What is Hemodialysis

Hemodialysis is a way of removing wastes, salt, and extra water from your blood. It also helps keep healthy mineral levels in your blood. It is done when your kidneys no longer work properly and cannot keep your blood clean.

During hemodialysis, your blood travels outside of your body through a tube to a machine (dialyzer). A filter in the machine cleans the blood and the blood returns to your body through a tube. It is usually done 3 times a week. Visits last 3–5 hours.

What happens before the procedure?

You will need a procedure to make an opening (vascular access). This is where blood is removed and returned to the body. There are three types:

• Arteriovenous fistula. An artery and a vein are connected. This is usually in the arm.
• Arteriovenous graft. An artery and a vein in the arm are connected with a tube.
• Venous catheter. A tube (catheter) is placed in a vein in your neck, chest, or groin.

What happens during the procedure?

• Your weight, blood pressure, pulse, and temperature will be taken.
• The skin around your access will be cleaned.
• Your access will be connected to the machine.
  • If you have a fistula or graft, two needles will be placed through it. They will be connected to a tube. The tube will be connected to the machine. The needles will be taped to your skin. This keeps them from moving.
  • If you have a tube (catheter), it will be connected to a plastic tube. That plastic tube will then be connected to the machine.
• Your blood will go through the tube to the machine. The machine will clean your blood. Then your blood will go back to your body through a tube. Your blood pressure and pulse will be checked a few times while the machine is running.
• When dialysis is done, you will be disconnected from the machine. If you have a fistula or graft, the needles will be removed and a bandage (dressing) will be put on the access. If you have a tube, the tube connected to the machine will be removed.

Hemodialysis is done while you are sitting or reclining. You may sleep, read, or do other tasks that can be done in this position. If you have side effects, tell your doctor.

The procedure may vary with doctors or hospitals.

What happens after the procedure?

• You will be weighed.
• Your blood will be tested. This is usually done once a month.
• You may have side effects. These may include:
  • Dizziness.
  • Muscle cramps.
  • Feeling sick to your stomach (nausea).
  • Headaches.
  • Allergic reaction.

Summary

• Hemodialysis is a way of removing wastes, salt, and extra water from your blood.
• Before the procedure, you will need an opening where blood is removed from the body and returned to the body. This is done with a procedure.
• During hemodialysis, your blood travels outside of your body through a tube to a machine. A filter in the machine cleans the blood.

Hemodialysis, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Fatigue. Energy levels usually return to normal the day after the procedure.
• Itchiness. Your health care provider may be able to prescribe medicine to relieve this.
• Achy or jittery legs. You may feel like kicking your legs. This sometimes causes sleeping problems.

Follow these instructions at home:

Eating and drinking

• Talk with your health care provider about how much fluid you can drink. Keep track of your fluid intake to make sure you do not drink more fluid than is allowed. This is important because fluid can build up in your body between dialysis sessions. Built-up fluid affects your blood pressure and can make your heart work harder.
• Limit your salt (sodium) intake. This is important because:
  • Sodium makes you thirsty, which creates a problem since the amount of fluid you can drink every day is limited.
  • Sodium affects your blood pressure levels. The more you control the amount of sodium in your diet, the more control you may have over your blood pressure levels.
• Limit your intake of the mineral potassium. Potassium levels can rise between dialysis sessions. If they become too high, they can cause a dangerous heart rhythm and even death.
• Limit your intake of the mineral phosphorus. Consuming too much phosphorus can cause your bones to lose calcium. This makes them weaker and more likely to break. Consuming too much phosphorus may also make your skin itch.
• Eat high-quality proteins that are low in phosphorus. High-quality proteins include those found in fish, poultry, and eggs.

Vascular access care

• Avoid sleeping on the site where blood is removed from your body and returned to your body (vascular access).
• If your vascular access is on your arm:
  • Do not lift weights or heavy objects with that arm.
  • Do not wear tight clothing over that arm.
  • Do not have your blood pressure measured on that arm.
  • Do not allow needle punctures (such as for taking blood) on that arm.
• If you have a catheter, do not open it between dialysis sessions.
• If you have a fistula or graft:
  • Wash it with soap every day and before each dialysis session.
  • Feel for a vibration over the access site (thrill) every day. A thrill means the access is working.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider. This includes vitamin and mineral supplements. Talk with your health care provider before taking new supplements.
• Carry a wallet card, bracelet, or medical identification tag that shows you are a dialysis patient. Always keep it with you. If you are in an accident or have a medical emergency and cannot communicate, this item will inform health care providers about your condition.
• Keep all dialysis visits as told by your health care provider. Dialysis appointments should be scheduled regularly. Do not skip an appointment.

Contact a health care provider if:

• You have a fever.
• You have chills.
• Your vascular access feels warm.
• You find a pimple on your vascular access.
• You have any of the following around the vascular access site:
  • Swelling.
  • Redness.
  • Bleeding or drainage.

Get help right away if:

• You have a fistula, and pain, numbness, or unusual paleness develops in the hand on the side of your fistula.
• You have a fistula or graft and you do not feel a thrill.
• You develop dizziness or weakness that you have not had before.
• You develop shortness of breath.
• You develop chest pain.
• There is pus at the vascular access site.
• There is bleeding at the vascular access site that cannot be easily controlled.
• You become disoriented or confused.
• You develop blurred vision.
• You have jerky movements you cannot control (seizure).

Summary

• After hemodialysis, it is common to have fatigue, itchiness, and achy or jittery legs.
• Keep close track of your fluid intake, limit intake of sodium, potassium, and phosphorous, eat high-quality proteins, and take vitamin and mineral supplements as directed by your health care provider.
• Take proper care of your vascular access, and contact your health care provider if you have problems with your vascular access, such as warmth, swelling, redness, drainage, or bleeding at the site.