Dialysis and The Procedure

If you’re looking forward… wait, not a good way to phrase that… if you’re going to enter Dialysis soon, it might be helpful to get an idea of the process.  First thing is you get a shift and days.  There are usually three shifts if the center don’t have a nocturnal (overnight) shift.  Generally the first shift starts at 6am, the second at 11am and the third at 4pm.  The days will either be Monday, Wednesday and Friday or on Tuesday, Thursday and Saturday.  I go to M-W-F and on the second shift.  I used to be on the third when I was working full-time so I could stay as close to my daily schedule as possible.  The T-Th-S schedule is more difficult to get on because many working people like it so they only interrupt two days of work for dialysis.   They didn’t have any chairs available and so, even when they did, I didn’t change my schedule.  I was used to it and so was work. Of course, that makes no difference now as I am not working any more due to a “layoff” as I describe in “Dialysis and Your Job“. So, I am now on second shift and M-W-F.  Occasionally I will go on first shift if a chair is available just to vary things and keep life from getting mundane.  There’s nothing like getting up at 5am to remind you of the pleasure of not having to get up at 5am!

If you read my post about “Dialysis and the Necessities“, you have an idea of what items I take with me to dialysis.  Like a homeless person carrying all my belongings, I get it all from the car to the center.  There’s usually a waiting room where you’ll be called in before you can enter the treatment area.  Sometimes, the door to the treatment area is locked, sometimes it’s not depending on the circumstances.  I always check with the tech to make sure he/she is ready to receive me.  If not, I wait in the waiting room.  They don’t want people milling about the treatment area because it’s a sterile environment.

There are two things for me to do before I get in the chair for treatment.  I must wash my access site and weigh-in.  Washing the access site has been optional in the past but lately the CMS/Medicare has been pushing it to reduce infections.  Think about it if you don’t do it already. If your access gets infected, you’ve got some real problems!  Keeping your access site infection-free is REALLY important.  That site is standing between you and your treatment.  If it gets infected you’ll suffer for it in many ways.  Don’t take chances.  Wash it with anti-bacterial soap!

The weigh-in is how the tech will measure your fluid gain between sessions and be the basis for how much fluid the dialysis machine will be set to remove.  Here’s the problem.  Say, you had a big meal last night.  Some of that weight may not be fluid.  If you had a regular meal, it’s probably fluid.  Consider this as you discuss how much fluid to remove.  You do that right?  (LOL)   Don’t worry. Most of us just give the weight to the tech and go about our usual pre-dialysis procedure not thinking about how much is to be calculated.  Discuss it with the tech, however.  You need to be aware of how much fluid will be taken off and only you know you your body better than anyone else.  If you had a large meal before dialysis, don’t try to remove as much fluid as may be calculated.  Or use that number but keep track of how your blood pressure is doing in the last hour and have the tech reduce the fluid removal if your BP starts going too low.  You may be trying to remove fluid that’s not there.  The result of trying to remove nonexistent fluid is cramping.  We don’t like cramps.  They hurt and they are a symptom that something’s not right.  (See my post about “Dialysis and Cramping“)  If you’re cramping, figure out why and make some changes.  Have the doctor increase your dry weight if you’ve picked up some pounds.   Know your body and know your fluid removal limit.

Also, if it’s a Monday or Tuesday, don’t try to take off all the weekend’s accumulation on the same day.  You’ve still got two more sessions that week to remove excess fluid.  Spread it out and be careful during that week about your fluid intake.  For example, I went in “heavy” this last Monday.  The fluid removal calculation was a 1/2 kilo over my maximum removal so I told the tech to only take off up to my max and I would take the rest off on Wednesday.  I’ll just have to watch my fluid intake more carefully on Tuesday.  At the Monday session, I went right to my limit.  I had minimal dehydration and very minor cramps.  But I left a 1/2 kilo above my dry weight.

Before you are seated in your chair, the tech will want a “standing blood pressure”. After this is complete, you can be seated in the chair where another blood pressure is taken.  Doing a standing and sitting BP will indicate if there are any heart or circulatory problems before the session starts as this could effect the treatment.  For example, if your blood pressure is low before treatment, it will probably go lower and that’s not good.  If it’s too low, it could be dangerous and you’ll have to dialyze at a hospital.  The risks of dialysis with blood pressure too low  are considered worse than the risk of forgoing treatment.

Along with BP, the tech will take your temperature before and after dialysis.  They need to see if your body temp is too high, indicating a fever or infection,  and if it’s too low.  The blood circulating through the dialysis machine is controlled to a set temperature.  Keeping that temperature consistent with yours will make dialysis more comfortable and less stressful on your blood vessels.  I once experienced really bad chills during dialysis. I felt like I was freezing! The nurse checked the machine and the temperature controls were set too low.  So, in fact, I was suffering from hypothermia.  I got a practical lesson on why taking my body temp and setting the machine to the correct temp is important.

There’s an interesting link in Wikipedia about the procedure.

In the next installment, we’ll get in the chair and get hooked up.

© 2012 DevonTexas

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About DevonTexas

I am a person with ESRD (End Stage Renal Disease) which means my kidneys don't work. Forty or so years ago that would have been a death sentence but today there is Dialysis which means I can be hooked up to a machine that will clean my blood as the kidneys should. Three days a week, I go to a center and have too very large needles stuck in my arm to remove and replace my blood as it passes through a process where it's cleaned and the fluid is removed, a process taking a little over four hours each time. I want to advance knowledge about dialysis so that other patients can learn from my experience and mistakes. We shouldn't have to reinvent the wheel, eh? There is so much to be learned and experienced about our predicament. There are vast resources available to support us and enrich our lives but many patients don't know about them. There are also many issues that we have to deal with whether we want to or not. So I blog about them. All comments are confidential until I approve them. If you don't want your comment public, let me know and I will respect that. So, feel free to leave a comment. Enjoy.
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