Update 3/30/13: I fixed a link to the Social Networking post. Sorry for the inconvenience of it not working,
This is part three of the three part series. The first part is “Dialysis and the Procedure”
Okay, so you’ve managed to find something to do for three or four hours as the machine recirculated your blood, cleaned it up and removed excess fluid. Some people are able to sleep and some aren’t. I really admire those who can. Some, I’ve observed, nod off almost immediately. That’s just amazing to me. I wish I could, but something about having two large needles in my arm, the sounds of alarms and conversations and other noise keeps me awake. When I am able to sleep it’s a 10 or 15 minute nap. I believe my record is about 30 minutes. So, I generally play on my tablet/pad computer as I mentioned in “Dialysis and Social Networking”
The last hour is the worst for me. I am tired of dialysis even though it’s life-giving. My butt hurts, my back is sweaty, my right arm is straining to be moved after being in the same position for so long and my left arm is itching and chaffed from the blood pressure cuff. If you’re going to cramp from dehydration, this is when it happens. For more on cramping, see my post, “Dialysis and Cramping” If you’re going to have blood pressure problems, this is when they’ll occur. When the alarm goes off signaling my treatment is finished, I’m ready to leap from the chair like a race horse from the gate! Like Spongebob, “I’m ready! I’m ready!”
It never fails there are a couple other patients coming off at the same time. As much as the center tries to stagger patients so that doesn’t happen, it does. I try to be patient as I wait for my turn. Finally, the tech comes to my rescue and begins the process to remove me from the machine. Again, with the thermometer to measure my body temp and with the final blood pressure to make sure I’m in shape to be taken off.
If the blood pressure is too low, the tech can add saline to bring it up so they want to make sure I’m stable before they remove the needles. That last blood pressure is important. However, there was the time that all conditions were “green” and I still “soured” after the needles were removed. The tech had to re-stick me so she could add a generous 750 cc’s of saline! I described these events in my posting “I’m working, I’m working!” I hope you don’t have to go through that sort of experience. It’s unpleasant.
Once things look good, the tech will begin removing the tape from the needles. This is the reason I shave my right arm. Tape tearing out hair is painful. Over what seems like a long time, the first needle is removed and disposed of, then the second. With each, the puncture site is covered by gauze and tape. Some patients hold each site until it’s clotted between each needles removal because there may be a distance between the two that can’t be reached with one hand.
You have choice of holding the site until it clots or using clamps. I prefer holding because the clamps actually cause damage to the A/V fistula. Most authorities discourage the use of clamps and, especially on new fistulas. Recommendation: “Don’t use clamps!” If you can hold the site with your other hand, do that. Make your fistula last as long as you can.
After 5 or 10 minutes, the sites should be clotted and the tech will finish taping them off. One last standing BP and you weigh out. The final weight is verification that pf how much fluid was removed. It’s a rather primitive way to do it but it’s the popular way. Give that number to the tech and gather up your belongings. For me it’s all the items I mention in the posting “Dialysis and the Necessities“.
After a few hours, you can safely remove the bandages covering the needle sites. I wait for about four hours. It’s recommended that they be removed in 3-5 hours because it’s a pressure bandage and you don’t want that pressure applied for so long it damages the fistula. After treatment, be careful about using that arm or leg where the puncture is still healing. I once used my arm to push my heavy mattress and it opened the site resulting in bleeding even after six hours! One time, just pushing myself out of the dialysis chair with my access arm resulted in opening the site and bleeding under the bandages. Lesson learned: don’t use your access arm for a while. Be careful with it even while bandaged.
Of course, the chances of leaking at the access site are greater in the first half-hour or so after treatment and while the site is bandaged. Often you’ll hear a patient heading out the door return because their site is bleeding. That large needle leaves a large hole! It’s scary when it happens but eventually, it’ll happen to you. I try to monitor the site frequently to make sure I don’t get a surprise. One thing I’ve discovered is a leak will probably happen if I’m wearing a new or a long-sleeve shirt! LOL My worst fear was that it would happen while I was driving home, so I kept bandages and paper towels in the car just in case. As exhausted as I am after dialysis, I didn’t want to be cleaning up blood from my car seat, too! Fortunately, I never had that happen.
If you drive yourself, make absolutely sure your blood pressure is safe. You don’t want to pass out in the parking lot or while you’re driving. If you don’t feel absolutely sure of yourself, take some extra time and give your BP time to come up. A couple times that took an extra 30 to 45 minutes. It’s not worth risking your life or other’s lives.
Very often after I get home, I rest for a while. Frankly, dialysis just takes everything out of me. I’ve seen some people bound out of the center just like they came in, all bouncy and such. I wish that case with me but it’s not. I only allow myself an 8 ounce cup of water as much as I would like more and I just sip at it. I’m dehydrated and thirsty but, of course I am. I just finished dialysis to remove it. Putting fluid back on is counter-productive.
Often, I see some patients come in in really bad shape and leave only slightly better. One reason people come in and leave in bad shape is they think they can end the treatment early without suffering consequences. Not possible! If you leave treatment early, it’s not much different than skipping a treatment. You don’t get the proper cleaning and you don’t remove enough fluid. All those toxins build up in your blood and never get removed. It’s a shame really. I understand wanting to terminate treatment. I’m anxious to get it done with too but dialysis is a slow, gradual process and it takes as much as time it does. Leaving treatment early can be lethal. That’s why the tech will have you sign an “Against Medical Advice” (AMA) form if you do. The center doesn’t want to assume responsibility for you if you die or suffer from a short treatment. Some centers require it even if you leave 15 minutes early.
I’ve seen patients who repeatedly leave treatment early and abuse their fluid restrictions in between. In fact there are patients who bring large containers of fluid with them to dialysis. If they’re new, the tech may say something about it or not, but some are recalcitrant patients who should know better and the techs have given up. I won’t repeat myself about fluid control as you can read about it in “Dialysis and Fluid Control” but you must keep in mind, your kidneys aren’t functioning. That fluid has to go somewhere and it always goes to the wrong place. Repeated and constant fluid retention will be fatal over time. Here’s a link to a visual of why that’s the case.
So, now you’re home and dialysis is complete. If it’s Monday or Tuesday, you only have two more treatments to go and then you’ll get a two day reprieve before it all starts again. But’ it’s keeping you alive. Make the best of it.