[VentWorld Note: originally posted July 10 2000]
My good friend (a 54 year old, white male with a C-6 spinal cord injury which occured in 1979, 21 years ago) is currently hospitalized in Erie, PA in a medcal center's Medical ICU floor due to health complications. In January 2000, he began outpatient dialysis. At first, the dialysis caused his blood pressure to bottom out 2 or 3 times. Then, after extensive tests and proceedures which led to additional complications (see below), they learned how to control his blood pressure with medications (takes a blood pressure pill before dialysis, and something afterward if needed). These early complications of dialysis have greatly weakened his respiratory system and he is now using a ventilator. His goal is that he will only need to depend upon the ventilator at night until he eventually loses his ability to breathe independently (which could be months/years off yet, we hope).
Early Complications of Dialysis:
Doctors tried to find the cause of his blood pressure bottoming out, so they used a doppler test and found clot in his leg. They then put him on heparan to disolve the clot, but this caused a right side peritineal bleed, so they discontinued heparan and instead put a filter in his aorta to catch the clot, if it loosened. He then developed sepsis and became really sick, and was partially comatos because his respiratory system became too weak to allow him to breathe properly. As a result, he was put on a ventilator. He has never really regained his strength to date.
The outpatient dialysis centers in the area refuses to accept individuals who are vent dependent due to their policy (they do not have a respiratory therapist on staff and/or it is too much liability). The hospital does not provide outpatient dialysis, only in-patient acute dialysis. So, once he is released from the hospital, he may, and, in all liklihood will, be refused appropriate life-saving medical care because of this aparent catch 22.
As of today, July 10, 2000, at 10:00pm, there appears to be at least three such patients (counting my friend) who have become or are about to become more or less permanent patients in the hospital's Medcal ICU because they need dialysis and are ventilator dependent and cannot receive dialysis anywhere else except in the hospital soley because they are ventilator users.
We are asking everone we can reach if there are any known medical risks associated with receiving dialysis while using a ventilator, and to tell us how other individuals in similar situations get these services in their communities.
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I am a respiratory therapist and I have cared for ventilator patients in every setting imaginable. There is no contraindication for dialysis just because the patient is on a ventilator. If this patient goes home on the ventilator, there is even less liability (if in reality that is possible) because the patient and his family/caregivers maintain the ventilator, and a respiratory therapist is not needed to be present at all times (usually no more often than once monthly).
The hospital or outpatient dialysis center should be willing to let the patient sign a waiver of liability for the ventilator while he is receiving dialysis. I am sure his insurance company would get involved if they have to pay the bill for ICU care just because of the need for dialysis. I would get the local tv station involved too. It is rediculous that a patient can live at home on a ventilator without a respiratory therapist present, but can't go to a medical facility for out-patient treatment because he is on a ventilator.
This could (and should) be a cooperative effort between the home care company providing the ventilator for the patient, and the dialysis facility. The home care respiratory therapist could train the nurses or technicians at the dialysis center how to monitor the patient and the ventilator, to put them at ease.
This is a do-able thing. There is no good reason that I am aware of for this not to work.
It can be very safe to receive dialysis while on a vent. I am also a respiratory therapist and have worked with multiple respiratory and renal failure patients. I think dialysis centers are scared that something will go wrong with the vent and they will maintain liability for any problems caused by lack of knowledge and, therefore, inadequate response.
What area do you live in? I may be able to recommend a source for you.
I am a Director of Nursing at a LTC vent home. We handle these situations by having the doctor switch the person over to peritoneal diaylsis. This makes a huge difference on acceptance into community based homes. Maybe have the person talk to the Dr?
I am a nurse working with vent clients in home care setting and hemo diaylisis or PTN diaylisis is not a problem in home care. if you have the right home care agency. most hospital social services directors can give you the information you need to help you pick the right home care agency for your needs. being vent dependant you should also consider getting a respiratory home care agency that can come out to your house and do your treatments in home for your convience.
I have a List of home care agencies and Respiratory agencies for the state of MN if you need information in this state. if you are in another state try a county social worker they usually have listings for their state and county.
I am in the same situation,my sister wants to come home on vent,but no dyalysis center will accept.I live in TN.I guess i will learn the home dyalysis.
|<Frustrated in Montana>|
I have a friend who is 43 and has been a quad for 2yrs. this June 05. I've been trying to find caregivers for him here in Billings, MT but no one seems to want to help because they say he's a liability on the vent. He can go up to 10hrs. without it and I'm still getting the run around with medical personel and medicaid. I am willing to help him in the night if someone could be with him during the day so that I can work. We talk everyday, two times or more a day and I have not been able to see him in a year, he knows that I love him, I send him tea, chocolat, jerky, gum, cd's and that is what keeps him goin. The hospital he is at, Queen of the Valley in Napa, CA wants to move him. He's already been moved twice in less than a year. The hospital's attorney says that he is TRESPASSING and he never wanted to be in California in the first place! He wants to be here in Montana! Please help and give some advise what i can do to get him back.
My mother is critically ill on a ventilator and dialysis. The hospital wanted to place her at a home over 200 miles away, and I am refusing/stalling. I have also asked if I can sign a wavier of liablity with the nursing home (and am waiting for a response)where she was previously and where we are still holding a room. They do ventilators OR dialysis. Does anyone know of an option for vent and dialysis together in Westchester, Orange or Putnam Counties in New York State?
Can you give me some information or help with a center for vent/dialysis elderly mother, lives in Shreveport, LA, but the center is trying to transfer her to a facility in Chicago, she's all I have and I nor have she ever traveled, are being apart since I been born, please help me, I know its got to be a place closer than Chicago.
My father is in the same situation. No nursing home or outpatient dialysis clinic will accept him as a patient. He is using a Trach collar during the day and a ventilator at night. The doctors have been very negative with wanting us to make a decision to let my father pass away (because he doesn't fit within the norm) but he is very aware of what is going on and wants to continue treatment. We will be going home with a home ventilator and doing home hemodialysis. I am not aware of any complications with needing dialysis as well as the ventilator. I think the complications that your friend will face will be the usual complications any dialysis or ventilator patient would face.
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