A Room of Its Own
New Dialysis Center Opens

BY THERESA JOHNSTON

16-year-old Valerie Retiz (left) shares a laugh with her sister, Vanessa.

WINTER 2007-- It’s a typically busy Wednesday afternoon in the new Pediatric Dialysis Treatment Unit at Lucile Packard Children’s Hospital. At one station, 16-year-old Valerie Retiz of Watsonville, Calif., works intently on a jigsaw puzzle, seemingly oblivious to the lifesaving machine at her side that’s filtering impurities from her blood. At the next station, 13-year-old Jacqueline Castillo of San Jose, Calif., quietly passes time watching the Disney Channel. Not far from her, a yellow Labrador is visiting patients as part of the hospital’s pet therapy program.

As he makes his rounds, Steven Alexander, MD, couldn’t be more pleased. For years, he notes, Packard Children’s outpatient dialysis unit was isolated from the rest of the hospital in a stuffy, narrow room that was depressing for kids and nurses alike. The biggest drawback was its small size--only two young patients could be accommodated at any one time. ''We had to send most kids over 15 out to other facilities,'' recalls Alexander, who serves as medical director of dialysis and kidney transplantation at Packard, and director of pediatric nephrology. ''We had teenage dialysis patients in adult dialysis units with 60-year-olds up and down the Peninsula.'' 

Packard’s new 3,000-square-foot dialysis unit, which opened in April off a sunny courtyard near the Day Hospital, can handle six young patients at a time, up to 24 a week. Its equipment--including new dialysis machines donated by the Hospital’s San Francisco Auxiliary--is state-of-the-art. And depressing it is not.

Steven Alexander, MD, explains a procedure to dialysis patient Ricky Jolivette.

On one end of the long, citrus-colored room, children can gaze out onto a patio planted with bright pink-and-white impatiens. On the other end, drawers are loaded with coloring books, puzzles, and other toys. Overhead, new flat television/ computer screens hang above each reclining chair, allowing patients to play video games, watch TV, or keep up with their homework. If a child wants privacy or a nurse needs to perform a dialysis procedure, a touch of a button lowers shades from the ceiling. 

''I just like the way you feel when you walk into it,'' Alexander says of the unit, which he lovingly designed with the help of Packard Children’s chief biomedical engineer, Dean Peterson, and a team of physicians, nurses, social workers, and child life therapists, headed by the architectural firm of Hawley Peterson & Snyder. ''Yes, you’re entering a dialysis unit. But it’s light, it’s cheerful, and the colors are bright. If you stand on your tiptoes you can see the mountains.''

Jacqueline Castilo enjoys coloring with siblings Jose Luis and Sofia while she undergoes treatment.

Dialysis, of course, would not be high on any kid’s list of fun things to do. The procedure involves connecting a patient, via two long, flexible catheters, to a hemo-dialysis machine about the size of a home water heater. Then the child must stay put for three to four hours while the dialyzer circulates his or her blood through a filter that gently extracts waste substances and excess fluid. Usually the treatment is prescribed three times a week to support children while they wait for kidney transplants. 

Alexander is particularly eager to show off his new unit’s water filtration system, which ensures that the dialysate solution used to cleanse his young patients’ blood is completely sterile and free of undesirable trace elements. When visitors come in to see the water treatment room, he proudly passes out samples of the ''ultra-pure'' water in plastic wine goblets. ''You can’t make it any purer,'' he shouts over the hum of the pumps. 

Alexander with the new unit's water filtration system.

Water quality is extremely important in these systems, Alexander explains, because when the dialysis water contains contaminants like bacteria or chlorine, infections can occur and patients tend to suffer more from chronic inflammation--and that can lead to long-term health problems like hardening of the arteries. ''Life expectancy is now up to 50-plus years for a child with end-stage renal disease,'' he notes, ''so we have to be thinking now about their health as adults.''

The new equipment should be particularly helpful for long-term dialysis patients like 17-year-old Ricky Jolivette, of Pacifica, Calif. Ricky has had problems with his kidneys since infancy; he’s already had two transplants, and is now waiting for his third. Three times a week, for the past year, his grandparents have been shuttling him to Packard for his three-and-a-half-hour treatments.

In the old dialysis unit, Ricky says, there was only one television set, and he had to wait for a nurse to change the channel. Now, with the big, new flat screens, it’s easy for him to surf the auto websites he enjoys, or catch up on his favorite television show, Law & Order. 

Another person who appreciates the new unit is Chris Holzberger, of Watsonville, Calif. Working around her job at Safeway, she brings in her 16-year-old niece, Valerie, three times a week. Valerie has suffered from lupus since she was 7 years old, and now her kidneys are failing. The family is hoping for a transplant within a year. 

Holzberger has nothing but kind words to say about Packard’s staff. But the old unit was so cramped that there was barely any place for her to sit. ''This place is much roomier, and they’ve got TV, games, and puzzles to keep her occupied so she doesn’t get squeamish,'' she says, nodding at Valerie. Another plus is that the girl can interact with more kids in the new unit. ''It makes her feel not so alone.''

Alexander’s next goal for the unit is to set up a training room, furnished like a child’s bedroom, where parents can learn how to administer home peritoneal dialysis. In those treatments, the dialysate solution is instilled through a tube into the child’s lower abdomen, where it absorbs waste products and toxins before being drained, measured, and discarded. 

Packard's new 3,000-square-foot dialysis unit opened in April.

Usually it takes a couple of weeks for parents to feel comfortable doing peritoneal dialysis. But at least in the new unit they’ll have a pleasant place where they can learn--and nurses to teach them. One of the best things about the new unit, Alexander says, is that it has allowed him to recruit a full team of ''rare and wonderful'' nurses who are specialists in pediatric dialysis. 

In fact, he says, it’s pretty rare and wonderful to have an on-site outpatient dialysis unit at all. ''What this allows us to do is have sicker kids in an outpatient dialysis setting whom we can see as part of our daily rounds. It really increases the opportunities for physician-patient-family interaction,'' he says. ''It’s another sign of the commitment this hospital has made to providing first-rate, absolutely top-of-the-line care in everything.''