Editor’s note: After more than 20 years on in-center hemodialysis, Jennifer Castillo decided it was time to go back to peritoneal dialysis, which she used to do in the 1980s. She explains why she likes the treatment choice in her article in NN&I’s August issue. Below, Castillo talks more in-depth about why she made the switch and chose peritoneal dialysis over home hemodialysis, and offers insight for current in-center patients and staff.
NN&I: Did you ever consider trying home hemodialysis? Why did you ultimately choose peritoneal dialysis over home hemodialysis?
Jennifer Castillo: I did home hemodialysis in the 1980s when I was completing college. Home hemodialysis literally puts your assistant on dialysis too. It has more steps and complexity then peritoneal dialysis. I can do more on my own with peritoneal dialysis and not tax my partner. Home programs must provide for caregiver or partner burnout with respite care as needed.
Both systems are time consuming and are part time jobs that require running a one-patient treatment center including managing inventory delivery and breakdown, disposal after treatment, problem solving for defective equipment or supplies, and troubleshooting unexpected treatment issues as they arise.
“Practice makes all the difference to get used to what to do and in what order to do the procedure.”
NN&I: Were you nervous when you first decided to switch to a home dialysis treatment?
Castillo: I was very motivated to do home dialysis and had even negotiated with my doctors to learn the hemodialysis machine in the center in the early 1980s. I would setup my machine between dialysis shifts in order to start treatment more quickly. For me, I am taking care of myself and completing my own paperwork and parts of the treatment process like taking my blood pressure, putting in and taping my own needles.
NN&I: Was there a learning curve to performing the peritoneal dialysis treatments?
Castillo: Even though I had done peritoneal dialysis in the 1980s the equipment was much improved. I used my training directions for every exchange during my first week at home. Practice makes all the difference to get used to what to do and in what order to do the procedure. I had to get used to different kinds of clamps and disposal of the bags after each treatment.
“Anything an in-center technician or nurse knows, a patient can learn.”
NN&I: What advice would you give an in-center hemodialysis patient considering switching to peritoneal dialysis?
Castillo: Anything an in-center technician or nurse knows, a patient can learn. Overall, you as the patient will be able to provide a consistent and reliable treatment and prevent mistakes that may be made because of the workload and time constraints managed by the dialysis staff. You will learn what works best for you in the comfort of your own home. You get to control your treatment schedule. If you want to plan a dinner out, you work your treatment around that time.
“Prospective patients need to speak with and visit home patients so they can build their confidence and see how manageable the process is.”
NN&I: Do you think some renal professionals might have misconceptions about who can perform peritoneal dialysis? Do you think the therapy has the potential to be used more?
Castillo: There is definitely the potential for more peritoneal dialysis to be used. Patients would feel better and have a more relaxed diet by doing peritoneal dialysis. Peritoneal dialysis is long, slow, gentle dialysis so patients will not feel washed out or need a day to recuperate from their treatment.
It is all about setting expectations that home dialysis is doable and provides patients with better care and they will feel better. Further, patients who don’t have a medical background need to be encouraged that home treatment is definitely possible. Prospective patients need to speak with and visit home patients so they can build their confidence and see how manageable the process is.
Renal professionals like to be in control. Knowing the variation in patients and how well or poorly a patient can follow instructions adds to the challenge of deciding on performing home care.
NN&I: Have you ever experienced any negative effects from the treatments, like infections?
Castillo:My biggest challenge on peritoneal dialysis with the cycler is being able to sleep at night. Initially, falling to sleep is hard for me although I have gotten better at it by lowering the sound of the machine. Taking care of alarms does interrupt sleep, but does not happen often.
I have not had any infections, but I follow the training I received and never shortcut what I was taught to do to use the machine and for daily exchanges.