What happens before hemodialysis?
You must prepare for your first hemodialysis session weeks or even months in advance.
If you’re able to do hemodialysis at home, your healthcare provider will teach you how to properly perform the procedure and review common problems that may arise.
You’ll first undergo minor surgery to make it easier to access your bloodstream. You may have one of two procedures:
- Arteriovenous fistula (AV fistula): Your surgeon connects an artery and vein in your arm.
- Arteriovenous graft (AV graft): If the artery and vein in your arm are too short to connect, your surgeon will use a soft, hollow tube (graft) to join them.
These procedures make the connection between your artery and vein easier to access during hemodialysis. They also help your blood flow in and out of your body faster.
In some situations, you may need to start hemodialysis quickly. Your healthcare provider may temporarily insert a catheter into a vein in your leg, chest or neck. A catheter is a soft, hollow tube. It consists of rubber, silicone or another medical-grade material.
Your healthcare provider will also teach you how to clean your fistula or graft to prevent infections. Signs of infection include:
- Pain.
- Tenderness.
- Swelling.
- Discoloration (red, gray, pink, brown or black).
- Fever.
Protecting your fistula or graft and the surrounding area is important. The following tips can help protect the areas:
- Avoid sleeping on your access area.
- Avoid wearing jewelry or tight clothes that may squeeze your access.
- Avoid wearing a purse or bag strap across your access.
- Don’t take blood pressure or have blood drawn from the arm that has your access.
If you accidentally damage your fistula or graft, you may no longer be able to use it for hemodialysis.
Do I need to change my diet before starting hemodialysis?
What you eat and drink can limit the effectiveness of hemodialysis and affect how you feel. Certain foods and drinks can create a lot of waste in your blood, create extra fluids in your blood, raise your blood pressure and make your heart beat faster.
Before you start hemodialysis, a dietitian who specializes in kidney diseases (renal dietitian) will work with you to create a hemodialysis diet.
It’s a good idea to avoid foods that contain a lot of:
- Potassium: Too much potassium in your diet can accelerate your heartbeat. Examples of potassium-rich foods include bananas, avocados and dry fruits.
- Phosphorus: Too much phosphorus in your diet can make your bones brittle and your skin itch. Examples of phosphorus-rich foods include dairy, chicken, turkey, hot dogs and canned chili.
- Sodium: Too much sodium (salt) in your diet makes you drink more fluids. Examples of sodium-rich foods and drinks include vegetable juice, sports drinks, fast food and seasonings.
What happens during hemodialysis?
Your hemodialysis nurse or technician will put two needles in your arm.
The needles are 15- or 16-gauge. The outer diameter of a 15-gauge needle is about 1.8 millimeters (mm), which is approximately 2.5 times larger than the tip of a ballpoint pen. The outer diameter of a 16-gauge needle is slightly smaller — about 1.65 mm. Soft tubing connects both needles to the hemodialysis machine.
If you’re on home hemodialysis and have proper training, you may put the needles in yourself.
The hemodialysis machine removes your blood from one of the needles in your arm. It then circulates your blood through the many mesh tubes in the dialyzer. The dialyzer moves excess waste and fluids into a dialysate solution.
The hemodialysis machine eventually returns your filtered blood to your body through the second needle in your arm.
During the session, your hemodialysis machine regularly monitors your blood pressure. It may adjust the speed at which your blood flows in and out of your body.
Is hemodialysis painful?
You may feel a slight pinch when the needles enter your fistula or graft. However, the hemodialysis process itself doesn’t cause any pain.
Why does hemodialysis take so long?
Healthy kidneys work nonstop to filter your blood, even while you sleep. Even with advances in treatment, hemodialysis can’t wholly replicate your kidneys’ consistency and efficiency.
Healthy kidneys filter about 150 quarts of blood in a single day. Hemodialysis is only 5% to 10% as effective as healthy kidneys. As a result, sessions generally take three to four hours to complete.
What happens after hemodialysis?
You or your healthcare provider will remove the needles and clean your access areas. You may continue your everyday activities.
Many people feel tired or ill after standard hemodialysis sessions. Your symptoms may last for several hours. However, some people report having more energy with more frequent hemodialysis. Talk to your healthcare provider about what type of hemodialysis is best for you.
