Hemodialysis removes wastes and excess fluid outside of your body. During a hemodialysis treatment, blood is removed from your body and pumped by a machine through a dialyzer. The dialyzer is the semipermeable membrane that cleans your blood.
While having your treatment, you sit or lie next to a hemodialysis machine. A nurse or technician puts two needles into a vein in the forearm called an access. One needle is connected to tubing, which takes your blood out of your body to be cleaned. The blood is returned to your body through tubing attached to the other needle. There is about one cup of blood outside your body at any time. All your blood is filtered through the dialyzer several times. At the end of treatment, all the blood is back in your body.
Putting needs into your arm can cause a little discomfort. Dialysis does not hurt, although some people do feel nauseated or dizzy during parts of the treatment. Mostly, hemodialysis is a quiet time. During treatments, most people keep busy doing things like watching TV, reading or talking.
• Most people need hemodialysis three times a week.
• Each treatment lasts about four hours
• The actual time at the Dialysis Unit is about 5-6 hours with transportation times and post treatment monitoring
• You will be weighed before and after each treatment to make sure extra fluid is removed
• Appointment times are individualized to accommodate the specific patient needs
• Evening shift treatment times are available to meet the needs of working patients
• Audio-visual entertainment is available during dialysis.
• Adult nephrology care is available
To place an access, to get your blood, a surgeon will perform an operation to strengthen one of your veins or to put a soft tube inside your arm or thigh.
If possible, the surgeon will attach a vein and an artery together to for a fistula. This is the best possible type of access. If your veins are small or weak, the surgeon inserts a graft instead. This is a soft tube connected to an artery on one end and a vein on the other. Blood runs through the graft. Both a fistula and a graft are underneath the skin. A permanent access can take up to a few months to heal properly.
If you need dialysis before a permanent access is in place, the doctor will create a temporary access. This is done by placing a special tube, called a HD catheter, in a large blood vessel in your neck or groin area.
How will hemodialysis affect your lifestyle?
You might enjoy having four days a week when you do not have to worry about dialyzing. You will probably be able to travel if you make arrangements in advance to dialyze at another clinic (center). You can exercise and do most sports after checking with your doctor.
You will probably have to limit your intake of salt, foods rich in potassium, dairy products and fluids.
It is also very important to follow the meal plan recommended by your dietician in order to avoid malnutrition. Poor diet can cause depression, tiredness and a lower quality of life.
Since your body will hold onto fluids until you have your next dialysis treatment, you will gain fluid weight between sessions.
Possible complications of HD
The major complication of hemodialysis is blood clots, clumps of blood that block the fistula or graft. A clot must be removed, or it can permanently block the access. If an access is blocked, you may need to use a temporary catheter.
During a hemodialysis session, it is normal for your body to lose fluid and salt, which can cause hypotension, low blood pressure. You may feel light-headed, sweaty, or nauseated. You may also develop leg cramps or headaches during dialysis or at other times.
Your doctor should be able to solve some of these problems by adjusting your dialysis. Following your diet and restricting fluids may also help.
The access may become infected. To avoid infection, the skin over the access must be cleaned before the needles are put in, and needle wounds that have not healed must be protected.
The signs of infection are:
• Redness at the access site
If you have any of these signs, you should report them immediately.
• Nurses and technicians perform treatment for you
• Regular contact with other hemodialysis patients and staff
• Usually three treatments per week; four days off
• No equipment/supplies kept at home
• Medical help is available quickly in an emergency
• Travel to and from dialysis center three times a week on a fixed schedule
• Permanent access to your blood required, typically in your arm
• May feel tired or worn down because blood is cleaned only three times a week
• Insertion of two needles for each treatment by different members of dialysis staff
• Restricted diet/limited fluid intake
• Runs some risk of infection
• Possible discomfort like headache, cramping, nausea or tiredness