Leaving on a jet plane: flying with a PD cycler or NxStage System One
When you choose home dialysis, you can travel without having treatments at a center you don't know. Instead, you can do your own treatments. And, you don't have to plan your work trip or vacation days around when a center has slots for you—you can choose your own schedule, too.
This article covers air travel with a PD cycler or NxStage System One home hemo machine. We'll tell you your rights under United States law, help you see if your machine will fit on board or must be checked as luggage, tell you about dialysate, and share some handy travel tips.
Travel tip: When you make your travel plans, call and ask if the airline has a Disability or Special Assistance Coordinator. This person can help you work through the airlines' systems.
Your rights when you fly
The Air Carrier Access Act (ACAA) of 1990 says airlines can't discriminate against people with disabilities. The law applies to both U.S. and foreign flights. The U.S. Dept. of Transportation (DOT), which oversees air travel, has rules under the ACAA to help people with disabilities travel by air. These rules, called 14 CFR Part 3821 cover your rights when you need an "Assistive Device"2—like a portable dialysis machine.
These rights include:
- Not counting your machine as a carry-on item if it fits in the overhead bin or under the seat in front of you on the plane (Section 382.41(d)).
- Help to stow and retrieve your machine as a carry-on (382.39(b5)).
- Stowing your machine so it is one of the first things off the plane at the end of the flight, if you checked it as luggage (382.41(f2)).
- Giving your machine priority over other bags if space is limited (382.41(f3)).
- Baggage liability limits don't apply if the airline loses or harms your machine—they must pay based on the purchase price (382.43(b)).
- You can't be asked to sign a waiver of liability for loss or damage (382.43c)).
Your rights when you check a dialysis machine as luggage are less well known. Some airline counter agents will try to charge you a fee if you have two suitcases plus a machine. Some will try to charge you if your machine weighs more than 50 lbs. Some do both. DOT spokesman Bill Mosley says, "We've told carriers that they shouldn't charge for dialysis machines, which are assistive devices." Under the ACAA (Section 382.57), the airlines are not allowed to charge you for your dialysis machine.3
Here is the section of the manual that tells the airlines that they can't charge you:
Question: Are airlines allowed to charge for providing services to passengers with disabilities?
Answer: Airlines are not allowed to charge passengers for providing services or accommodations required by part 382, but may charge for optional services or accommodations. Examples of required services for which carriers may not charge are assistance with enplaning, deplaning, and making flight connections, and the carriage of assistive devices (including the provision of hazardous materials packaging for wheelchair batteries, when appropriate). Examples of optional services for which carriers may charge are the provision of in-flight medical oxygen and stretcher service. [Sec.382.57]
Carry-on or checked luggage?
Our table below lists the nine largest airlines, their phone numbers (with voice mail prompts), and their carry-on bag limits. You can use this information to measure your PD cycler—inside its case—to see if it will fit on the plane or must go as checked luggage. Note: The NxStage System One is too large to fit in any airplane cabin and can only go as checked luggage.
| Airline (Phone Number) |
Carry-On Size Limit (must fit in an overhead bin or under seat) |
|---|---|
| American Airlines 800-433-7300 (Press 2, then 1) |
45 linear inches (length x width x height) & 40 lbs. |
| Alaska Airlines 800-252-7522 (Press 3) |
51 linear inches (10" x 17" x 24") |
| American Trans Air 800-225-2995 (Press 4) |
11" x 15" x 15" for under seat; 9" x 15" x 25 for overhead bin |
| Continental 800-525-0280 (Say "Other") |
51 linear inches and 40 lbs. |
| Delta 800-221-1212 (Say "Reservations Representative", then say "Something else") |
45 linear inches (22" x 14" x 9") and 40 lbs. |
| Northwest 800-225-2525 (Say "Agent") |
45 linear inches (22" x 14" x 9") and 40 lbs. |
| Southwest 800-435-9792 (Live humans!) |
50 linear inches (10" x 16" x 24") |
| United 800-864-8331 (Press 3, then say "Agent") |
45 linear inches (22" x 14" x 9") |
| US Airways 800-428-4322 (Press 4, then 1) |
51 linear inches |
Travel tip: See this list of many more airline toll-free numbers and websites.
Medications and syringes
Bags go astray. It doesn't happen often—and when it does, they most often arrive on the next flight—but it does happen. To be safe, always pack all medications in your carry-on bag—never in your checked luggage.
Airplanes don't have refrigerators, so if you have a drug that must be kept cold, ask your pharmacist how to package it for travel. If you bring syringes, you must also bring along the drug you inject, like insulin or EPO. And that drug must have a professionally printed label that says what it is. There is no limit to how many empty syringes you can bring—as long as you also have the drug with you.
