Haemodialysis is the process of filtering toxins of the body through an artificial kidney (known as dialysis machine). It is performed in a dialysis center, three times a week, with the patient being connected to the dialysis machine by blood lines or catheters. It can replace some of the functions of healthy kidneys, but not all. However, there are instances when people survive for a decade or more on haemodialysis so one should be very positive and well informed to take better care of self and family.
Once haemodialysis is started, it is very important to watch one’s fluid intake, because kidneys cannot get rid of all the excess fluid as urine. In addition the dialysis treatment is limited in the total amount of fluid that can be removed each session. It can be a challenge for dialysis patients to find the right balance of fluid intake. One approach to controlling thirst is to limit salt intake and choosing foods that are lower in potassium and phosphorous. It is advised to approach a dietician for menu plan of CKD patient.
Process of haemodialysis
At arrival to the dialysis center,vital signs of patient (weight; BP; HR; T) are recorded by the nurse/ attendant. A nurse or dialysis technician will clean one’s access site (place where injections needles will be pricked generally in the forearm of hand in which AV fistula is present. For fistula or graft, two needles will be placed at the access site and taped securely in place. This is usually performed by a certified haemodialysis technician. Each needle is attached to a catheter or tube which is connected to the dialyzer. One tube brings a small amount of blood to the dialyzer for processing and the other tube returns the blood to the body. Doctor may prescribe a numbing cream to be applied in advance of needle placement. When treatment is completed, the access needles are removed from the arm, and a small pressure bandage is applied. Over time, many patients report that the discomfort of needle placement is momentary and tolerable.
The first time dialysis treatment will be short, about an hour and will gradually increase to full time of 3-5 hours by the first week. One may experience nausea or cramping in the muscles as the excess fluid is removed from blood. The treatment team can discuss strategies to minimize these side effects, including altering the machine parameters, medication adjustments, and dietary changes. Patient will have a BP cuff in place for repeated measurements during dialysis treatment. Registered nurses assess each patient, monitor patient’s during treatment and give medications.
The patients’ vital signs and weight are rechecked post dialysis treatment, to make sure that s/he are medically stable and recorded in the dialysis diary. Then one may be able to leave and resume usual activities until the next session. Sometimes, blood may ooze out from the bandage but is nothing to worry about. The blood may stop by applying pressure and bandaging again by the technician/ nurse. It is better to wait for 5-10 minutes after dialysis to check whether blood is oozing or not and after that leave the hospital.
Preparation For Haemodialysis
A patient and their family need to plan well in advance about carrying out haemodialysis. Once doctor confirms that dialysis has to be started, the first time dialysis must be done very carefully. With AV fistula in place, it is less complicated to carry out dialysis. A sponge ball may be pumped around 100-300 times a day to strengthen the fistula.
The next step is to identify the hospital where one would like to carry out dialysis. People who get subsidy from mediclaim/ cghs/state health schemes/ others should definitely opt for the empanelled hospitals. List of empanelled hospitals are nowadays available in various websites. We shall try to incorporate the same in this website in due course of time.
It is advisable to opt for a dialysis centre which is close to one’s house. A dialysis centre may be identified based on hygiene factor, availability of good technicians, availability of nephrologists, etc.
Appointment may be made with hospital authorities to complete paper works relating to subsidy/ cashless facility as per eligibility of the patient. It is advisable if an informed person visits the hospital for such work along with the patient to carry out the formalities without any hassles. The hospital will issue a hospital card for identification of the patient and a dialysis diary which has to be produced every time a patient goes for dialysis. CGHS patients also require to produce a certificate issued by CGHS for carrying out dialysis for a certain no. of weeks which has to be renewed timely failing which one has to pay from own pocket to carry out dialysis in the empanelled hospital even if the patient is undergoing the same for years together.
It is better to keep the documents in a small folder to be carried to the hospital for dialysis. It is advisable that the patient is accompanied by someone while going to and returning from hospital as it gives mental strength to the patient. Also, sometimes some medicines, catheter etc may have to be purchased from medical store then and there which may be difficult for the patient to do on his/ her own.
The dialysis diary is used to record the details of each dialysis including duration, weight, BP, etc pre, post and during dialysis to monitor the condition of the patient. In case complications arise in patients dialysis is paused for a while and then resumed again.