Coming home positive from dialysis session: first time in B Braun in Port Laoise


The afternoon started with the taxi arriving at home at 13:30., the journey to Port Laoise was over almost as soon as it had begun. I was there for 13:45. Fifteen minutes? That was even shorter than the twenty minutes I had been told it would take. But here I was, a patient no longer just a visitor, like last Friday. It is amazing how quickly the HSE can move when they want to.

There was no one else in the reception when I arrived, I suspect because I arrived those fifteen minutes early. However, it did not take long before Ger Farrell, the manager of the centre arrived to welcome me. He asked if I had signed in. I said that I had not, as I did not know that we needed to as we did not do that back in Tullamore. He informed me that it was a requirement of Tullamore that the Port Laoise centre have a sign in, so that seems rather strange. However, I duly signed in and I will remember to do so in future upon arrival.

Having sanitized my hands, we moved on into the main room. I took off the extra clothing and my shoes and got on the scales. This is how every dialysis session starts for everyone. The centre cannot know how much extra fluid to take off unless they know how much heavier than your dry weight you are on arrival. Of course, dry weight simply means without extra fluid. It’s the base weight on which everything else is based.

And off the scales and into the isolation room. No, it’s not because of Covid-19, it’s because of living with HIV as the latest guidance says that

HIV positive patients should be either segregated/cohorted in an area portioned or physically separate from susceptible patients during HD or have HD treatment in an isolation room.

HSE, Blood-Borne Viruses in the Haemodialysis, CAPD and Renal Transplantation Setting, July 2014, §7.3.3

And then I got to see the B Braun dialysis machine. It looked somewhat similar to the Fresenius one to which I was so used in Tullamore and Tallaght, but moving forward I have to get used to this. Up onto the couch (not a hospital bed — this is progress) and meet the first nurse to put me on to dialysis. I am not terribly good at remembering names, so I wrote hers down in my dialysis notebook. It is bright yellow and matches the highlight colour of the dialysis unit.

Libertine, known as Teeny, proceeded to work out how much fluid to take off me. Fortunately my new dry weight of 76.5kg had made it with the rest of my notes via the eHealth system.

Weigh in 78.3kg
Dry weight off76.5kg
Weight to take off1.8 kg
Plus wash back0.3kg*
Target UF2.1 kg — 2.1 litres
Note:*usually should be 0.5 but
I know that I normally come
off 0.2kg light on targets so
we took it off the washback
at this point.
Table 1. Target fluid working

So, the above shows the working out of the target UF of 2.1 litres. With the machine set, we put a blood pressure cuff on my right arm (and then found a smaller one and a smaller one again to make it fit. It seems I have very skinny arms).

The first BP reading was 138/85 with a pulse of 94. The rest of the readings through the treatment are in Table 2. It has been my practice for some weeks to record the BP readings as they happen in my dialysis notebook so that I have some idea of what is going on and can refer back myself and not be reliant on the notes on the dialysis machine. It also means that I can refer to the notes when seeing other medical practitioners.

SystolicDiastolicPulseTime
138859414:30
1466893
143889216:30
1581089517:00
123788817:30
1279410718:00
Table 2. Blood pressure/pulse readings

Teeny got the needles into my arm first time, with a little direction from me. The lines were connected to the needles, and then a clamp put on my T-shirt and the lines clipped into place. This seems much better than having them lower down and taped to the pillow as they were in Tullamore. Now I understand what so many people have been saying about clamps. It never made sense before.

Liam #dialysissupportbear supporting me while I was on dialysis – note the clamp on my left arm.

Some time into the session, I noticed that the label on my isolated machine. Not quite sure why it is isolated when the HSE says

It is NOT necessary to have a dedicated machine provided that disinfection processes are properly carried out between patients according to a protocol that incorporates the manufacturers’ instructions.

HSE, Blood-Borne Viruses in the Haemodialysis, CAPD and Renal Transplantation Setting, July 2014, §7.3.3

but as in Tullamore, I have a dedicated machine. Of course in Tullamore I actually had two isolated machines. Anyway, the machine has my name on it. Or at least it was meant to have my name on it. What was on it was

Michael Mc Farland Campbell

which is not my name. My name is

Michael McFarland Campbell.

It is important to me not to have the space in McFarland. The Irish Passport office attempted to put a space in my name at that point claiming that that was the Irish practice. I pointed out that in the documents supplied my name does not have that space. Therefore, they fixed it for both me and my husband, Andrew. So, I asked Ger to change the label. He went and got the labelling machine and produced a small size one so that I could check it, and when it was correct, he then produced a larger one to go on the machine. The smaller one he gave me to go on my dialysis notebook.

Liam #dialysissupportbear even has somewhere to sit. The patient tables have a box to put things in, so we reckoned that Liam could sit in it. So he did. It meant he was on hand if I needed him, and he could see all that was going on.

Liam in his new seat

I forgot to say that prior to entry to the dialysis room, my temperature was checked in line with the Covid-19 precautions. At 16:19 two more nurses came in to check over the machine and its settings to ensure all was correct. At that point they took my temperature again. It was 36.3 ºC. All duly noted in my notebook.

A little later, Ger came in, and saw the notes in the notebook, I think because I was noting the next BP values. He reckoned that I had too much time on my hands, and as I had good handwriting he had a job for me to do. He went out, returned with a permanent marker, removed my BP cuff and asked me to write my own name on it. Duly done, it was replaced on my arm!

In Tullamore, we no longer got given any food or drink whilst on dialysis as this was to stop any vectors of infection. In Port Laoise, this limitation is not in place. So I was offered “tea and toast” or “tea and a sandwich”. I opted for tea and turkey sandwiches.

Turkey sandwiches, biscuits, and tea

Talking of food, the dietician, AnnMarie, popped in and gave me two sheets of a food diary to complete and bring back on Monday. I know that my eating is not great and ought to be better. Since the high potassium incident at Christmas I have been asking to see a dietician in Tullamore but no one came. So, I am pleased that with the move to Port Laoise, this seems to be in hand as well.

The whole experience on Friday was great. I sent a text message to Ger praising him and thanking him as

I haven’t come back from a dialysis session feeling as positive for some time… see you on Monday.

I’m looking forward to heading across tomorrow afternoon for the next session. I am sure I will meet more members of staff and have more names to remember. As I said to Andrew when I got home, I ought to have gone there a year ago, but I had resisted it. I am now glad that I did go and have a look before deciding for myself that I should transfer my care there.


Sources

HSE, Blood-Borne Viruses in the Haemodialysis, CAPD and Renal Transplantation Setting, July 2014 https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/blood-borne-viruses-in-the-haemodialysis-capd-and-renal-transplantation-setting-july-2014.pdf [accessed 2021-03-21]

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