Christy and her caregiver set up the dialysis machine as they were trained, following the manuals, and based on their experience. While the machine is priming, Christy performs the pretreatment measurements and data collection. These include: weight, sitting and standing blood pressure and pulse, and temperature. There are many other data points that may need to be captured on any given treatment day depending on the specific circumstances and needs. More on these details in a future blog post.
It’s agreed that 1 Liter of fluid should to be removed this treatment. The snap and tap is performed and pretreatment is competed all the way to being ready to connect to her access. Christy continues to use the catheter originally place in her neck and upper chest. Christy is using a catheter for her access for a variety of reasons. If you have a fistula or graft, the access care and management is somewhat different, but the overall hemodialysis treatment is the same.
Today her caregiver is not changing the catheter dressing. This happens once a week because she uses Tegaderm CHG by 3M (Chlorhexidine Gluconate I.V. Securement Dressing – Gel pad contains 2% w/w CHG [TM]). After gloving and masking, caregiver removes the arterial (red) toggle cap, cleans, aspirates and flushes the line noting a smooth easy pull and push of the syringe, then connects the line. No heparin is needed as yesterday’s pod and post were clear. The step is then repeated on the venous (blue) lines and dialysis is ready to be performed.
The caregiver sets up the machine with specific starting rates and volumes learned by experience. After checking that all lines that should be open are open and all lines that should be closed are closed; the kidney button is pressed to begin treatment. In less than a minute readings start to indicate a normal start, and the caregiver starts documenting the blood flow rate, pressures as well as all the other treatment observation data. We’ll discuss much more about this in a future blog post.
Caregiver gradually increases the blood flow rate incrementally making note of the arterial and venous pressures until the blood flow rate is running at 400 milliliters per minute. This is the target run rate for Christy. Every 30 minutes the caregiver takes note of blood pressure, pulse, dialysate, UF and the arterial, venous and effluent pressures. After about 2.5 hours the treatment is almost complete.
They prepare to return the blood and stop the dialysis machine. The caregiver disconnects the arterial line from Christy, connecting it to the dialysis machine and presses the rinse back button. While the blood is returning, the arterial catheter port is cleaned with an alcohol swab and is capped with an antibiotic gel cap. If you have a fistula or graft your access care is different but the result should be the same. With the blood returned and the machine stopped, the venous line is disconnected and the port cleaned and capped.
The post-treatment vitals are collected: sitting and standing BP, weight and temperature, patient and access condition. Caregiver notices that the pod has a slight blood film and the post is slightly streaked. Perhaps they will need to use heparin tomorrow. Christy now takes pictures of the end of session post and pod condition. More on this topic in an upcoming blog post.
Before Christy Health, the caregiver would hand write and then make sure the treatment flowsheet report was compete, scan it, then email it to the administrating nurse. Now a button click does it all and we’ll explain all that in a future blog post.
Mitch is Christy's caregiver and husband. I've had to learn fast because she really keeps me on my toes. I've found that organizing her data and health information, while challenging, is the only way for me to begin to understand how complicated a life she lives.