I started back in 2004...these patients like myself doing home dialysis are the key to that data that scientists need to fulfill that need for our wellbeing. It may take sometime but I think it will happen..... just remember, it doesn't have to be a Nxstage, any dialysis machine can do it, but I know "Smaller is better"
          .

          I recently attended a webinar by a Nephrologist from Australia who was talking about the benefits of this. But I was wondering .. can Nocturnal Dialysis only be done with buttonholes?


          Fistula and buttonholes is the preferred choice, I have mine since 1984...now tell me, can a graft last that long? what about a cathetor? I don't think so....for long term dialysis the fistula along with buttonholes is the gold..



          What if you have been unsuccessful at establishing them?


          I am sure there are some new methods or ideas in the works, such as Hero


          -----------------------------------
          My Blog Site
          Http://www.dailyhemo.org
          sigpic

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          • #20
            Re: Nocturnal Pros and Cons

            Oh wow that is excellent Gus! Thanks for linking me to that thread!
            Angie
            Kidney KornerDialysis Ethics Forum Kidney PixAwareness Shirts KidneySpace Donor Search
            I will be walking a Kidney Walk in Ontario Canada Sept 18th 2011
            • Peritoneal Dialysis = 4 yrs
            • Hemo Dialysis (in center) = 2 yrs
            • 2 kidney transplants = 1990 - 2001 & 2007 to present

            Comment


            • #21
              Re: Nocturnal Pros and Cons

              Originally posted by Gustine View Post
              Heya there,

              all kinds of things can happen during a dialysis session and in most cases neither the patient or staff may know it. Back in the years when I did dialysis there was an incident where me and one of the staff spotted some sprinkled blood near my chair and we looked around and didn't see where it may have come. Anyway, they cleaned it and went back to work...well several minutes later that same spot had more blood sprinkles but we looked and looked all over around my area and nothing! Again, they cleaned up and went back to work...finally, for the 3rd time I saw it...a very thin swift sprinkle coming from my fistula! Actually, the needle was starting to make a tiny puncture above the surface of my fistula causing blood to sprinkle....the problem was solved, but imagine in a center where staff are not paying attention? Normally a patient is checked every 30 minutes for vitals, but in some cases staff won't come back to check you over 1/2 an hour! As a staff member of a dialysis clinic you really have to constantly look out for your patients, making brief stops and checking all is okay....
              Well,
              I will tell you what I witnessed in center.
              I actually had a few people tell me I should not mention this to other patients, but I feel it is important to know what can happen.
              I am afraid to sleep at my center now after witnessing this.

              Across from me was a man in his 40's or 50's and he was telling the nurse that he was feeling hot and unwell, felt like his blood pressure was low.
              They brought the man some ice chips and a cold cloth.
              Ten minutes later the man asked to lie back as he was still not feeling well, complained of feeling dizzy.
              There was a curtain near his machine and even though at least 3 nurses and some cleaning people and others were walking by and supposed to be checking things,
              They just assumed the man was imagining not feeling well.
              Then the man started to convulse and was passing out, it was quite scarry to see.

              After this no one had really checked that well under or near the machine to make sure things were ok- no alarms had gone off also.

              Finally one of the cleaning persons notices that there was a huge pool of blood under the machine and behind it where a curtain was.
              The man had probably lost at least half his blood.
              All I know is that he had to be admitted to hospital and his family was told there was an incident with the machine, so they might not even know the whole story...

              Another thing is the sensors for leaks somehow were not working on that machine.

              At my unit if you are sleeping they only check up on you every hour or so and even let people have their faces, heads and bodies all covered with blankets- I find it surprizing as you can't tell if someone is ok or not when u can't see them.

              Comment


              • #22
                Re: Nocturnal Pros and Cons

                Ottawagirl, your center must be the unluckiest place in the world to dialyze! At my center they are scrupulous about checking on people frequently and we are not allowed to cover our accesses during dialysis. I have seen the nurses gently lift up blankets to see if a sleeping patient is okay.
                To the stars through difficulty!

                Comment


                • #23
                  Re: Nocturnal Pros and Cons

                  Like OttawaGirl said, same in my Canadian city I remember there would be an hour that would go by and no one would check on me. This is just one of many reasons people need to check! And heck that wasn't even nocturnal. I would not trust doing nocturnal in my city.
                  Angie
                  Kidney KornerDialysis Ethics Forum Kidney PixAwareness Shirts KidneySpace Donor Search
                  I will be walking a Kidney Walk in Ontario Canada Sept 18th 2011
                  • Peritoneal Dialysis = 4 yrs
                  • Hemo Dialysis (in center) = 2 yrs
                  • 2 kidney transplants = 1990 - 2001 & 2007 to present

                  Comment


                  • #24
                    Re: Nocturnal Pros and Cons

                    It is a fact, dialysis is very risky business and am sure many incidents go unreported, but what if the patient is empowered and educated about how dialysis works and how to tend for themselves? Then wouldn't that have been avoided? Perhaps yes!
                    My Blog Site
                    Http://www.dailyhemo.org
                    sigpic

                    Comment


                    • #25
                      Re: Nocturnal Pros and Cons

                      Oh,
                      I guess I should also mention I was actually refused oxygen a couple times at my center and actually filed a complaint about that nurse.

