My Home Haemo Routines (I’m a Creature of Habit)

“Motivation is what gets you started. Habit is what keeps you going.: Jim Ryan.

This post came about as a result of a post I made on the Home Dialysis Central Facebook Discussion Group about changing the filters, and from there, the realisation that perhaps talking about my routines may be of interest/help to somebody.

So the starting point, I guess, is to describe my setup. I do home haemodialysis, every other day, overnight (nocturnal) for between 8 & 9 hours, and that is the key routine that everything else serves.

I do my treatment solo—unassisted by a care partner. I have a dedicated treatment room and my machine is a Fresenius 5008s, plumbed into the mains water supply, and I live in North West England—midway between the cities of Chester & Liverpool.

We moved to our current home in 2020 and the installation work for home haemodialysis included the water supply and electrical work, with an additional pump to help with the removal of the waste, as it had to be moved further to reach the main drainage than the machine alone could cope with. The installation work looked like this:

There is a Rverse Osmosis system (R.O.) with two wall-mounted filter housing chambers, a water softener machine, a waste pump, and a water cut-off leak detector. Everything sits in/above a tray/reservoir to contain any unintended water spills.

There is a large space in front of the waste pump where the dialysis machine eventually will sit.

Once everything was installed and we were off and running, I found something that really helps me is my routines. I have several routines: for treatment, for stock ordering, for maintenance and cleaning. I’m very much a creature of routine.

With regard to maintenance and cleaning, the R.O. system needs the wall filters changing monthly. I do them on the first of the month, so that it’s a really easy routine to remember: a month change means it’s time to do the wall filters. You can see from the middle picture of these three the difference in condition between a new filter and a used filter. I also take this as the trigger for a deeper clean of the treatment room, so I steam-clean the floor and sanitise the shelves, power outlets, light fittings, switches & shades that aren't a part of the normal, day-to-day cleaning routine.

While I’m in the treatment room giving it a thorough going over, it’s also time to rotate and fill up all my supplies and place an order with my unit for items I’m going to need to cover the next month. Steri-wipes, blood vials, MRSA test swabs, wall filters, numbing cream, needles, and some medications come direct from my unit. My monthly review normally takes place in the first 10 days of the month, so it fits together as an ideal time to be doing it.

In addition to this routine monthly cleaning, I also have two further filters on the back of the machine to change every 3 months. However, I don’t need to remember to do this, as the machine gives a series of reminders in a 5-day countdown to this filter change becoming essential, and at the due date the machine won’t let me start treatment until these have been replaced.

The remainder of my supplies are ordered directly from Fresenius, on a 4 weekly rota: order on a Thursday, miss a week, delivery on a Thursday, miss a week and repeat. This means the orders don’t always match up with the calendar, as there are 13 of these 4-week cycles to the year, but at the moment they’re fitting into the same pattern and routine nicely.

Pre-treatment, I set my table up the exact same way every single time:

• Clean the table, hand-gel bottle, and tape with a sani-wipe.

• Lay a clean-field down over the table, with gauze nearest me in the centre.

• The clean-field that will go over my thighs when needling is to the left; skin wipes for needle sites are to the right.

• Above the gauze are two syringes.

• Above the syringes to the left and right are the two needle/tube sets.

• Along the front edge of the table are 10 lengths of tape to go across the arm to secure needles & tubes in place, and an orange waste bag.

• Along the side edge of the table are two longer pieces of tape for taping along the arm.

• To the right of the clean field, I have spare wipes, gel, and tape—just in case they’re needed.

This set up means that at a glance, I can tell if I’ve forgotten something.

The result of these routines is that I have mental security that everything is clean, properly maintained, in date and in good order, so that I’m in the best possible position to benefit from my dialysis. Getting the best possible treatment and the greatest amount of time is my overriding objective.