Hemodialysis

What you should know

Hemodialysis is a procedure to remove chemicals, wastes, and extra fluid from your blood. Hemodialysis does the job of your kidneys when they cannot, such as in chronic kidney failure. A machine takes blood from your artery and pumps it through a dialyzer. The dialyzer removes chemicals, waste, and extra fluid from your blood. Once they are removed, clean blood from the dialyzer returns to your body through a vein. You may need hemodialysis for the rest of your life.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• You may have an allergic reaction to the medicines or dialysate to be used. An allergic reaction may cause your skin to get red and itchy, and you may suddenly have trouble breathing. During hemodialysis you may throw up, have a headache or seizure, or feel very tired. Your blood pressure may drop too low or go too high. You may have chest pain, trouble breathing, and your heart may not beat properly. You may get an infection or have bleeding inside your abdomen. You may have muscle cramps or pain in your arms and legs.
  
  
• If you do not have hemodialysis, your body will continue to hold excess water and unwanted chemicals and wastes. Your body may swell, starting from your feet. You may have heart problems, chest pain, and trouble breathing. You may have seizures, trouble thinking, go into a coma, or even die.

Getting Ready

The week before your hemodialysis:

• Your caregiver will need to check your arteriovenous fistula (AVF) or arteriovenous graft (AVG). An AVF is made up of an artery and vein connected together. An AVG is an artificial tube that is used to connect your artery and vein. The AVF and AVG are usually done in your arm, but your leg may also be used. The fistula and graft are where your caregiver puts needles during dialysis. Blood will go out from and come back to the AVG or AVF after being cleaned by the hemodialysis machine. When your caregiver sees that your AVF or AVG is working well, he will tell you that you are ready for hemodialysis.
  
  
• You and your caregiver will work out a hemodialysis schedule, or how frequently you need to have hemodialysis. Your caregiver will advise you what schedule is best for you, depending on your condition.
  
  
• Your caregiver will let you choose to have hemodialysis in a special center or possibly at home. You and your caregiver will talk about what is best for you. Your caregiver will first make sure you are properly trained and have the right equipment before letting you have hemodialysis at your home.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Ask a family member or friend to drive you home after your procedure. Do not drive yourself home.
  
  
• Tell your caregiver if you know or think you might be pregnant.
  
  
• You may need to have different blood and urine tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The day of your hemodialysis:

• Write down the correct date, time, and location of your procedure.
  
  
• Ask your caregiver before you take any medicine on the day of your hemodialysis. These medicines include insulin, diabetic pills, high blood pressure pills, and heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Do not wear tight-fitting clothes on the day of your procedure or surgery.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

• Your hemodialysis may be done in your hospital room or in a dialysis center. You may be asked to change into a hospital gown or wear a hospital gown over your clothes. Your caregiver will ask you questions and check your weight, blood pressure, pulse, and temperature. You will be asked to sit back on a comfortable reclining chair. Your caregiver may give you medicine to thin your blood. This medicine will help prevent your blood from clotting in your blood vessels and in the hemodialysis machine. Your caregiver will clean the area over your AVF or AVG. He will insert 2 needles over your AVF or AVG and tape them in place. He will then connect tubes from the machine to the needles in your arm and start the hemodialysis.
  
  
• You may read, watch TV, or take a nap during hemodialysis. Your caregiver will check on you several times to make sure you are OK. He will also check the machine several times to make sure it is working. It has alarms that sound if your blood pressure or pulse changes too much, or if the tubing gets loose or kinked. Do not be afraid when the alarms go off. Your caregivers will find the problem, turn off the alarm, and continue your hemodialysis.
  
  
• Your hemodialysis may also be done in your home. Your caregiver will make sure you are properly trained and that you have the right equipment. You will do the procedures for dialysis taught to you during your training. You will have to check yourself before, during, and after hemodialysis. You will also prepare, check the machine, and connect the tubes and needles needed. You will also have to respond to alarms and correct any problems during your hemodialysis. You will need to call your caregiver if you are not feeling well or if you continue to have problems.

After your hemodialysis:

Your hemodialysis session may last from 2 to 10 hours, depending how soon your next session will be. When it is finished, the needles will be removed from your arm, and a bandage will be wrapped tightly over it. You may have to rest for some time until your caregiver sees that you are ready to go. You may continue sleeping, reading, or watching TV.

Contact a caregiver if

• You have a fever.
  
  
• You cannot make it to your appointment on time.
  
  
• You feel very tired most of the time.
  
  
• You get a cold or the flu.
  
  
• You have a metal taste in your mouth.
  
  
• You have questions or concerns about your hemodialysis.

Seek Care Immediately if

• The problems for which you are having hemodialysis get worse.
  
  
• You have chest pain or trouble breathing.
  
  
• You gain a lot of weight very fast.
  
  
• You suddenly have a seizure, become confused, or lose consciousness.
  
  
• Your legs suddenly become swollen.

Learn more about Hemodialysis (Precare)