Arriving at the clinic
You may want to have someone come with you to your first treatment in the dialysis center. This person can help you with listening to information you are given. It may also be good to have someone who can drive you home after your treatment.
Once you have your vascular access in place (either a fistula or a catheter) you will undergo your first dialysis treatment. As your kidney function has deteriorated over the past few weeks or months, you may have been feeling progressively more unwell, tired and perhaps depressed. You may feel anxious about what the dialysis treatment will be like, and how it will make you feel.
When you walk into a hemodialysis unit for the first time, it can be a daunting experience. The unit may seem busy, with nurses tending to patients, setting up machines etc. Some machines may be beeping and flashing, and the sight of the machines with patients attached – with their blood in the lines – may make you feel like running for the door.
We understand this – and we will do all that we can to support and reassure you. You will be met in reception and introduced to your nurse, who will then measure your weight, blood pressure, pulse and temperature.
Commencing your dialysis treatment
You will then be escorted to your dialysis machine, which will have been set up ready for you. You will be made comfortable in a special dialysis chair, and shown how to use the controls to change the position, put your feet up or down etc. During this time your nurse will be chatting to you, asking how you are feeling and whether you have any problems, questions, or concerns.
Preparing your vascular access
Once you are comfortable in your chair and ready, the nurse will prepare your vascular access. Whatever your access, your nurse will be meticulous in ensuring that you are not exposed to risks of infection. For this reason she will need to wash her hands and wear protective eyewear and gloves.
If you have a venous catheter, this will involve removing the caps on the connection and sucking out the heparin flush that is in the catheter. If the catheter is patent and working fine, you will see some blood in the syringe. She will then flush the catheter with saline to prevent it clotting. If you have a fistula or graft and it is matured and ready for cannulation, your nurse will insert the fistula needles.
Inserting needles (cannulation) into your AV fistula or graft
Whether you have an AV fistula or graft, two needles will have to be inserted each time you dialyze. Nobody likes the idea of having needles put in, but your dialysis nurse is highly skilled and experienced, and will ensure that the procedure is as quick and pain-free as possible.
Patients often say that it is not nearly as bad as they had feared, and quickly get accustomed to it. Occasionally a needle may be poorly positioned and need to be removed and replaced. The needles will be inserted, secured with tape, and flushed with saline.
Connecting to the hemodialysis machine
You are now ready to be connected to the machine. The nurses will attach the dialysis lines to the end of the needles and start the blood pump. You will see the blood being gently pulled from your arterial needle. The lines will turn pink and then dark red as they fill with blood. Your nurse will check that all the monitors and controls are within the set limits, and ensure that your dialysis prescription is programmed into the machine.
You will probably feel a little relieved. Your nurse will ensure that you are comfortable and make sure that you have everything you need within easy reach. Your nurse will regularly check that the machine is delivering the dialysis as prescribed and make sure you are feeling fine.
In the early days of your treatment, you may feel a little bit dizzy when you first go on the machine. Your blood pressure may drop a little when you first begin dialysis, but usually this returns to normal very quickly. Your nurse will be observing for this and may ask you to recline your chair so that your feet are up and you are slightly laid back. If you do feel dizzy or light-headed, tell your nurse and she may adjust your treatment slightly.
Completing your dialysis session
Once your dialysis dose has been delivered, which will take a minimum of four hours, your machine will alarm to alert you and your nurse that your treatment time is complete. Once again, strict control measures will be taken to protect you from infection when your nurse handles your vascular access and blood lines. Saline will be used to flush the blood that is in the dialyzer and blood lines back into your body.
Your needles will be removed and you will be asked to press on the puncture site until it has stopped bleeding. This can take as long as 10 minutes and it is important to ensure that there is no bleeding before you get up. Some patients use plastic clamps that are placed over the puncture site and apply pressure. Once the bleeding has stopped, a small plaster or piece of gauze will be applied, which you can remove once you get home.
Your nurse will want to check your blood pressure, pulse, temperature, and weight before you leave to ensure that they are all within normal limits. If all is well, you can then go home.
Getting established on dialysis
Of course you will be returning in a day or so for your next treatment. As you establish your dialysis sessions and attend the clinic three times per week, you will soon get used to the procedures and the routine will become very familiar. Many patients report how much better they feel once they have started dialysis, and feel an immediate benefit from the removal of the harmful waste products that have built up in the body over the past weeks or months.
You will get to know all the staff and maybe some other patients in the clinic very well. Everyone is there to help and support you. We aim for you to receive the best possible standard of dialysis to keep you feeling as well as possible. Our staff will regularly give you feedback on your blood results and how your dialysis treatment is working. We will also ask for feedback from you on how you are feeling, whether you have any problems, and to make sure that you are happy with all aspects of your treatment.
Tips for your dialysis
• Wear comfortable, lightweight clothing. We will need to get to your fistula or your venous catheter so make sure that these are easily accessible without having to remove items of clothing.
• Some patients feel a little chilly on dialysis, so you may wish to bring a cardigan to wrap around you. We have blankets available if you need them.
Think about what you would like to do to pass the time. You will be sitting in the same place for a minimum of four hours. Some patients just like to use this time to sleep. Others read, watch TV, or listen to music. Whatever you prefer, it is completely up to you.
In our busy lives, time is valuable. And so is your health. That's why it's important to take time for effective dialysis. A minimum of four hours of effective dialysis, three times a week is all it takes to guarantee sustainable dialysis therapy.
Each minute of your dialysis session counts. To understand why, it's important to know what's going on in your body and the dialyzer during the session. At the beginning of the session, your blood and tissue contain a high concentration of waste substances as well as too much water. The dialyzer can therefore remove relatively large quantities. As the session progresses, these levels decrease and it takes longer for the blood cleansed by the dialyzer to extract the last remaining toxins, which are hidden away in the remotest and poorest circulated tissue of your body. It's the removal of precisely this last percentage of toxins that is so important for both your short- and long-term health.
In addition to dialysis time, Kt/V is the most widely used quality measure for your dialysis treatment. It tells you whether your blood was thoroughly cleaned of urea during dialysis treatment. The value Kt/V is made up of the cleansing capacity of the dialyzer, the dialysis time, and the amount of water in your body. The higher the amount of blood running through the dialyzer during your treatment, the higher the Kt/V, meaning more toxins are removed from your blood during the dialysis session and more efficient the dialysis treatment.
Fresenius Medical Care technology has provided doctors and nurses with an instrument capable of calculating Kt/V during every dialysis session, giving direct information on the dose of purifying treatment actually administered. Online clearance monitor (OCM) is the device we use to calculate Kt/V and is integrated into most of our dialysis machines. Systematic use of this device allows the actual duration of dialysis to be correlated, not just to the number of treatment hours, but above all to the target Kt/V. At the end of each dialysis session, both the Kt/V target and the prescribed dialysis time have to be achieved. International guidelines recommend a certain target of Kt/V to be reached, and we are proud to say that in the network of Fresenius Medical Care centers we achieve well above this target.
Innovative products and therapies
At every therapy session, you benefit from Fresenius Medical Care products and therapies, such as our cardioprotective hemodialysis, in combination with the experience and insight gained from many years of NephroCare expertise in renal care.
Fresenius Medical Care's first-class patient care begins with our comprehensive and innovative product range. The most important components are developed and manufactured in our own laboratories and production facilities, many of them in Germany.