Branden's Transplant

Branden started his peritoneal dialysis at home yesterday. He's taken over the guest room, which now looks like a hospital, and dialyzes about four times a day. In about two weeks we'll get the continuous cycling machine that will allow Branden to dialyze at night while he's sleeping, but for now the nurses want Branden to know how to dialyze manually, in case of emergency I guess.

The nice part about all this is that Branden doesn't have to go to the hemodialysis center down the street anymore. Also it only takes about two hours total to dialyze via peritoneal, instead of the usual four of hemo.

The difficult part of this process so far is that Branden still feels the same: Exhausted, swollen and out-of-breath. But please note that I didn't mention "nauseous." And that's a win as far as he's concerned.

Anyway, this is the process that Branden now follows for peritoneal dialysis. I think it's kind of interesting - and pretty amazing that anyone actually figured out how to do this - so I've outlined it below:

1) Branden (and anyone else in the room) has to first put on a mask. All doors and windows have to be closed, fans and/or AC turned off and pets out of the area. The object is to keep as many germs as possible out, of course, but to also make sure that none that are present can blow onto Branden's catheter while it's exposed.

2) Branden goes and washes his hands for one minute. He then turns off the water using a paper towel. Even though we anti-bacteria the bathroom every day, we've been told that bathrooms can never be safe enough when it comes to dialysis.

3) Branden uses a dresser as his "flat surface." He first scrubs the dresser clean with Purell hand sanitizer. Then he lays out his supplies, which include a catheter tip, a couple 2x2 cotton squares and some medical tape. Nearby sits a heating pad that's constantly warming Branden's solution.

4) Branden first hangs the warm bag of solution on a metal pole stand. He lays another empty solution bag on the floor. Using a cotton square and some medical cleaning fluid, he thoroughly cleans the end of his catheter and hooks it up to a new catheter tip. This is the dangerous part of the process. If any germs get on the exposed catheter they can go straight to Branden's peritoneum and cause a rapid and deadly infection.

The catheter tip keeps Branden's actual catheter even farther away from any germs though. And the nurse who came yesterday to check everything out assured us that if Branden follows the process outlined above, there isn't any reason he should have a problem with infection.

5) Branden hooks up to the plastic floor bag to drain his "dwell." The dwell is the fluid that's been sitting in Branden's peritoneal cavity since the last time he dialyzed (using the peritoneal method) about four hours prior. It contains all the funk that needs to come out of Branden's body and is the reason that peritoneal dialysis exists. It takes about 10 minutes to drain all this fluid.

6) Next Branden hooks up to the warm plastic bag hanging above his head. This contains one of three percentages of dextrose solution, depending on Branden's blood sugar at the time. Using the power of gravity, the solution slowly drains into Branden's abdomen. The process is usually painless, though Branden has complained of some mild cramping. (Warming the solution is supposed to alleviate most of this.) Branden also tends to feel full afterwards, just as someone would if they stuffed themselves with food.

And now for the amazing part: Once the clean fluid is introduced into Branden's abdomen, osmosis starts shifting all the toxins that Branden's kidneys are no longer able to filter across Branden's peritoneum. The peritoneum acts as a one-way filter; the funk can't go back into his body. It instead sits in his abdominal area and is only removed when Branden starts a dialysis treatment. (It drains into that plastic bag - Step #5.)

7) After all the warm fluid is in Branden's abdomen, he unhooks his catheter and removes the catheter tip. (Another dangerous moment.) He then re-covers his catheter and removes his mask.

Now for the housework: Branden re-cleans and bandages his catheter exit site (where the catheter enters his body) with the remaining 2x2 cotton square and some medical tape. Then he weighs and drains the dwell fluid. He takes his blood pressure, temperature and tests his sugar. Weighs himself. Starts warming another bag of solution on the heating pad. And then writes all this down for the nurses, who need to see his paperwork regularly in order for him to continue receiving dialysis at home.

Each treatment takes about 30 minutes from beginning to end. And in a few weeks they should only take place while Branden's sleeping. Add that to no nausea and I think we're going to be even better off than we are now...and just in time for the holidays!!