Nocturnal dialysis - video transcript

Anthony Crump 0:14
Hi, I'm Anthony Crump and I have kidney disease.

Sridevi Govindarajulu 0:37
Hi, I'm Dr. Sridevi Govindarajulu, one of the nephrologists and the Director of the Renal Unit at Toowoomba. This is basically our new Dialysis Unit. This was purpose built for nocturnal dialysis treatment. We have 10 stations here, which we use for training purposes and for patients to have dialysis for respite purposes and also some of our patients to have nocturnal dialysis treatment in the facility at night.

Sharon 1:13
So my name is Sharon and I'm one of the Clinical Nurses in the Home Dialysis Unit. I work specifically with hemodialysis patients. So dialysis is a therapy that replaces the function of your kidneys when they fail. So you think about the fluid that you drink, your body depends on your kidneys to excrete that excess fluid. And also the waste products that your body accumulates. If those elements are allowed to accumulate, your body can't continue to function. So you require dialysis to balance everything.

Life on dialysis is very restrictive. So most people dialyze either every alternate day, or at least three times a week. And at the end of the day, the more dialysis you have, the healthier you are and the better your long term prognosis is. We have a very wide age group. We have a fellow who came to us when he was 16. He's now 18. And probably the oldest person we would have would be in their late 70s. I've known Anthony since he was around 25. He started his dialysis career in center so he was supported by nursing staff. I think that the transition to dialysis was difficult for him because of his age, and also his family circumstances. He had young children. Yeah, just the stress that was associated with life and health problems would have been difficult.

Anthony as a patient, I don't want this to go to his head, but I think he is amazing. It's just been beautiful to see his progression and to see how motivated he is. And he has become an outstanding advocate and support person to other people who were perhaps looking down the barrel of having to start dialysis or on dialysis and struggling.

Anthony Crump 3:53
I've been on dialysis for about five years going on six in January. I'll come in at night time drive in my own, so I'm here for about nine hours through the night. Yeah, pretty time consuming really you just get set into a routine and that's pretty much just got to do it I suppose. I come in, wash my hands and I try and lay everything out prepare it all, sit and wait for the machine to do its thing while I'm doing more preparations to set myself up for the night.

Before I did the training at the back, I kind of watch the nurses, how they did it, and I pretty much just taught myself, so when I went out the back to train, instead of doing it in six weeks I think I was done in four weeks. So yeah, I was able to go home a lot earlier than most patients. Yeah, pretty much it was pretty scary at first then. Well, you know, you've just got to take charge with it, I suppose.

Then I just connect up to the machine and it just comes out of the arterial pressure comes around into the filter then it catches itself in a bubble catcher and it comes back into the venous then.

I pretty much do it for myself really most of all because, that sounds a bit selfish, but if I can't do for myself then I won't to do it for my kid in the long run so it's pretty much, I come first, then you know what I mean, he's there kind of thing so got to look after myself so I can do my responsibilities, priorities. I like going 10 pin bowling with him really something different, instead of you know, it's always football with me and him or we're wrestling and stuff, so yeah, I just like chilling out with him really, play a bit of Warzone together. He's cool, he's good kid - I've had no problems with him, he's awesome.

Sophie Morris 6:36
Nocturnal dialysis isn't new, it's something that's been going on for quite a while. But I guess we're unique here in that we have set up this building so that patients can come and use the facility by themselves without staff. And we do this in another facility as well. We have a patient who uses Cherbourg Hospital overnight, we have a patient that uses the hospital there and they're completely independent with their care but inside a hospital building. Nocturnal dialysis empowers patients because they are free to do what they like during the day. Most people do it at least three nights a week but most people do it every second night so they have less fluid restrictions, they have less dietary restrictions. Some people are able to maintain, you know, full time jobs because it frees up their day and they're not on a dialysis machine three days a week for five hours.

Anthony Crump 7:31
The nurses here in the Renal Unit, they probably I don't know I don't want to say better but yeah they're a lot more polite, patient, you know they see the same patients every day pretty much so they'd rather see you do better than bad so they try and push you in the right direction. My kidney is probably better, I don't know, but a few of patients reckon you don't realise how sick you are until you have another kidney. It's pretty much like a silent killer, you know, it's not like heart attack where you get pain in the heart - I felt like I had the flu, then you know, I didn't go to hospital for about four-five days later because I kept fighting it and then, pretty much left it too late, almost too late. If I could tell anybody anything, don't be forced into something you don't want to do. So if you need to be healthy, be healthy instead of getting a doctor's, because you aren't going to like it when the doctors tell you the truth that you need to go to gym and do whatever, so just try and work on yourself before it's too late. Yeah, don't save it for the last minute because you might not have that minute.

Sridevi Govindarajulu 9:03
The Clive Berghofer Dialysis Unit is now about a year old. Previously, we were working off from the main Renal Unit, but due to the space, confidentiality, patient care, all of those factors prompted us to move into a bigger unit. The greatest advantage of this type of dialysis is empowerment. Tony is unique, Anthony Crump, he used to be on nocturnal dialysis at home at Oakey but because he's recently moved in to live with his parents and there are too many people at home he's no longer able to continue to dialyze at home at night and that's what we refer to as nocturnal dialysis is dialysis at night. And with Tony's body weight, we were struggling to maintain his clearances on dialysis, whereby we are removing adequate level of the kidney toxins, we couldn't do it in five hours. So we had to really get him back on to eight hours dialysis in order to achieve optimal clearances. And the only way we could do it was through nocturnal dialysis. And being in the new unit, it was quite innovative, where the nursing staff came up with the idea, whether we could just start dialysis here for Tony as a nocturnal patient, and I have to really commend Josie as well, who's our Nurse Unit Manager. It can be quite isolated, but there is a buzzer he can buzz in case there's any crisis overnight when he's doing his own dialysis treatment. He was already doing it at home, so it was really second nature for him. We had to just make sure that it was a safe environment and we had all the buzzers necessary, in case there was a crisis for crisis management. And with the eight hours dialysis, this is particularly relevant in Tony because he's going to be a future transplant candidate. And he's currently been down to P.A. hospital and hopefully will get a transplant in the near future.

Anthony Crump 11:13
I do nocturnal and I've tried to encourage a lot of younger people to try and do the eight hours instead of doing five, it's more better and you know, it frees you up a lot, they've got more time for the day really. Most of my time here, I was pretty much just trying to lose the weight to get on the transplant list. So hopefully I can, you know once I get a kidney I can go back to work, so that's, that's pretty much my goal really to go back to work. I don’t know you just feel more in control probably because it's, you're taking care of you life really, you know, it's pretty much not in the hands of somebody else. You know if I do something wrong when in and, you know, it affects me it's not you know, you can't pass the blame to the other person because it's my problem. Yeah, you know, that's how I feel. I don't really feel any power or anything, when I do it but yeah, it's just to me, it's routine, normal thing every second day for me, like it's part of my life. It's who I am. I can't change the fact that you know, I mean I've got to come here every second night and do it. it's like a job. You just do it, because you have to really.

I'm all done now, so I just head home, get my boy ready for school and make him some breaky.

Sharon 12:36
He said to me one day that he feels like his life is on the right path because of dialysis. He feels like if dialysis hadn't have happened, he maybe might have taken a more destructive life path. Yeah, I think that's really significant.

Sridevi Govindarajulu 13:19
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