As an ESRD patient, your doctor would have offered you a choice between
- CAPD (Continuous Ambulatory Peritoneal Dialysis)
- APD (Automated Peritoneal Dialysis)
- Haemodialysis (at home, hospital or dialysis centre)
- Renal Replacement or Kidney Transplant
Taking into account your age, condition and circumstances, after a detailed consultation with your doctor, if you have finally chose haemodialysis at a hospital or dialysis centre, here are some useful tips to help you be as comfortable as is possible.
AV Fistula
: You will have to undergo a short surgical procedure, to prepare vascular access or an AV fistula, for allowing the blood out and back into your body, during dialysis. Follow the subsequent exercise and precautions that are prescribed to you diligently. Your fistula plays an important role in dialysis and it is crucial that you take proper care of it. Study
"how to take care of my vascular access?" at the NKUDIC site carefully. Your AV fistula literally acts as your lifeline and you must protect it.
Always
carry your tourniquets with you and in the event of any bleeding from the site, make sure they are immediately tied tightly
above the fistula.
Opt for a fully equipped hospital or dialysis centre
: Whenever feasible, choose a facility which has adequate emergency facilities, such as a well equipped Intensive Care Unit and emergency medicine specialists on hand. Due to financial or other constraints, this may not always be possible, but if you have the option, go for this reassuring choice.
Interact with the dialysis nurses and technicians
before making your final choice. These are the people who will be interacting with you more than your doctor and your welfare is largely dependent on their performance, expertise and compassion.
Familiarize yourself with the facility and procedure beforehand:
Preparing yourself mentally can lessen the shock and difficulties associated with this frequently required 4 hour procedure. While patients are generally advised to take dialysis 3 times a week, financial and other constraints often force them to go less frequently.
Discuss your choice of dialyzer and optimal number of reuse with your provider beforehand:
It is possible that a particular dialyzer is more likely to suit you than another. Importantly, most dialyzers are meant for single use, but due to financial limitations, patients are forced to reuse the dialyzer and blood lines. The efficiency of the dialyzer reduces with each use and your attempt to save on the dialyzer may prove costly if you reuse it too frequently. The same is true of blood lines as well. Though they can generally be reused far more frequently than the dialyzer, a leak or clotting will prove highly expensive in terms of blood loss and the danger of a blood clot entering your blood stream.
Check if you should take your insulin, blood pressure or other medication prior to dialysis:
Unfortunately, patients often miss out on this crucial information. Blanket instructions given (“Do not take your medication”) may or may not be suitable in your case. After the first one or two sessions, you and your care providers will have a better idea about what precautions you should take. Make sure you review this concern with your staff.
Be Prepared for Long Waits:
Even if you are provided with a prior appointment, frequently there are long waits at the centre. This is because most facilities are stretched to their capacity and emergency cases (which are fairly common) can easily disrupt the tight schedule. Additionally, the overworked staff and machines are also prone to absence or breakdown. You also need to factor in the commute time. If you feel weak or are unwell at the end of your dialysis, you may have to wait a while at the facility, before you are considered fit to leave. Accepting all these factors and being mentally prepared for such scenarios will lessen your frustration and fatigue.
Reclaim the rest of your life:
The whole point of dialysis is to extend the duration and quality of your life. But the whole affair can be so intimidating and taxing that patients often end up agonizing in anticipation of the next session. Some people do take some time to recover after the dialysis, but try to get back to constructive activity as soon as you feel upto it. The logistics do need to be taken care of. However, aim to organize dialysis and the rest of your life in such a manner, that you spend the least possible time pondering over your dialysis, in between the sessions.
Keep yourself occupied at the facility:
Carry a book, music, puzzles, your laptop or work to the facility. If you prefer, meditate or pray. If you have difficulties during dialysis, it is better to keep yourself distracted. And if you are comfortable anyway, it is constructive use of your time.
Wear similar, loose fitting clothing to every session:
Loose fitting because you should be comfortable for the long time that you will need to spend at the centre. Ensure that you wear similar clothes as this can have a significant impact on your weight. Heavy jeans, belts, etc. can raise your weight and a greater amount of water removal will be set for your session. Excessive water removal will leave you dehydrated and drained.
