Nightmares about dialysis are fairly infrequent for me, but when one comes it takes its toll. I wake up in a cold sweat, horrified, and unable to get back to sleep. The reason for dialysis nightmares is simple: there’s just so damn much that can go wrong.
For-profit dialysis providers—and they’re almost all for-profit—cut corners wherever they can to increase profits. After all, as corporations their sole function, by law, is to deliver value to shareholders; any provision of quality dialysis services is a byproduct—an unintended consequence. Of course, if one dialysis provider started killing off its customers, they’d proportionately start to lose profits. The problem is that there’s only two major dialysis providers in the US. Heads they win; tails you lose, as it were.
But back to the nightmares.
One of the ways for a dialysis provider to cut costs is to convince patients to participate in dialyzer reuse.
When dialyzers are reused, they are disinfected with poisonous chemicals—usually formaldehyde or renalin—after each use, then rinsed, and tested. I was a reuse patient for several years because I was told that more red blood cells would be retained between uses and I’d be less likely to have a reaction to new dialyzers. Besides, I’d be able to use a larger and more expensive dialyzer under reuse. Non-reuse patients were doomed to crappy, throw-away dialyzers.
While various studies in the US indicate no conclusive evidence of increased morbidity or mortality with dialyzer reuse, some older studies have shown increased mortality rates related to reuse. In other words, there’s at least some evidence that dialyzer reuse can kill you.
I stopped being a reuse patient after doing a bit of research and finding that the alleged benefits were refuted and the Europeans were reaching drastically different conclusions with their studies about dialyzer reuse.
“The fact that the symptomatic benefit attributed to reuse a decade
ago has now been refuted leads one to conclude that the sole reason for
practicing reuse is to reduce treatment costs.”
I was also having a recurring nightmare of being dialyzed with someone else’s dialyzer. I took it as a clear warning signal.
One of the big things that can go wrong in any dialysis unit is human error. Shit, after all, happens. Last week in my dialysis unit one of my dialysis nightmares became all too real: the dialyzers of two patients on either side of me were switched. Apparently the two patients had close enough blood types and no complications, as both were back for treatment later in the week apparently none the worse for wear. But this could easily have been deadly. Most frightening of all, a quick Google search for “wrong dialyzer” indicates this isn’t all that uncommon of an event.
When I was on reuse, the protocol was for a dialysis technician to sign off on the dialyzer and then for one of the nurses to separately sign off on it. But—surely as another cost-cutting measure—my unit is down to a single RN, a medications nurse (who may be an RN or an LPN), and fewer technicians for 16 patients at a time. Near as I can tell, the nurse doesn’t always sign off on reuse dialyzers any more.
I’ve always been fanatical about checking my dialyzer and potassium bath before sitting down. Once in the chair I ask that the machine be turned so I can monitor blood flow rate, venous and arterial line pressures, blood pressure, and the rate at which fluid is being removed.
Within the next month or so I’ll be moving to a different dialysis unit—one with only 12 patients at a time, a better physical layout for patient monitoring, and closer to home. It’s in the next neighborhood rather than the inner-city. But watching this particular nightmare play out in real time, in this reality, has me convinced to begin more earnestly investigating home hemodialysis.
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