                      Even tho that was last year, it is still upsetting to know.

                      I was actually in the hospital a few years ago for surgery and had breathing problems and no one checked up on me for quite a few hours then did nothing...till I ended up unconsctious in intensive care unable to breathe.

                      I'd be afraid to fall asleep at the centre I'm at right now....

                      Ah.
                      I was also in the hospital before chrismas for lung problems and they were very insistent I needed blood pressure medication or I think a nurse told me it was something else and I unknowingly took it I'm pretty sure,
                      but this one afternoon my blood pressure was very low and I came back to my room around 1pm after some apts,
                      next thing I know it is 9pm and no one had checked up on me or brought me and food!

                      maybe I just get all the horrible service who knows!

                      Comment


                      • #26
                        Re: Nocturnal Pros and Cons

                        Well folks its me again. I am now past my one year mark on Nocturnal in center dialysis. I go on at 915 normalized and get off 8 hours later. Get home about 545 and come in and make coffee and take the dog for a walk. Its a lovely sight as I dialize/sleep and dog walk in a night shirt and those cheap plaid pants that are for something. So far have not been arrested. Oddly enough I go back to the center on our walk.
                        I have had a night or two when I cannot sleep but then I have them at home. Most days its, Mr. McGee if you don't get up I'm going to turn the bed over. I've call you 5 times and NO MORE! So then reluctantly I rouse and hold my sites, BUTTON HOLES of course, get up and weigh and pack my duffel and out the door.
                        With my Pulmonary Hypertension, I'm not sure how much better I feel, but I know that it is not as bad as it was on 3x4.
                        My labs are disappointing as I wanted my Kt/v to be 4.0 or better and its now in the 3.9x range for the last few months. I am not sure if I will ever make my goal but then I drink a little more than I used to, I eat a lot more and some of the things are not quite right. I rationalize that I am only cheating a little and I write them down. And then review at the end of the month. My fluid cheating is with my bounds of less than 20ccs a day, but my greens are too high and I have cut back on them. Have upped my fresh fish and cut back on my beef and one way or the other I'll make my 4.0.
                        My PTH was up and down like the Dow Jones and was never in bounds and not predictable, no know reason. That was the 3x4 days. Now the PTH is mainly even and in bounds and is a notable event to the dietitian when it is out of bounds. Once I believe in about 14 months. Not bad. My phosphorous and potassium are steady and tend up or down but slowly as to be able to keep them in check. They are no longer spikes, just small waves.
                        I do miss sleeping with my wife. That's a downer.
                        I like to walk back and forth to Dialysis but due to the night time luggage I cannot.
                        I see no other down side.
                        To me its not a matter of life or death its a matter of quality of life. Its just better. My body knows it but does not know why, nor do I care. Its a lot like love, it is, what more can be said!
                        Well enough and its now time for me to change into my sleeping duds and get ready for a good nights work.
                        Thank you DaVita for this opportunity.
                        Cicero

                        .
                        May God have mercy on us all

                        CK

                        Idiopathic globular membranous nephritis 1999-2006
                        Feb 2006 Dx about 1-2 yrs before dialysis. Dialysis start 6-2006
                        Chest Cath 4 mos in center hemo dialysis
                        Fistula, button holes, self stick days 07-09 in center hemo
                        Graft nocturnal hemo 4Q09 to present

