Last updated: Dec-7-2004
DISCLAIMER
I am a patient, not a doctor
This information is based upon my own experience
Any medical advice should be approved by your physician
From now on your life will be dependent upon a machine. But don't forget, we are also dependent upon refrigerators, ovens, cars, computers, and many other machines.
Don't see this day as the end, it is the beginning of your new life.
Kidney failure is a very unique disease that can be treated for many years and let you go on with your life.
For your first treatment, and maybe the first few, have somebody coming with you. You may be too nervous to drive and to remember everything they tell you. After the treatment you may feel fine but maybe not for driving.
When you sit in the chair your friend can call the nurse if needed, bring you something, cover you with a blanket, recline the chair and help you pass the time.
Bring a few things to pass the time, books and games. In many units there are TV's, if not get yourself a hand held one, or a radio, or a laptop.
See how much room you have for your belongings. Your friend can help in arranging things you bring with you.
It is a good idea to visit the unit before you go for your first treatment. You'll have ample time to find the place and to park, you'll meet the staff and other patients, and you'll get the "feeling" of it.
Be prepared for a cold air-condition, summer and winter. Remember that you have to sit there for hours. Don't wear shorts or sandals and have warm clothes and a vest. Blankets are usually available in the unit.
In most units you'll have to wait in the lobby until called. Children are not allowed, in some places no visitors are allowed. Once inside, you are expected to weigh yourself and to take your temperature. Your weight is taken in kg, multiply it by 2.2 to convert to lbs.
Your temperature is in degree Celsius. 36 to 37 is normal (96.8 to 98.6 F).
You are also expected to wash your access site. Every center has its own way of doing that.
To save time I take a hot shower at home then put on a clean shirt.
Hopefully the center's doctor will see you. A doctor must prescribe the dialysis treatment, this is not the job for the staff.
You'll have to fill a lot of paperwork too. Consent to the treatment and other stuff. Copies of these forms will be filed in your chart. You may change everything you signed at a later time.
The preparation for dialysis may take 15-25 minutes. You sit on your chair and the dialysis technician sets the machine and connects you.
Above the machine you'll see bags of saline. This is sterile water with 0.9% salt. It is used to rinse the machine, to give you some fluid if needed, and to push the blood back to you at the end.
Another name that you may hear is heparin. This is a medication that prevents blood clotting when it is outside the body. Heparin is usually injected after the needles are in place. In addition you may have a continuous flow from the machine.
Note that most of the staff is not RN (Registered Nurse) but technicians. Some of the techs have more experience in sticking needles than the nurses. Only in dialysis non-RN techs may stick needles and give you saline and heparin. Medications like EPO are administered by RN only. The good news: no more shots. In almost all units EPO and other medications like iron or antibiotics are injected via the plastic tubing.
If you have a catheter in your neck you won't need needles. If you need needles, the first few times smaller needles are used. Don't get scared, big needles don't hurt more than small ones.
Commonly used needles, gauge color code:
#15 blue--- larger
#16 green
#17 orange
#18 pink--- smaller
Inserting the needles is no fun, but you'll survive, and over time it will be easier. If you are real chicken ask for numbing shots. I have never used them.
Another option is to numb the access by a cream that you put on it about 1 hour before dialysis.
To learn more go to Emla Cream .
After a needle is inserted you should hardly feel any pain.
If you have a graft (plastic tube in your arm) you have to tell the tech which side your artery is on, they will help you with this.
Both needles are poked in your dilated vein. However the lower needle takes the blood to the machine and is called the arterial needle and the higher one returns the blood and is called the venous needle.
Remember that once in a while the needle may punch through your vein and cause a blood leak under the skin.
This is called infiltration and may happen even to the most experienced nurse. Don't panic, but you'll have a blue/purple bruise for a couple of weeks.
While on the machine, don't move your arm too much, or you may do it to yourself.
When your blood is moved through the machine it doesn't touch any internal part of it and it is confined to the plastic tubing, which is disposed after use. The dialyzer may be reused and in that case your name should be marked on it.
Before, during, and after the treatment your blood pressure is taken. Ask about the reading and be familiar with your numbers. A sharp decline when connected means that you lost too much fluid.
After the needles are in place the tech will connect the arterial line to the machine and the pump will start sucking your blood out (scary term but true). After the lines and the dialyzer are filled the other line will be connected to your venous needle. Once the circuit is closed the pump will be set slowly to the desired speed.
From now on you are dialyzed. The machine cleanses the blood from toxins and removes excess fluid.
The machine may beep from time to time because of internal alarms. Don't be upset if it takes a couple of minutes for a tech to come.
Your diet on dialysis is different from what you had before. For starters you can eat more protein. If you haven't yet talked to the dietitian, that's the best time. Over time your medication may change, for instance you may reduce or terminate your BP medications.
Your diet and medications will also change when your urine output is reduced significantly.
This may take from a few months to a few years.
Sooner or later you will also meet your social worker.
Check if you are allowed to eat and/or drink on the machine. In many centers they won't let you. If you can, don't overdo it, and eat only foods that are on your diet.
Have a cell phone. A few units won't let you use it. I don't know why. The machines are not sensitive to the cell phones, if they were, cells would have been banned everywhere.
Dry weight is your desired weight after excess fluid is removed from your system.
You may hear the term UF (Ultra-Filtration) which is the removal of fluid from your system. UFR is the rate of UF, or how fast fluid is removed, measured in gram/hour.
You may see on the machine your goal (total desired UF), UFR, and how much was actually removed. There is also a timer showing how much time is left for you. Don't be shy, ask where this timer is located.
On your first treatment they won't try to pull too much fluid from you unless you have accumulated a lot of fluid in your system. You may also run for a shorter time and at a slower blood flow.
Your dry weight is estimated by your doctor, based on your input. If they try to pull too much fluid you will have low blood pressure and may feel dizziness and nausea. Tell them!
You may also have cramps in your legs. Call a tech the moment you feel them start.
Don't stretch your legs or you may inflict cramps upon yourself.
You may have to sit there for about 3 - 4 hours. Don't move your dialysis arm a lot, keep it at rest. At the end your blood will be returned to you and the needles removed (almost painlessly). After you stop bleeding and your arm is taped it is time for two more BPs, one sitting and one standing.
Get up from your chair slowly. If you feel dizzy SIT! Then try again. Do the same at home.
After that you have to take your weight and temperature once more and you are free to go.
You may feel exhausted for a few hours or for the rest of the day. This should improve after your dry weight is fine-tuned.
Don't try to learn everything on your first treatment (or the second), but you have to talk to the dietitian ASAP.
Soon enough you'll receive a few vaccinations, like hepatitis B and pneumonia. These may be repeated every few years.
Flu shot is recommended annually in the fall.
The kidneys clear most medications, so if you don't make any urine you may need smaller doses. I usually received half the regular dose of antibiotics. Remind that to your doc. In general you should receive or at least consult your neph about any treatment or meds that are prescribed by another doc.