Airport security
If it has been a while since you took an airplane trip, you may find that some things have changed. You can only go to the gate if you have a ticket for a flight that day. You can't bring any kind of fuel (including a cigarette lighter), knives—of any length—or other weapons, toxic chemicals, or anything that could explode. Nail clippers, tweezers, knitting needles, and scissors with blades shorter than 4 inches are okay to bring in carry-on bags.
Bring a photo ID with you, plus your boarding pass. You will put your carry-on bags onto a belt to go through an X-ray machine. Ask for help if you need it to lift your cycler onto the belt. Because most airport security guards have never seen a PD cycler, you may have an easier time if you bring the manual for your machine and/or a letter from your doctor to explain what it is.
You'll also need to remove metal from your body before you pass through the metal detector. Gold or silver jewelry will not set off the detector in most cases. Coins, belt buckles, cell phones, and shoes may have metal that will set off the detector. Wear shoes that are easy to remove; you can ask for a chair to make this easier. If you set off the metal detector, the security guard will ask you to step aside for a more careful search.
If you have an insulin pump, a pacemaker, a steel plate in your body, a prosthetic limb, or other hidden medical devices, tell the security guard before you go through the metal detector. It's a good idea to have a letter from your doctor to explain what the device is—especially if he or she suggests that using a metal detector or hand wand to detect metal would be harmful to you.
Preboard the plane
As an assistive device, a PD cycler has priority for stowage. Be sure to measure it first so you know it will fit in an overhead bin or under the seat.
If you plan to bring your cycler onto the plane, tell the gate agent, and ask for help to get your cycler on board and stowed if you need it. When boarding starts, the agent will ask for "passengers who need assistance or extra time getting down the jetway." Board then, to be sure to have room to stow your machine.
About that dialysate...
When you do PD or use a NxStage machine for home hemo, you'll need to bring dialysate on your trip, too. Plan ahead so your supply company can ship most of the boxes to where you're staying. The airlines should take a day or two of dialysate without a fee for extra or overweight luggage—but more than that will cost you money. For the airlines, all supplies must be in their original boxes, with the contents clearly labeled.
If you'll be staying in a hotel, call ahead and talk to the Bell Captain or Hotel Manager. Explain that you will need to receive life-saving medical supplies for your stay. Ask if they can waive the fee for accepting packages (or charge you one fee, rather than per-box). Many hotels can provide a bathroom scale for your room. It won't be as accurate as your home scale, but beats bringing one along.
If you're doing PD, you'll need to warm the bags. An electric heating pad won't take up much room in your suitcase. Lay a towel down above and below the heating pad, and put the bag on top to warm it. Use the "low" setting.
Travel tip: When you travel with suitcases, the rule of thumb for tips is $1 per bag. When an item is heavy or you have many boxes, look for a Skycap with a large cart. He'll watch for your items, take them off of the baggage claim belt, load them onto the cart, and even help you find a cab.
Plan to tip $5-10 for your machine (based on how heavy it is) plus $2 per box. You'll also have to tip the cab driver and the hotel Bellman.
Back-up care
You don't need to arrange for dialysis when you travel on PD or with the NxStage for home hemo—but it's still a good idea to arrange for a back-up center in case you run into a snag. Talk with your home training nurse or social worker to find one. It's also wise to do some homework about nearby hospitals, and to carry a copy of your medical record and a list of all your current medications with you in case you need to be seen by someone who doesn't know you.
Travel tip: Print this article and bring it to the airport. Most people have never seen a portable dialysis machine. If you need to, you can show the article to the counter agent when you check in—it can help your trip go more smoothly.
Disability travel complaints
We hope your travel goes smoothly. But if you have a problem, you can report it to the toll-free DOT Disability Hotline at 800-778-4838 (voice) or 800-455-9880 (TTY).
Happy travels!
References
- U.S. Department of Transportation. 14 cfr part 382: Nondiscrimination on the Basis of Disability in Air Travel.
- What Airline Employees, Airline Contractors, and Air Travelers with Disabilities Need to Know About Access to Air Travel for Persons with Disabilities: A Guide to the Air Carrier Access Act (ACAA) and its implementing regulations 14 CFR part 382 (page 8) and Appendix III: Frequently Asked Questions (page 147).
- Section 382.57 of 14 CFR Part 382 reads "Charges for accommodations prohibited. Carriers shall not impose charges for providing facilities, equipment, or services that are required by this part to be provided to qualified individuals with a disability."