Hemodialysis (cont.)
Adjusting to Changes
Even in the best situations, adjusting to the effects of kidney failure and
the time you spend on dialysis can be difficult. Aside from the "lost time," you
may have less energy. You may need to make changes in your work or home life,
giving up some activities and responsibilities. Keeping the same schedule you
kept when your kidneys were working can be very difficult now that your kidneys
have failed. Accepting this new reality can be very hard on you and your family.
A counselor or social worker can answer your questions and help you cope.
Many patients feel depressed when starting dialysis, or after several months
of treatment. If you feel depressed, you should talk with your social worker,
nurse, or doctor because this is a common problem that can often be treated
effectively.
Getting Your Vascular Access Ready
One important step before starting hemodialysis is
preparing a vascular access, a site on your body from which your blood is
removed and returned. A vascular access should be prepared weeks or months
before you start dialysis. It will allow easier and more efficient removal and
replacement of your blood with fewer complications. For more information about
the different kinds of vascular accesses and how to care for them, see the
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) fact
sheet
Vascular Access for Hemodialysis.
Equipment and Procedures
When you first visit a hemodialysis center, it may
seem like a complicated mix of machines and people. But once you learn how the
procedure works and become familiar with the equipment, you'll be more
comfortable.
Picture of a Graft
Dialysis Machine
The dialysis machine is about the size of a dishwasher. This machine has
three main jobs:
- pump blood and watch flow for safety
- clean wastes from blood
- watch your blood pressure and the rate of fluid removal from your body
Dialyzer
The dialyzer is a large canister containing thousands of small fibers through
which your blood is passed. Dialysis solution, the cleansing fluid, is pumped
around these fibers. The fibers allow wastes and extra fluids to pass from your
blood into the solution, which carries them away. The dialyzer is sometimes
called an artificial kidney.
- Reuse. Your dialysis center may use the same dialyzer more than
once for your treatments. Reuse is considered safe as long as the dialyzer
is cleaned before each use. The dialyzer is tested each time to make sure
it's still working, and it should never be used for anyone but you. Before
each session, you should be sure that the dialyzer is labeled with your name
and check to see that it has been cleaned, disinfected, and tested.
Dialysis Solution
Dialysis solution, also known as dialysate, is the fluid in the dialyzer that
helps remove wastes and extra fluid from your blood. It contains chemicals that
make it act like a sponge. Your doctor will give you a specific dialysis
solution for your treatments. This formula can be adjusted based on how well you
handle the treatments and on your blood tests.
Needles
Many people find the needle sticks to be one of the hardest parts of
hemodialysis treatments. Most people, however, report getting used to them after
a few sessions. If you find the needle insertion painful, an anesthetic cream or
spray can be applied to the skin. The cream or spray will numb your skin briefly
so you won't feel the needle.
Most dialysis centers use two needles-one to carry blood to the dialyzer and
one to return the cleaned blood to your body. Some specialized needles are
designed with two openings for two-way flow of blood, but these needles are less
efficient and require longer sessions. Needles for high-flux or high-efficiency
dialysis need to be a little larger than those used with regular dialyzers.
Picture of arterial and venous needles
Some people prefer to insert their own needles. You'll need training on
inserting needles properly to prevent infection and protect your vascular
access. You may also learn a "ladder" strategy for needle placement in which you
"climb" up the entire length of the access session by session so that you don't
weaken an area with a grouping of needle sticks. A different approach is the "buttonhole" strategy in which you use a limited number of sites but insert the
needle back into the same hole made by the previous needle stick. Whether you
insert your own needles or not, you should know these techniques to better care
for your access.
Next: Tests to See How Well Your Dialysis Is Working »
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