What to expect when starting dialysis
I've you've been told that you will need to start hemodialysis soon, this can be a terrifying time. This fear can be compounded by the fact that many health-care providers can be less than forthcoming with information about what actually is involved in the hemodialysis treatment.
Here, we will discuss the actual procedure of hemodialysis, not the physiological processes involved (that's a story for another day), but what will actually happen to you the first time you go for hemodialysis.
Firstly - a note about access : Your blood will be removed from your body for hemodialysis either by placing two needles into a fistula, or a central venous catheter. The fistula is an enlarged vein in your arm or leg, which is created by a surgical procedure of turning a vein around on itself to create a much greater blod flow than normal. (I will be writing more about this soon). A Central Venous Catheter is a tube inserted either into your chest, or the jugular vein in your neck. This Central Venous Catheter allows high volume access to your blood supply.
When you arrive at the dialysis unit, you will be asked to weigh yourself. This is done so that the staff can calculate how much fluid gain has taken place since your last dialysis treatment, and therefore how uch fluid will need to be removed this treatment.
Once you have weighed, you will be required to thoroughly wash your hands and fistula area (if you have one). Once you have washed your hands and fistula, you will need to dry these areas with either a disposable paper towel, or using an air-drier.
You will then proceed to your dialysis chair, where the technician will calculate how much fluid needs to be removed from your blood, and any other factors that will affect your treatment.
Once the technician has set up the dialysis machine with all the appropriate calculations, you will have your blood pressure and pulse recorded. You will be asked to do a "sitting" and "standing" blood pressure.
Now you will need to sit in the chair, and the technician will prepare your access (either fistula or Central Venous Catheter) with a sterile solution, usually alcohol.
Now, if you are using a Central Venous Catheter, the technician will connect the "lines" from the dialysis machine to your catheter. If you are using a fistula, the technician will use a small amount of local anaesthetic (if you have requested it) to "deaden" two areas on your fistula for the insertion of the needles. Once the area is numb, two needles will be inserted into the fistula. One for incoming blood (blood that has been cleaned). One for outgoing blood (blood which is removed from your body, taken through the dialysis filter, and cleaned of toxins).
Once the needles have been inserted, the technician will connect the lines from the dialysis machine to the needles in your fistula, and slowly increase the "pump speed" of the machine. As this speed is slowly increased, your blood will be removed more quickly. The more quickly your blood can be removed, the more times your blood can be run through the "dialyser" (the filter which cleans your blood), therefore the more toxins can be removed from your blood.
If you are unsure about anthing that your technician is doing during dialysis, ask them. A better informed patient is a safer, happier patient.