What to Expect When Starting Hemodialysis In-Center

Hello, I am a new patient just arriving at the dialysis center for my first in-center dialysis treatment. I’m nervous.  The only time I have been here is for a tour and it was overwhelming. I had dialysis in the hospital, but it sure looks different in here. What do I do first?  Where do I sit?  What happens next?  What should I have with me?  Does someone need to stay with me?   

All these questions bubbled through my brain when I walked into a dialysis center twenty years ago to have my first treatment.  Did I say twenty years ago?  Yes, I did. I have been on hemodialysis in-center for twenty years.  I know how it feels to walk into a dialysis center full of anxiety, not knowing what to expect.  Now you just relax.  I will walk you through a day in the life of a dialysis patient treatment in center. You have already signed the mountain of paperwork the social worker brought you.  They will give you copies of everything you signed.

Did you bring a warm blanket, some headphones and something you like to do?  Did you bring a snack (if your center allows food)? If someone is staying with you through the treatment, they will need to wait until you are on the machine before coming into the treatment area.  They will need to wear a paper smock while they sit with you.

Great.  You are now ready for the Great Adventure called In-Center Hemodialysis.   

The technician will come get you when it is your turn for treatment.  They will show you where your chair is for this treatment.   Put your things on your chair.   The first day the technician will walk you through the next steps.  In the future you will do it.

1. Walk over to the scale and find out how much you weigh.  It is usually done in kilograms, so do not be worried when it looks different than pounds.  Sometimes there is paper and pencils to use to write the weight down or keep it in your memory until you can tell your technician.  Today the technician wrote it down for you.   You both walk back to your chair.
2. The technician will place a blood pressure cuff on your non-fistula/graft arm and take a blood pressure with you standing beside the chair.  This gives them a baseline reading.  They will also ask how you feel and if there have been any changes. 
3. Take a little time before you sit down to make your chair comfortable.  Put your snack bag on the chair table opposite your fistula arm. If you brought a sheet to cover the chair, put it on the chair. Make sure your things are easily accessible with one arm.  Plug your headphones into the plug on the TV/ channel changer; Or ask where it goes. Shake your blanket out so it is ready to cover you.
4. Take a seat in the chair that will be yours for the next three to six hours, depending on your treatment time.  A nurse will come over and do an evaluation with you because this is the first time you have been here.   Usually the technician in your area will be there to hear your answers, that way they get to know you, too; and find out  if you are new to dialysis, or if you are an experienced old hand at dialysis.  They will ask you if you have a chest catheter or a fistula/graft already being used.
5. Most new patients have a chest catheter, so we will start with that assumption. Another blood pressure called a sitting blood pressure will be taken.  A nurse place you on the machine through the chest catheter.  This process does not hurt.  The only time it may hurt is when stitches are pulled on gently, or when she is cleaning your catheter site.  After you are undergoing treatment another blood pressure will be taken.  Dialysis should not hurt, so if it does tell someone.
6. A word about blood pressure being taken. The dialysis center is required to take a blood pressure once every thirty minutes while you are undergoing treatment.  They cannot change that.  However, if your BP is acting high or low they will decrease the time between measurements. You can help make this decision with your nurse and technician.  Blood pressure is one way they can tell how you are doing throughout dialysis treatment. Do not take the cuff off because it is uncomfortable. The dialysis machine automatically takes the BP and if the cuff is not on your arm they will alarm.
7. You have seen how this works in the hospital.  One line in pulls blood out of your body and sends it into the filter called a kidney. Do you see the long filter looking gadget attached to the machine?  That is called a kidney and it will do some of the work your kidneys are not doing today.  Not to worry, no more than a couple of tablespoons of blood are out of your body at any time during dialysis.  The other line they attach will return the cleaned blood to your system.
8. If you have a fistula or graft ready to go, the only difference will be they will use needles in on the access in your arm. Clean your access arm after you get your weight. This will help prevent infections.  The needles may hurt going into your skin, but there is lidocaine available to help. Also, you can buy or get a lotion prescribed to put on thirty minutes before you come in to dialysis that helps deaden the feeling in the area where the needles go.  The two needles are attached to long thin hoses: one is for venous blood, the other is for arterial blood.  Your blood makes the trip to the filter and back to you in a one-way trip.
9. Enjoy your treatment time.  Watch TV. Do the fun things you brought.  Have your snack.
10. Very important:  If you start to feel funny or different, let your tech or nurse know immediately.  Since this is your first treatment at the center, they will be watching you carefully anyway.  You need to tell them if you feel weak, get a giant headache, or muscles start to cramp.  Dialysis is making some serious changes during treatment to your body.  You can have some serious complications. 
11. Today your dialysis treatment went well, and you are ready to go home.  First the nurse will come to take you off of the machine.  She will disconnect both tubes carefully.  She will check to be sure the bandage she placed over the catheter site is all right.  She will tape it all down properly.
12. A sitting blood pressure will be taken while you are still sitting in the chair. The another will be taken after you stand up.  You will be asked how you feel.  If you start to feel dizzy, sit down immediately and report how you feel.
13. A trip back to the scale for your weight after dialysis.  You will notice you have lost a few kilos in fluid. Give your new weight to your nurse or technician.
14. Clean up your chair area of all your things. Unplug your headphones.  Unplug any devices you had plugged in.  Remember your cords and personal things.  Have good manners and throw your personal trash out.  Try not to leave a mess for the technicians to clean up around or on your chair.
15. It is time to leave.  Have a good day off dialysis and we will see you for your next treatment on your MWF or TTHS schedule. 

So, in review, you came into the center, found your chair, took your weight, had a nurse or technician put you onto a dialysis machine for your prescribed hours of treatment.  The most exciting time was when you were put on the machine and then when you were taken off it. Fairly boring for the rest of it as you slept, watched TV, ate your snack, or did things you brought with you.  You probably feel tired.  Go home, eat something, and get some rest.

Remember you dialyze to LIVE, not live to dialyze!  Do something fun between now and your next dialysis treatment.  We will see you back at the dialysis center according to your schedule, either MWF or TTHS.

 Watch your fluid intake…. but that is another topic.