Reduce Travel Stress for Your Home Dialyzors

This blog post was made by Beth Witten, MSW, ACSW, LSCSW on July 23rd, 2015.
Reduce Travel Stress for Your Home Dialyzors

Helping patients live a full life, including travel for work or pleasure, is highly rewarding for dialysis staff and patients alike. Help your patients by making sure everyone knows how to plan a trip with dialysis the low stress way.

Educate your patients about travel starting in training and regularly afterwards. Be sure they know what you will do to help them and what they can do to help themselves. Information handoffs that fail and supplies that don’t arrive where they are supposed to are frustrating for you both.

You might consider writing a handout for their training manual that encourages your patients to let you know as soon as possible about their travel plans. When you educate them and create the handout, some things you will both need to consider include:

  • Will the patient do home dialysis while traveling or in-center treatments? Each requires different arrangements—and a very different time frame.
  • Will the treatment length or frequency be less? If so, the patient may need to switch to a standard in-center HD diet and fluid limits. Alert the dietitian and the patient! At least one patient has died on vacation when he ate his usual level of potassium, but got less treatment than he was used to.
  • Will the patient travel outside the U.S.? Alert patients that Medicare won’t pay for in-center dialysis outside the U.S. or its territories (Puerto Rico, Virgin Islands, Guam, and Saipan).

Below are some detailed questions that will arise.

If the patient plans to do home dialysis while traveling:

  • Will the dialysis water and electrical needs be met by the travel site? If not, what sort of accommodations can be made? (Examples: CAPD vs. CCPD, bagged dialysate for a NxStage System One, a generator)
  • Is any kind of accommodation needed for transportation or lodging? (Examples: assistance to make plane connections, handicap accessible hotel room, power strip, etc.)
  • If taking or shipping home dialysis equipment and supplies:

    • Is there a detailed checklist of supplies so nothing is left behind?
    • If something is left behind or the patient has a problem, whom should s/he call?
    • For plane travel, does the patient have the Department of Transportation guidance (see below) and a letter from the doctor confirming that supplies and equipment are medically necessary to avoid extra luggage costs?
    • How far ahead must shipped supply orders be made?
    • Who needs to order the supplies (patient or home training nurse)?
    • What paperwork is required to place the order?
    • Can an order be confirmed to track order receipt and supply delivery?
    • Is there a storage cost at the travel location until arrival?

If the patient plans to do in-center dialysis while traveling:

  • Does a nearby clinic have a treatment chair open? Planning months ahead—especially to hot travel spots or around holidays—and being flexible on dialysis days/times can free up more options. Clinic lists are available in several places (see list below) and some providers have national travel staff.
  • Will the clinic follow the patient’s prescription and support self-cannulation?
  • Does the clinic accept the patient’s insurance?
  • What is the expected out-of-pocket cost for the clinic? For the doctor?
  • Is pre-payment required?
  • What paperwork is needed, who will send it, and what’s the deadline?
  • Will the clinic at the destination confirm the reservation in writing?
  • Is there any chance the clinic may cancel the reservation or change the scheduled day/time of dialysis?

Find a dialysis clinic:

Booklets & fact sheets

With a little upfront planning and education, you can help your patients feel this way:

Traveling with my NxStage machine takes a lot of diligent preparation and meticulous planning for my entire care team, but the end result is worth all of the work. Once I first traveled taking my own machine with me, I never wanted to travel and go in-center again. The flexibility of dialyzing when I want to and at the frequency my body has become accustomed to makes vacation feel like vacation again.

Charles D., home hemodialysis

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Comments

  • miriam

    Jul 27, 9:16 PM

    Can I purchase a dialyzer & travel to Europe for PD???

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  • Henning Sondergaard

    Jul 24, 2:36 PM

    As someone who is away from home and in a different country several months a year I have a few additions to an otherwise well thought out and researched post.

    We need to acknowledge that for safety reasons those who do their treatments at home also need to look at the in-center list unless they can make it back home safely if a treatments fails and they need another one fast. So many things can go wrong and especially when in a novel environment.

    I was lucky enough to have to have someone sign off on my NxStage supplies at my US destination. I have a great relationship with the doctor who did that. We never see each other but I know if I ever need him, he and the clinic is there for me. I did have an acute exam one of the first times I was there so now I trust in that clinic 100%. Other than that he just writes scripts for my saline - the only thing I can't bring and that is not supplied for me.

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    • Beth Witten

      Jul 25, 9:00 AM

      Thanks for reminding me of some other tips I should have provided. You're right that when traveling, home dialyzors need to know where to go if they need to do in-center dialysis. It's good for the home clinic to alert a clinic in the area where s/he is traveling that one of their patients will be in their area and ask if that clinic can provide emergency backup. The home dialyzor should travel with insurance cards and a packet of current medical information that includes their dialysis prescription. I'd recommend taking the same information that would have been required for in-center dialysis just in case. This will be handy if s/he needs to go to a hospital, see a doctor, or do an in-center treatment. S/he should have the phone numbers of the home clinic and treating nephrologist too in case calls need to be made for any reason.

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