What hemodialysis is, and how to manage it.
What is hemodialysis?
What to Expect When you Arrive For Treatment:
1. When you arrive at the clinic the nurse will take your blood pressure, weigh you, and seat you in a chair next to the dialysis machine.
2. The nurse will insert two needles into the blood vessel that your doctor created. (Called an arteriovenous fistula or AV Fistula or AV Graft) The needles will be attached to two separate tubes that connect to the dialyzer machine. The nurse may also give you medicine at this time to prevent blood clots.
3. The nurse or dialysis technician will attach the tubes to the dialyzer and set it to the doctors orders. One tube will take your blood into the dialyzer and clean it, and the other tube will bring the cleansed blood back into your body.
4. You will be attached to the machine for 3-5 hours and about 3 times a week depending on your condition. While you are being treated you may relax, read a book, or have company with you to pass the time. The nurse will be there during the entire procedure to make sure everything is going smoothly.
5. Once your treatment is finished the nurse or technician will turn the machine off, and the nurse will remove the needles from your arm. You may need to hold a small bandage on the place the needles were inserted for a few minutes to help them seal and stop bleeding.
6. The nurse will have you stand slowly and make sure that you are not dizzy, and then weigh you. Once you are feeling ok you are free to leave.
Safety During Treatment
Trained nurses and dialysis technicians will be there to monitor you during treatment. Please let them know if you experience any of the following symptoms:
- Pain in your chest
- Shortness of breath
- Bleeding from the sites where the needles are inserted
- Feeling of being hot, cold, or having chills
- Headache or dizziness
- Upset stomach or the urge to vomit
- Muscle cramps
- Pain, warmth or redness at the needle sites
- If you aren't able to feel blood flow or pulse at your AV fistula or graft
Taking Care of Yourself At Home
Your doctor will provide you with a special diet called a 'renal diet.'
While on this diet it is important to remember:
1. High amounts of PROTEIN can be hard on your kidneys, but you will need to eat adequate amounts to keep your body healthy.
- Some examples of protein are meat, fish, cheese, eggs, and other dairy products. You may work with a dietician to find out what the right amount is for you.
2. SALT can make your body hold onto water. The purpose of dialysis is to remove water, so eating more than one half teaspoon of salt a day will make you hold onto more water.
- Foods that are high in salt are pickled, smoked meats/fish, processed foods(foods that are prepared), and snacks such as chips.
*You can use herbs and spices to flavor your food without the salt. Be careful about using salt substitutes because some contain potassium, which should be avoided.
3. WATER/FLUIDS are restricted to a special amount. This amount will be decided by your doctor after examination. It is important to follow your fluid restrictions because if not fluid can build up in your body and make your blood pressure increase.
*If you are feeling thirsty and are worried you will reach your fluid limit for the day it can be helpful to have some ice chips. Be conscious of the amount of ice chips you consume as your sensations may have changed and you can be at risk for cold burns.
4. POTASSIUM should be limited. During renal disease your body is not able to filter potassium out of your body. High levels of potassium can negatively affect your heart by sending it out of rhythm.
- Foods that are high in potassium are bananas, potatoes, cantaloupe, honeydew melon, spinach, red/white/pinto beans, artichokes, and fish such as cod, flounder, halibut, salmon, and scallops.
*Instead you may have: apples, peaches, pears, watermelon, and berries.
5. PHOSPHOROUS should also be limited. Your body also cannot filter phosphorous out, and for that reason your levels can become very high and be dangerous.
- Foods that contain phosphorous are eggs, beans, peas, beer, cola drinks, nuts, cocoa, and dairy products.
*Instead you may have certain non dairy products, brie cheese, ricotta, and cream cheese.
6. Do not take MAGNESIUM containing supplements. Some antacids contain magnesium. Please consult with your doctor before taking any over the counter medications.
7. Your doctor will prescribe you CALCIUM supplements. It is important to take your calcium because it will help keep your bones healthy.
Dialysis Food Pyramid
Take all medications prescribed by your doctor, and call if you are unable to do so. Do not take any over the counter medications without consulting your doctor first.
Caring For Your Dialysis Treatment Site(Av Fistula/Av Graft)
- Do not do anything that will place pressure on the site. This could include wearing tight clothing over it, and lying on it while sleeping.
- Have blood pressure readings taken in the opposite arm if your dialysis site is on your arm.
- Check your site daily and after treatment for signs of infection such as redness, warmth, swelling, and bleeding. Call the doctor if any of this occurs.
- Check your site regularly for the feeling of vibration. If you lose this sensation please call your doctor.
- Do not put lotions, creams, or other products onto your dialysis access site
Chronic Kidney Disease and Diabetes
Kidney disease is often a result of diabetes and can make treatment more complicated.
- Blood sugar and blood pressure: If you have diabetes it is very important to keep your blood sugar and blood pressure under control. If left uncontrolled these factors can cause chronic kidney disease to get worse.
- You are at greater risk of having uncontrolled sugars because of your kidney disease. Your kidneys are not able to filter the insulin in your blood as it did before, so your medications must be adjusted to make up for this.
- You will want to maintain a strict renal diet with special attention to reduced protein, reduced potassium, reduced salt, and reduced phosphorous. A dietician will work with you to help make a meal plan.
- Your doctor will need to monitor you more closely by ordering labs(such as albumin, cholesterol, A1C), and having more doctors appointments.
- You should take your blood pressure regularly in your arm without a dialysis treatment site and notify your doctor if you are experiencing blood pressures over 130/80mmHg
Clinical Diabetes. (n.d.). Retrieved April 03, 2016, from http://clinical.diabetesjournals.org/content/25/3/90.full
Dialysis. (n.d.). Retrieved April 03, 2016, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022165/
Dialysis. (2013). Retrieved April 01, 2016, from http://chemwiki.ucdavis.edu/Core/Physical_Chemistry/Physical_Properties_of_Matter/Solutions_and_Mixtures/Case_Studies/Dialysis
Dialysis. (2015). Retrieved April 03, 2016, from https://www.kidney.org/atoz/content/dialysisinfo
Guy_getting_hemo [Photograph]. (2014, March 1). Https://en.wikipedia.org/wiki/Step-by-step_description_of_hemodialysis.
Pellico, L. H. (2013). Focus on adult health: Medical-surgical nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Phosphorus pyramid [Photograph]. (2015, April 30). Http://www.renalandurologynews.com/hyperphosphatemia/phosphorus-pyramid-for-ckd-provides-diet-advice/article/407095/.