Dialysis Is a Set of Routines

This morning buttoning up the cycler at the completion of dialysis I let my hands get ahead of my routine and turned the power to the cycler off before removing the cassette. I had to turn the cycler back on and wait awhile until I could open the cassette door, remove the cassette, and shut it down again.

During morning coffee my wife and I discussed how dialysis is a massive collection of routines which I have blogged about, in part, previously. In this blog, I intend to address the routine aspect of dialysis and its importance in more detail.

In my dialysis world, I have annual, quarterly, monthly, weekly, and daily routines that together contribute to my successful dialysis. The following addresses these routines.

Annual: On an annual basis my Dialysis Nurse is scheduled to inspect our dialysis home and all aspects pertaining to conducting dialysis therein from cycler setup to storage to cleanliness of shower heads and shower drains etc. Anything and everything that remotely “touches” my dialysis routines.

Quarterly: While I have labs every month, on a quarterly basis I am required to use only 2.5% dialysis liquids, capture it in bags, and submit it during labs along with a 24-hour urine collection. Also, certain labs such as A1c, etc. are required on a quarterly basis.

Monthly: I have monthly labs during which I present the previous night’s biometric readings (weight etc.), and my thumb drive is exchanged. I am provided any shots required and have a general blood draw for routine dialysis-related analysis that I often report herein. I am also provided a monthly Fresenius handout expanding on some aspects of dialysis. I must conduct an inventory of my dialysis supplies and request refills as necessary from my dialysis nurse. I must conduct an inventory of my dialysis supplies such as boxes of fluids, cassettes, etc., and place an order with Fresenius for resupply. I must accept supplies in this manner according to a supplied Fresenius schedule and supervise the stowing of same in our household storage area.

Daily: This gets to be more complicated so I’m going to bullet points here:

• 1600 turn on the cycler, unbag the cassette and set up the cycler to a point
• Break out gauze for port, and also four 2x2s and cotton swab for shower
• In the bathroom break out two new paper towels and lay on the cleaned sink countertop. Prepare replacement port gauze cover and layout cotton swab, cleaning solution etc.
• Turn on the shower, set it up, remove clothes and existing port cover, remove the neck lanyard holding the catheter and tape the catheter to the chest, and shower.
• Upon completion of the shower and drying off, clean the port area with a cotton swab cleaning fluid and 2×2 cotton pad, apply ointment to the port, prepare 2×2 cotton cover for port and tape on, remove tapped catheter and place in lanyard, dispose of used sterile supplies, get dressed etc.
• Check that cycler is where it needs to be in prep for night’s use
• About 1900 complete setting up cycler for night’s use. Involves 10-12 minutes of direct involvement with the cycler.
• Getting ready for bed involves among other things, washing of hands like a surgeon, breaking out my catheter and cleansing the end for two minutes having it wrapped in 2×2 cotton drenched in cleansing fluid, making the cycler ready for connection, actually hooking up to the cycler. After hooking up to the cycler ascertain if a static 50mL initial drain will take place and if so jump in bed; if not hit bypass on the cycler then to bed.
• In the morning after dialysis is completed, disconnect from the cycler, take biometric readings enter the same into the cycler, and make up patient and drain lines in preparation for cassette removal. Upon a signal from the cycle that the dialysis is completed, remove the cassette, make up cassette lines, and deposit all disposables into a plastic garbage bag for placement in our trash bins.

As you should have ascertained by now, there are a multitude of routines involved in dialysis treatment. I have found that if you establish a parsimonious set of routines, as complicated as it may seem, adherence becomes “routine” and comfortable to follow. By following a very set and ridged routine in dialysis, nothing gets left out and included that is potentially harmful to the patient.

If you are going on dialysis or on dialysis for that matter, establish routines. And BTW, no alarms last night!!!!