Once upon a time, my wife made an antique-buying trip to Jolly Ole, England. While there, she happened across the phrase “Bits and Bobs” and named her antique business the same. So what is this phrase, and how does it apply to dialysis?
“Bits and bobs” is a common British English phrase that means various small items or odds and ends. It’s akin to the American English phrase “this and that.” The phrase is thought to have originated from the world of carpentry, where “bits” could refer to small pieces of wood, while “bobs” was a term for small things or minor tasks. So herein, it means odds and ends pertaining to dialysis to catch us up on the minutia in the life of someone on PD.
Recently my evening on dialysis was hell. Every drain, all four of them, resulted in multiple alarms. I could only quiet these alarms by standing up on both feet for approaching half-hour for each drain. Remember that this happens regularly at about midnight, 0230, 0500, etc. Not very conducive to a good night’s sleep. Of course, I was blaming the cycler for being problematic based on past experiences with it. I was wrong – very wrong.
It turns out that when I set up the cycler the evening before, I neglected to remove the end cap from the drain line. While drain fluid can be forced out of the cap end under pressure, the system is not designed to do so and leaving the cap on restricted drainage. It was a problem of my own making.
There is a lesson here for all of us. We can NEVER lose sight that dialysis requires immense attention to detail. One little slip and problems much greater than losing sleep could result. This is especially cogent in the area of being fastidiously clean about any and all aspects of dialysis care and feeding. Fresenius provided me a sign that hangs over my prep station that reads, “If you even think you contaminated, you did!” I have added a check that the end cap is on the sink countertop as part of my mental checklist in the cycler setup. Hopefully, this is a one-and-done occurrence.
Last week I had a supply delivery. The day before, I received a garbled robocall from Fresenius along the lines that the delivery would be short. I called in and was told that the 1.5% five-liter dialysis solution was still in quality assurance and would be delivered later on—no idea when, just in due course. Delivery day came, and Fresenius logistics provided a window of 0900 to 1300. The delivery was actually made after 1600. As you may surmise, we’re not doing so well thus far. Two days later, after another call, the back-ordered solution was delivered.
Another lesson for the wise on dialysis – always have several weeks of backup supplies on hand even though this is a PITA. You never know when something like this will happen despite best effort on the part of all concerned.
The last bits and bobs has to do with CGMs, continuous glucose monitors. After going round and round with my GP and CVS, and Medicare, I found out via independent research that the Abbott Libre 3 is not yet approved by Medicare; the Dextron 7 is as is the Libre 2, but NOT the 3. The 7 is much more expensive, lasts only 10 days, and does not appear to have as well-developed an interface as the 3. So I have opted to continue to track approval of the Libre 3 and will buy it out-of-pocket for the time being.
Attribution: Only human intelligence was used in writing this blog, such as it is 🙂