                        Comment


                        • #27
                          Re: Nocturnal Pros and Cons

                          Originally posted by cicero View Post
                          Well folks its me again. I am now past my one year mark on Nocturnal in center dialysis. I go on at 915 normalized and get off 8 hours later. Get home about 545 and come in and make coffee and take the dog for a walk. Its a lovely sight as I dialize/sleep and dog walk in a night shirt and those cheap plaid pants that are for something. So far have not been arrested. Oddly enough I go back to the center on our walk.
                          I have had a night or two when I cannot sleep but then I have them at home. Most days its, Mr. McGee if you don't get up I'm going to turn the bed over. I've call you 5 times and NO MORE! So then reluctantly I rouse and hold my sites, BUTTON HOLES of course, get up and weigh and pack my duffel and out the door.
                          With my Pulmonary Hypertension, I'm not sure how much better I feel, but I know that it is not as bad as it was on 3x4.
                          My labs are disappointing as I wanted my Kt/v to be 4.0 or better and its now in the 3.9x range for the last few months. I am not sure if I will ever make my goal but then I drink a little more than I used to, I eat a lot more and some of the things are not quite right. I rationalize that I am only cheating a little and I write them down. And then review at the end of the month. My fluid cheating is with my bounds of less than 20ccs a day, but my greens are too high and I have cut back on them. Have upped my fresh fish and cut back on my beef and one way or the other I'll make my 4.0.
                          My PTH was up and down like the Dow Jones and was never in bounds and not predictable, no know reason. That was the 3x4 days. Now the PTH is mainly even and in bounds and is a notable event to the dietitian when it is out of bounds. Once I believe in about 14 months. Not bad. My phosphorous and potassium are steady and tend up or down but slowly as to be able to keep them in check. They are no longer spikes, just small waves.
                          I do miss sleeping with my wife. That's a downer.
                          I like to walk back and forth to Dialysis but due to the night time luggage I cannot.
                          I see no other down side.
                          To me its not a matter of life or death its a matter of quality of life. Its just better. My body knows it but does not know why, nor do I care. Its a lot like love, it is, what more can be said!
                          Well enough and its now time for me to change into my sleeping duds and get ready for a good nights work.
                          Thank you DaVita for this opportunity.
                          Cicero

                          .
                          Thanks for sharing this! We hardly ever hear any nocturnal dialysis stories and I only know one person on it in center like you (Getlife of KidneySpace forums is on it in PA). It is always good to hear how well people do on nocturnal!
                          Angie
                          Kidney KornerDialysis Ethics Forum Kidney PixAwareness Shirts KidneySpace Donor Search
                          I will be walking a Kidney Walk in Ontario Canada Sept 18th 2011
                          • Peritoneal Dialysis = 4 yrs
                          • Hemo Dialysis (in center) = 2 yrs
                          • 2 kidney transplants = 1990 - 2001 & 2007 to present

                          Comment


                          • #28
                            I started nocturnal 3 weeks ago. My kt/v was 1.1-1.3 when I was doing treatment on days. After 3 weeks on nocturnal my kt/v has almost doubled to 2.16. I know it still sounds low - but it's almost 100% better than it was. Trying to get used to the sleep schedule. I am starting to be able to work all day without fear of sleeping at my desk. Nurses in Nashua, NH are awesome!

                            Comment


                            • #29
                              I have been performing nocturnal HHD since April 2013, initially as part of a 5 month NxStage Medical trial for FDA approval of the System1 Cycler for nocturnal HHD treatments. Participation in the study has qualified me to continue to perform nocturnal HHD treatments regardless of FDA approval. After completing the study I have followed a treatment schedule that typically includes 2 ea. nocturnal treatments of mostly 40L treatments and 3 ea. daily treatments of between 23 and 31.5L treatments. I determined that the PureFlow SL makes nearly 64 liters of dialysate with a 60L SAK and I use it all rather than send the extra down the sewer.

                              I too, have experienced nice jump in Ktd/V values and have also been able to reduce my intake of phosphorus binders and loosen my dietary restrictions. The 6 to 9 hour nocturnal treatments at blood flow rates of under 300 ml/min are "kinder and gentler" than the 550 ml/min blood flow rates that I run for my short daily treatments. I work full time, and occassionally will put 11 hours in the office, making a week night treatment tough to get in. This in addtion to the periodic need to accommodate a week night activity make nocturnal the perfect solution. I do have to sleep in the day bed in my "dialysis room" rather than my own bed with my care partner/wife, but it is a small price to pay for the convenience and flexibility and therapeutic benefits of nocturnal hemodialysis.

                              Comment


                              • #30
                                Originally posted by dgromley View Post
                                Hi, My name is Dawn. I am a dialysis social worker and my clinic is going to be starting a nocturnal program soon. I was hoping to get some feedback from those of you that are involved in the program so I can share the information with my patients. Thanks!
                                Hi Dawm,

                                I have been on nocturnal for about 2 months and it has gone very well for me. I work and the schedule is perfect for me to keep working. The two things that I think you should take into account are that the nurse and tech should be experienced not new hires! That makes all the difference because it gives the patients confidence in their care. Second any nocturnal program should offer beds not 8 hrs in a chair! There are 8 patients currently on nocturnal at my center and 3 out the 8 can sleep pretty soundly but the rest it's hit or miss including me. My biggest issue is the chair. I'm 6'4" and sleeping in a reclined chair just is not comfortable for 8 hrs. Whats the point in offering nocturnal and your patients cant get the benefit of a goods night s sleep. When I get off the machine at 4 AM I go home and try to sleep until 10 or 11 AM and got to work around 12 or 1. If I were sleeping during treatment I could get to work on time and not have to alter my day! Thanks...

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