Our Home Programs
The home program is the solution for a patient who wants to continue with a normal routine. With this program, the patient does not need to visit a clinic; everything can be from the comfort of the patient’s home.
Peritoneal Dialysis (PD)
Peritoneal dialysis is the treatment method with the least overall side effects, so you won’t drained or exhausted after treatment.
Benefits of PD include:
Portable - take equipment with you on-the-go
Flexible - choose treatment times that suit your schedule
Time-saving - make fewer trips to the clinic
Simple - learn within two weeks
Fewer dietary restrictions- enjoy your regular diet
No needle insertions
How PD Works
Peritoneal dialysis uses the inner lining of your abdomen, peritoneum, as a dialysis filter. Because the peritoneum is lined with tiny blood vessels, waste and extra water in your blood can flow out of these blood vessels and drain out of your body.
Catheters
In order to be eligible for PD treatment, a surgeon will place a soft plastic tube, catheter, in your abdomen or chest. You will also learn how to use the catheter to fill your abdomen with dialysate, a sterile fluid. On average, two liters of dialysate are used per treatment.
Exchanges
After adding dialysate to the abdomen, it stays there for a few hours. The period between inserting fresh fluid and removing used fluid is called dwell time. While you go about your day, the fluid will collect all the waste and water it can hold. Then, you drain the used fluid and insert clean fluid. This process is known as an exchange.
There are two types of exchanges:
1. Exchanges by hand - Typically performed four times each day. The patient manually performs the exchange upon waking, at lunch time, at dinner time, and at bedtime. Each exchange takes approximately 20–30 minutes. This is also referred to as continuous ambulatory PD (CAPD).
2. Exchanges with a machine - The most common type of exchange. This requires a cycler machine that will perform a few exchanges overnight while you sleep. Fewer exchanges are necessary throughout the day; you may only need to perform one exchange during the day by hand. The cycler prescription can be adjusted to best suit your needs. This process is referred to as automated PD (APD) or continuous cycling PD (CCPD).
Preparing for PD
Catheter placement can be done as an outpatient surgery, so a hospital stay is not required. Patients typically experience little to no pain afterward; however, it is normal to experience mild discomfort for a few days.
Ask the surgeon who puts inserts the catheter to put a “transfer set” on the catheter. A transfer set is a tubing extension with a valve that will open and close the catheter. Having a transfer ease the PD process. You should also ask the surgeon to make sure the catheter won’t exit your body at your belt-line or under a skin fold. This will make your catheter more comfortable and easier to live with and keep clean.
After surgery, your PD training nurse will check your catheter, flush it with fluid, and teach you how to change the dressings until it heals.
Training
Once your catheter is placed, you’ll have one to two weeks of training. Your PD training nurse will teach you how to:
Store and order your supplies
Keep treatment logs
Take your blood pressure
Follow your diet and fluid limits
Recognize and report any problems
Set up a good place to do exchanges
Wash your hands
Take care of your catheter and exit site
Perform an exchange
Identify what kind of dialysate to use and when to perform an exchange
Use your cycler (if performing APD or CCPD)
A PD nurse will be on-call 24 hours a day, should you require assistance.
When you first begin to insert fluid, you are likely to feel very full and even experience stretching. After one or two weeks, you will become accustomed to the sensation, and the discomfort will subside.
More About PD
Availability
Peritoneal dialysis is the most common type of home dialysis. It is offered in every state. There are about 5,600 dialysis clinics in the United States, and approximately 40% of them train patients to perform PD.
Cost
In the United States, a large sum of the cost of peritoneal dialysis is paid for by the Medicare ESRD Program. Ninety-three percent of Americans qualify for these Medicare benefits, reagrdless of their age.
Do you have a job with a health plan? Wonderful! Your health plan will pay for the first 30 months of dialysis treatment. Should you apply for Medicare, it will be secondary during this 30-month period. That means it will pay all or most of the remaining balance after your health plan. Depending on your insurance plan, you will most likely have some co-payments.
If you do not have a health plan through an employer, PD can help you cut the costs you have to pay for dialysis. How? Most people under the age of 65 are unable to receive Medicare benefits until the first day of their third month of dialysis treatment. Those inital three months of treatments can cost tens of thousands of dollars! However, if you choose peritoneal dialysis, Medicare can start to pay from the first day of treatment. If the timing is right, Medicare may even pay for your catheter surgery!
Please read your health insurance policy; some health plans charge co-payments per day for PD treatments.
Medicare also pays your clinic a fee for each dialysis treatment it provides. The fee covers the cost of treatment plus the cost of the medications and supplies used during treatment. Because the fee covers all of these things at once, it is referred to as a bundled payment. The bundled payment system helps more patients choose peritoneal dialysis as their treatment as clinics are able to work more efficiently when patients feel better and use fewer meds.
Time
Periotneal dialysis can be performed at home, at work, and even when you travel. Manual PD exchanges do take time each day, but the timing can be adjusted to fit your schedule and lifestyle perfectly. PD with a cycler at night lets you do your treatments while you sleep so that your days are completely available. Once you are trained, you will only have to visit the clinic once a month to check your lab tests and treatment logs. You will also need to allow time to check your supply levels, order supplies each month, and receive the shipments.
Helper Tasks
Peritoneal dialysis can be performed without any assitance. If you have someone who can help you, he or she may train with you. They can also help you gather supplies, move boxes, set up the cycler (if you use one), or in some cases, perform your exchanges.
Advantages:
PD is done all day, or each night—not just 3 days a week
No exhaustion or drained-feeling after treatment
Completely personalized schedule
Painless
No needles necessary
No dialyzer necessary to clean blood. Your blood does not leave your body.
Can be performed anywhere
More privacy
Feel more in control with your overall health
Greater knowledge about dialysis treatments
Drawbacks:
Dialysate contains sugar; may lead to weight gain
Risk of infection, if instructions are not followed
Avoid bathtubs, or swimming in lakes or ponds
Must be performed every day
Supply deliveries may be inconvenient; supply boxes are heavy