In essence, there are 3 dialysis treatment options. This article provides insight into alternative treatment options for hemodialysis.
There are 2 types of peritoneal dialysis (PD): continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). Both types of PD have slightly different advantages, so it really comes down to your personal preference and lifestyle, along with your nephrologist’s recommendation – who will also take into account other underlying health conditions.
My husband was steered by his nephrologist towards APD (Automated Peritoneal Dialysis).
He had his surgery during Covid, so I dropped him at the hospital at 7:30 am. A small incision under general anaesthetic was made, and I collected him that evening at 6 pm. Having done quite a lot of research, I found the most helpful and informative site on Facebook, Peritoneal Dialysis Support UK. I took a pillow for my husband to gently hold against his tummy for the initial journey home. It was such a good tip, so I left it in the car for the couple of weeks he was unable to drive.
Whilst he was sore, he managed post-operation with strong painkillers, wearing tracksuit bottoms and a zip-front sweatshirt for a week.
Following surgery, we began scheduled visits to his kidney unit, where the incision and catheter were checked, and then the catheter would be ‘flushed out’ by the renal team until dialysis training was arranged.
He was told not to shower for almost two weeks. (Check this at your centre, as different hospitals have different timescales).
Due to Covid we were trained at home, I also received the training. I set up the machine given the extreme tiredness my husband suffered after a day at work (a symptom of end-stage kidney disease) and a two-hour commute.
It would have been really useful to have had the following tips before we began our journey:
- Ensure your bedroom (or treatment area) is set up and ready before the catheter surgery. Moving pieces of furniture around post-catheter insertion is not recommended. The lady who trained us at home suggested we switch a tall set of drawers to a shorter set in the spare room. She explained it was better if the machine wasn’t moved and was positioned at bed height… so she and I switched the drawers around.
- I had ordered (from Amazon) a strong trolley, which I envisaged would hold the machine and be rolled into place each night. As she suggested, I used the chest of drawers, and she explained that the trolley positioned at the foot of the bed would be ideal for setting up a tray with the necessary auxiliary requirements. I have included a few photos of our set-up below.
- Some, but not all, units provide a stand to hang the dialysis bags. Ours didn’t, and so again, taking the direction of the lady who trained us, I ordered an air dryer stand (thank goodness for Amazon in Covid, is all I can say).
- I had also read how sometimes drain bags can leak (usually if clips are not secured tightly). I have a large plastic box in which I place the drain bags on set up, and it has saved us two leaks (the fluid does have a smell that lingers if spilled).
- Storage is a huge consideration. The monthly delivery of approx 40 or 50 fluid boxes, plus auxiliary items, requires some planning. A spare room (bedroom) or garage/shed space needs to be cleared so that you are ready for the first (and subsequent) deliveries. We were stunned at the volume of our first delivery – imagine 40 plus banana-sized boxes, each weighing 10 kilos, plus a 25-kilo dialysis machine. Thankfully, the drivers will carry the boxes to your storage area.
- We store it in a shed, which is fine until winter frosts and snow arrive, as the fluid has to be kept above -4 degrees. From December to March, our deliveries take up half of the dining room (photos enclosed).
- If space is an issue, the renal units may pay for sheds to hold the stock or arrange fortnightly deliveries.
- Whilst we have a machine, we were trained to do ‘manual exchanges’ too. This works on a gravity fill – so we have, on weekends away, suspended the dialysis off wardrobe doors and car visors. The advantages are that we go away for weekends and holidays and do not haul a 25-kilo machine around that could cause sensor faults. It has also been very useful when there was a power cut forecast too.
In summary, the benefits of home dialysis on the machine (APD – Automated Peritoneal Dialysis), which takes 8&1/2 hours overnight, means that for us, we have the days free. Wider, as my husband is an engineer, it is a far more sterile environment than him doing a manual bag (CAPD Continuous Ambulatory Peritoneal Dialysis) exchange where he worked, which would have given increased risks of infection.
It took 2 days to train us, and once we got into a routine then, using the machine was easy. Post-COVID, there are training centres where patients (and their partners) are invited to attend for 2 nights to train with other dialysis patients. Arrangements are sorted by your renal unit for you (including travel and board), and it is free of charge.
Finally, I contacted our local council to arrange extra bins due to the volume of cardboard waste that is now generated.
We are registered with utilities on the Priority Service Register (resulting in a generator delivered twice during power cuts), and we have a medical waste collection each week, which was arranged through our Unit.
