In “Dialysis and the Procedure“, we got to the point of actually sitting the chair. Here, then, are the next steps…

Once in the chair, the tech will want to take your Blood Pressure again.  (Geeze! Again?)  But this is necessary to get a “sitting blood pressure”.  Like the standing, this may indicate a problem if it is high or low upon sitting compared to standing.  The tech is usually entering the settings on the machine while this in going on.  I will detail those settings in another post later about “Dialysis and the Machine”.  Also, they will prep for the “stick”, gathering tape and gauze to be used later in the process.

So, here you are in the chair and with one arm already immobilized by the blood pressure cuff and the other about to be prepped for the stick. The tech will clean the two areas with alcohol and cleaning solution. Some techs clean just the immediate two areas and some clean a wide area; it depends.  I prefer that they clean a large area and encourage them to do so.  My A/V Fistula access is only four years old and I’d like to keep it clean and operational for as long as I can.  Infection is a bitch and I don’t want to write about that from a personal account perspective.

Please note: I am writing this from the perspective of someone with a fistula access in my lower arm.  An access can also be in the leg or upper arm or a catheter.  I don’t have first-hand experience with those so I won’t write about them.  An A/V fistula is surgically created to “widen the vein, making needle insertion easier and enabling the blood to flow faster. Faster flowing blood is less likely to clot. ” (From Merckmanuals.com)

There are two tubes with those large needles (Yes, I have referred to them many times as “large, huge, etc.” because they are.  I don’t like getting stuck by any needle and these are the largest so far.  I can’t imagine anything larger and I don’t want to!)  One tube is for the arterial flow and the other for the venous flow and generally they are color-coded (Red and Blue) for that purpose.

In the picture, the red is the artery and the blue is the vein. This is standard practice for identifying veins and arteries because the arterial blood is red, or oxygenated, and venous blood is deoxygenated so it’s blue.  Although, in reality it will all be red when you see it flowing in an out of your arm.

The tech will insert a needle in the vein for each of the two needles. I’ve described this process in detail in other postings (“Dialysis and the First Stick“, “Dialysis Pain and Lidocaine” and “Dialysis and New Patient Orientation” to name a few.)  Using the tape and gauze, the tech will secure the needles in place.  You don’t want to have the needle become dislodged while dialysis is on-going.  The pressures are high enough that a great deal of blood loss can ensue.  If you’re sleeping and this happens, you may not be aware and, if no one’s watching, you can lose enough blood to require hospitalization or death.  It’s happened.  So, if the tech is careful to use lots of tape, don’t fret, it’s for your protection.  Yes, it can add to the discomfort when it’s removed but it’s better than the alternative. 

Once you’re all taped up, the tech will double-check the machine settings, do some charting (usually on a computer terminal), and you are ready to spend the next several hours being bored out of your gourd.  The length of dialysis treatments will be anyway where from 3 to 4 or more hours depending upon what the doctor has prescribed.  “A prescription for dialysis by a nephrologist (a medical kidney specialist) will specify various parameters for a dialysis treatment. These include frequency (how many treatments per week), length of each treatment, and the blood and dialysis solution flow rates, as well as the size of the dialyzer.” (from Wikipedia.com).

The length of time for the treatment is very important.  One very rare occasions, I stopped treatment early.  This is not good.  If you stop treatment in less than the prescribed period of time, the tech may require you to sign a “Against Medical Advice (AMA) form.  This protects the center from legal liability because a shortened treatment means you didn’t get all your toxins removed and may have too much fluid when you leave.  This could be fatal and the center doesn’t want to assume that responsibility.  You can’t blame them.  I’ve seen patients who regularly leave treatment early and they always look in terrible shape because their body is showing the effects of the lack of proper treatment.  They will probably end up in heart failure one day and die much earlier than if they’d simply finished the treatments. I personally don’t like feeling ill, so I get all my prescribed treatment.       It’s that simple.

My best advice is for you to find some positive activities to do during this time to help you pass the time.  Some patients are able to sleep.  I am one of those who can’t.  Occasionally I can nap for 15 to 30 minutes but that’s about it.  I try to do things like make calls to home-bound and “missing” members of my church.  Reading a book or magazine is good but I can’t seem to do that with one hand very easily.  Watching TV is popular but I get aggravated easily with TV so I spend most of my time on my tablet/pad computer.  I wrote about that in “Dialysis and Social Networking“.

I found a great article about “Things to do in Dialysis“.  It makes a good point about “Embracing Life” while on dialysis.  I couldn’t agree more.  Every day on dialysis is a day more of life.  Because of dialysis, kidney failure is not a fatal disease.  Make the best of every day you have.

In the next part, I cover getting done with the dialysis treatment.

© 2012 DevonTexas