Originally Posted by auntbea
My dr. has told me I will soon need to begin dialysis and I need to be thinking about which kind I want. From all the reading I have done, I think I would prefer the kind that is done at home through the stomach. Do you or anyone you know use this method? Is it just as effective? Is it hard to learn to do? Can this method be used long-term? What are pros and cons? Thanks for any info you might have that may help me make my decision.
The dialysis you refer to that is done "through the stomach" is called "Continuous Ambulatory Peritoneal Dialysis" (CAPD). A catheter is surgically inserted into the peritoneal cavity of your abdomen (not into the stomach). The cavity that is below your abdomen and contains your body organs (stomach, kidneys, intestines etc.). The cleaning solution is infused into the catheter and left to dwell for a period of hours. The fluid bathes the organs and works through osmosis (high concentrations moving to low concentrations, and low concentrations moving to higher ones). Think of a sink with dishes in it. The sink is the cavity and the dishes the organs. The water is the fluid.
The catheter isn't too big. It's a soft rubber tube with a hard portion at the end that is about 2" long (the whole thing is about 8" long). That is where the cap goes and where you hook up the dialysis bags to. They tape down rather nicely and don't show under most clothing, unless you are wearing clingy stuff. The exit site is kept covered by a small dressing to protect from infection and from it being tugged.
Once the catheter has healed, you are taught the procedure of infusing the dianeal fluid (a special fluid that is in large IV-like bags. The bags come in a variety of sizes with varying percentages of electrolytes). Your doctor will determine the size of the bags you need, and the strength of the solution to use, as well as the dwell time (the time you need to keep the solution inside you to get an adequate cleaning).
It's not a hard procedure to learn. Rather easy actually, and they give you a booklet to help you along and they make sure that they demonstrate it to you and that you can demonstrate it back to them without mistakes. As with everything, you get better with practice.
Most people have to use 2L or 2.5L bags of solution every 4 to 6 hours depending on how the body adjusts. Most it is every 6 hours. Meaning you infuse the solution at 6am, and leave it inside you for the 6 hours and go about your normal business. Than at Noon, you hook yourself up to drain out the used solution, and refill yourself with new, and then do it again 6 hours later.
Alot of doctors are jumping on the bandwagon of "night cyclers", which offer the home dialysis patient much more freedom. The bulk of the exchanges take place during the night over a period of 10 or 12 hours, with only one exchange being required in the day. These machines are costly though, and I'm not sure how insurance companies look at those things. Where I live the government pays for all dialysis patients medications and treatments and supplies as part of our health care system.
A major draw back of CAPD is that you can't get the catheter area wet, means you can't bath in more than a few inches of water, and absolutely no swimming. The risk of getting peritonitis (a very painful infection of the cavity lining) is high if there is contamination, and water can seep in there at the inserstion site of the catheter. Also a good clean/sterile technique needs to be used when dealing with the catheter itself for the same reason. Even with meticulous care, some people still get peritonitis and end up needing to be hospitalized and have antibiotics put into the dianeal fluid until it's cleared up.
Some people do well on CAPD, others don't and end up having to have hemodialysis which is 3 times a week, 4 to 6 hours each time. Most people on CAPD end up requiring hemodyalysis at some point down the road. As for life expectancy on dialysis, that is something you should talk to your doctor about. I can tell you that long term dialysis patients tend to be sickly and have a multitude of health problems. But again, those are issues that you should discuss with your doctor.
If you have any more questions, please feel free to post them and I'll do my best to help you along.