Voice of the Diabetic

Voice of the Diabetic

Back|

Next|

Table of Contents|

Home

Independent home dialysis possible

for blind persons

by Lois M. Schmidt, R.N., C.N.N

Lois Schmidt, R.N., C.N.N., is a certified nephrology nurse

formerly with the Peritoneal Dialysis Unit at Dialysis Clinics, Inc., Columbia,

Missouri.

Kidney failure is a disease occuring in about half of those people who have

diabetes. It presents new challenges to the person who may at the same time

be experiencing visual changes or blindness.

Preparation for dealing with kidney failure should include

a thorough education program to adequately assess all the choices for treatment.

Some patients who are eligible will seek a kidney transplant to replace their

failing kidney function. Others will decide to use a dialysis therapy. Those

who choose transplant may also require a period of dialysis treatment while

they await transplantation.

There are two basic types of dialysis therapies, with many

variations depending on the provider dialysis unit. Hemodialysis is usually

done at a dialysis clinic by specially trained nursing staff. However, it may

be done at home if the patient has a partner who can be taught to perform the

treatment. Peritoneal dialysis, commonly called CAPD (continuous ambulatory

peritoneal dialysis), is a self-care, home therapy.

Peritoneal dialysis works inside the body. It utilizes the

peritoneal membrane, which forms a "sac" inside the abdominal cavity,

to remove waste products and extra fluid from the body. This process is accomplished

by allowing dialysis solution to flow into the peritoneal cavity by way of a

permanent tubing, called a catheter, which is surgically placed through the

abdominal wall. The solution remains in the abdomen for four to eight hours

while the person goes about his or her usual activities. At the end of this

time, the dialysis solution is drained out and is exchanged for fresh dialysis

solution. This "exchange" is usually performed four times daily.

Special training is provided to patients choosing CAPD to enable

them to successfully use this therapy. All patients (including those without

visual problems) are encouraged to have a family member or friend participate

in their education sessions. Most people find it very reassuring to have a support

person available if needed.

The exchange procedure of CAPD can be performed by a blind

person using one of several assist devices available on the market today. This

specialized equipment, as with all home dialysis supplies, can be obtained through

dialysis units. For economic reasons, some dialysis clinics make use of supplies

from only one company and thus offer only one type of device. However, there

are at least four different types of systems available which may be used by

a patient with visual impairment and/or neuropathy (nerve damage) of the hands.

Some of the devices feature an ultraviolet light which provides extra protection

against infection. Others make use of large or recessed connections to help

prevent contamination. Each system has some special features which may make

it preferable for an individual patient's needs.

Another form of peritoneal dialysis is CCPD (continuous cycling

peritoneal dialysis). This type of dialysis makes use of an automated cycler

which is designed to operate while a person is asleep. The cycler is programmed

to exchange the dialysis fluid at periodic intervals during the night. While

this dialysis is more complicated than CAPD, it does allow daytime freedom from

exchanges. Also, it may be the appropriate choice for a patient who requires

the assistance of another person.

As with all things in life, peritoneal dialysis is not without

its disadvantages. The most serious potential complication of this form of dialysis

is the risk of peritonitis, infection of the peritoneal cavity. This infection

can usually be treated successfully with antibiotics. However, great care must

be taken by the patient to pay attention to cleanliness, so as to avoid infections

if at all possible.

There are also advantages to CAPD. One, particularly beneficial

for the diabetic, is that insulin may be added to the dialysis solution rather

than being given as an injection. Insulin administered in this way is absorbed

and used by the body in a way that usually results in good blood sugar control.

CAPD is a slow, continuous, gentle form of dialysis which provides a steady

chemical and fluid balance in the body. This can aid in maintaining normal blood

pressure as well as providing a sense of well-being. Also, since CAPD is performed

at home, the necessity of travel to a dialysis center three times a week is

eliminated.

CAPD has proven to be an effective form of dialysis for persons

with diabetes, including those with visual impairment and neuropathies. Extensive

education is required prior to the decision for choice of dialysis therapy.

Each individual must make his or her own decision based on careful evaluation

of needs, motivation and family support, as well as emotional and physical capabilities.

Those persons most successful with CAPD are those who are highly motivated to

participate in their own health care.

(From the Editor: I have received reports that sometimes, when

blind diabetics begin dialysis treatments, they aren't told about CAPD. Because

of the diabetic's blindness, his/her physician doesn't always explain the different

types of dialysis treatments. Unfortunately, it is, in some cases, assumed that

because the patient is blind, he/she won't be able to use CAPD therapy.

I visited Lois Schmidt, RN, CNN, at Dialysis Clinics, Inc.

(DCI) Peritoneal Dialysis Training Room in Columbia, Missouri. She showed and

explained to me step by step what CAPD patients, blind and sighted, must do

to successfully use this form of treatment. The training room contained a dummy

doll with a CAPD catheter connected to its lower abdomen. I actually went through

the process of hooking and unhooking the dialysis bags with and without solution

for the CAPD exchange.

All CAPD patients must be careful not to touch and contaminate

the ends of the catheter tubing, which could cause infection to the peritoneal

cavity. Blind patients are trained how to use the ultraviolet germicidal exchange

device. This instrument delivers a dose of ultraviolet light, which kills almost

all bacteria on key components of the catheter and exchange system connections.

Some dialysis units require that all patients, blind and sighted, use some sort

of exchange device when connecting and disconnecting solution bags. Lois Schmidt

said that, "When blind or visually impaired people become familiar with

the system, and can do it well and efficiently, they're no more at risk than

anyone else." She also said that when diabetes has advanced to the point

where the patient has lost his/her sight, they often, from neuropathy, lose

the feeling in their fingertips as well. It is imperative that blind patients

have fairly good sensory ability in their fingers because they must be able

to feel slots and/or openings to correctly use the ultraviolet germicidal exchange

device. DCI provides several days of step by step training for CAPD patients.

Lois Schmidt said that some blind diabetics may have difficulty

adding medication, such as insulin, to the bag if there is a problem with dexterity.

The insulin syringe needle is inserted into a small port, which must be prepped

with an anti-bacterial solution. There is a needle guide available that enables

blind persons to independently do this, but it is imperative that neither the

port nor the guide be contaminated. It doesn't take much bacteria introduced

into the port area to cause infection. The peritoneal cavity is a sterile area.

This cavity contains no white blood cells to fight infection. As soon as bacteria

is introduced, it colonizes, multiplies, and very quickly infects that cavity.

I am a blind diabetic who had no trouble with the CAPD exchange

procedure. It is important to realize that some dialysis patients, whether they

are blind or sighted, can use CAPD, and some cannot. It is well documented that

there are alternative techniques which enable blind citizens to participate

fully in mainstream society.)

Back to Top