Moment of Truth

I am a Nurse working full time in a Home Peritoneal Dialysis program. A large part of of my job is training new patients to do their treatments at home. Also in our system it is often necessary to train a spouse or assistant caregiver to aid the patient or sometimes completely control the treatment process.

There are many aspects to delivering and maintaining continued safe practices inside the realm of Peritoneal Dialysis but I believe the most important thing overall is the actual connection and disconnection of the patient catheter to the Peritoneal Dialysis system. This is what I refer to as "the moment of truth" and I actually use this phrase when training patients.

Infection (Peritonitis) is the number one problem that a Peritoneal Dialysis(PD) patient may encounter while on this modality of treatment. If a patient does develop Peritonitis they may be able to remain on PD with the aid of Antibiotic treatment, they may have to come off of PD temporarily to heal and rest their system or they may not be able to do PD at all again.

There are several ways that the PD patient may contract peritonitis but a very common reason is a touch contamination during connections and disconnections to the system. The patient connection is accomplished in a matter of seconds but must be continually meticulously executed using sterile technique in an attempt to continue on this modality of dialysis.
The mechanics of the connections are quite simple and very user friendly. There are differing brand names of PD equipment but the patient to system connection is very similar across the board. At the moment of truth the patient or caregiver has to remove a sterile cap from the end of their patient line and remove a sterile cap from the PD system line and make a safe quick connection. Once this union is made the circut is closed off to the outside world and the exchange of PD fluid can now occur in a sterile fashion. At the end of the PD fluid exchange the same careful technique is used to disconnect from the PD fluid line and a new sterile cap is placed onto the patient line. These patient to PD system connections are basically the same whether using a manual or automated PD system.

That's all for now on this topic. In one of my future posts I will discuss preparing for the "moment of truth". So to all you PD patients and PD trainers never fall short of that meticulous PD mindset.

Patient Champion Series: I wanted to share some of these awesome human stories that FMC has shared with me.

Anthony Lee                                                                    

Age 43 • Saginaw, Mich. • Featured on March 19, 2010
The More You Do, The Better You Feel
Anthony Lee is a 43-year-old dialysis patient from Saginaw, Mich., who loves spending quality time with his family and staying active. Lee was first diagnosed with diabetes, with the end result being the failure of his kidneys. He received a kidney transplant that lasted until three years ago, and he has been on dialysis ever since.
Anthony is a busy father with two teenage daughters, and he recently decided to transition from in-center hemodialysis to home hemodialysis with Fresenius Medical Care Saginaw Riverside. He will soon start dialyzing at home and is looking forward to the flexibility and independence that home treatment will give him.
Anthony likes relaxing at home and going to church to be around positive people. He also loves being active with his daughters and enjoys playing basketball. He’s a believer in the saying, “the more you do, the better you feel,” and encourages other patients to become more active and live life to the fullest. He wants to help his fellow patients understand how CKD affects their body, and the importance of following their treatment program.

More Nxstage Users!

Another great example of the growing Home Hemodialysis population!

PD = Peritonitis Myth.

Don't be swayed away from the kinder gentler treatment because of misinformation.

CKD Legislation

Thank you to everyone who submitted letters to their state representatives regarding the proposed Chronic Kidney Disease (CKD) education legislation. Our voices were heard and we are excited to announce very positive results! The final bill, Kidney Disease Education (KDE), went into effect January 1, 2010, and includes much needed benefits for both patients with Stage 4 kidney disease and health care providers.

The legislation states that Medicare will cover up to six one-hour face-to-face pre-End Stage Kidney Disease (ESKD) education sessions concerning modality choices. This legislation is designed to ensure that patients will have the opportunity to actively participate in their choice of therapy. In particular, the sessions should be designed to provide comprehensive information regarding:

* The management of comorbidities, including delaying the need for dialysis
* Prevention of uremic complications
* Options for renal replacement therapy (including peritoneal dialysis, home hemodialysis, in-center hemodialysis, as well as vascular access options and transplantation)


The KDE bill also allows for health care providers to be reimbursed for providing CKD education to Stage 4 CKD patients. Health care providers will be reimbursed at a rate of approximately $108* per individual session (HCPCS code G0420). Group sessions (between 2-20 people) will be reimbursed at a rate of approximately $26* per person (HCPCS code G0421).

Together, we were able to ensure this landmark legislation became law and help over 900,000 people in the United States with Stage 4 kidney disease. Now, more than ever, patients will be empowered to select a therapy option that best meets their needs and lifestyle.

If you would like to learn more about the new Kidney Disease Education (KDE) bill and how Baxter can assist with your education program, please contact your local sales representative at 1-888-736-2543, option 4.

New Modalities?

Wow a wearable Kidney???

PD Cycler Time Commitment

I wanted to talk a bit today about an option inside of options. For ESRD patients there are four basic options: Transplant, PD(peritoneal dialysis),HD(hemodialysis) and to do nothing and go without treatment.
Some may notice that my order puts PD in front of HD and my reason for this is that PD would be my choice before HD and I would recommend PD before HD to anyone seeking my advice. This choice is based upon a lot of PD advantages but in short it is the kinder and gentler dialysis.
Once PD has been chosen there two options inside of PD. CAPD(continuous ambulatory peritoneal dialysis) these are manual bag exchanges usually done four times throughout the day.
The other is CCPD(continuous cycling peritoneal dialysis) these are automated exchanges while connected to a small machine overnight.
When I begin the CCPD training for patients there seems to be a common misconception as to time commitment needed to receive adequate CCPD. The patient mindset seems to be that whatever their normal sleep time is will be equal to their total CCPD treatment time. When doing CCPD it is very common that your total treatment time can be nine or more hours. This is because the nighttime cycler prescription is written for several cycles and each cycle has a drain/dwell/fill time and again this is necessary for the Patient to receive enough dialysis.
Once the Patient understands this requirement it is almost never enough to deter them from doing CCPD. I think that this PD shortcoming in information can be avoided in the future by including this cycler information in whatever options program your system may provide. Hopefully this post will help too!

Home Hemodialysis

Hemodialysis treatments preformed at home is not a new concept at all, in fact I have known some patients that were doing hemodialysis(HD) at home as early as the late 1970's. The home HD option has become more widely used. I am very encouraged about this because it is a perfect transition mode of treatment for people on Peritoneal Dialysis(PD that for a number of reasons can no longer continue PD.

I am very excited of late as I have on good information from Doctors and staff that a home HD program will be starting in my area (Rochester NY) using the Next Stage equipment! Enabling the former PD patient to continue dialyzing at home is great because these folks have been running their own show, for the most part doing their dialysis treatments around their own schedule and not that of an outpatient hemodialysis center. With the next stage machine patients can travel just as easily as they could when on PD as this system does not need a special water treatment for dialysis. Another great benefit of home HD is that the patient can do more frequent shorter treatments at home instead of long treatments three days a week. These shorter more frequent treatments are a much better dialysis process for the body because there are less fluid management problems (osmosis) and better control over the removal of toxins (diffusion). Again not as good but similar to PD where in most cases you are dialyzing 24/7.


In most home HD programs you must have a partner that is trained and will be with you for all treatments. Some home programs offer the option of doing the treatments at night and they are monitored by health care staff remotely. As a Dialysis Nurse it is a great thing that the option of Home Hemodialysis is increasing in availablity.