NANI Dialysis Education

Dialysis Education

Dialysis is a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly. Normally, the kidneys filter the blood, removing harmful waste products and excess fluid and turning these into urine to be passed out of the body.

There are 2 main types of dialysis:

Hemodialysis and Peritoneal Dialysis

• In hemodialysis, a dialyzer (which is a filter) is used to remove waste and extra fluid from your blood.

The filtered blood is then returned to your body.

• Hemodialysis can be done at a dialysis center or at home.

• Treatments usually last about four hours and are done three times per week (in-center) or three hours each day for four to six times per week (home). Some people may need more time for treatments based on their specific needs.

• You will be given a schedule to follow. If you miss an appointment, you could risk issues that could lead to hospitalization.

DIALYZER

How do you prepare • Preparation for hemodialysis starts several weeks to months before your first procedure. To allow for easy access to your bloodstream, a surgeon will create vascular access. The surgical access needs time to heal before you begin hemodialysis treatments.

There are three types of accesses: • Arteriovenous (AV) fistula: A surgically created AV fistula is a connection between an artery and a vein, usually in the arm you use less often. It is usually created surgically but, in some cases, can be done by techniques that do not require surgery.

This is the preferred type of access because there are fewer risks of infection and complications.

• AV graft: If your blood vessels are too small to form an AV fistula, the surgeon may instead create a path between an artery and a vein using a flexible, synthetic tube called a graft.

• Central venous catheter: If you need emergency hemodialysis, a silicone tube (catheter) may be inserted into a large vein in your neck. The catheter tip ends inside the right atrium of the heart and is associated with poor outcomes. This type of access is temporary due to infection risks and complications.

It's important to take care of your access site to reduce the possibility of infection and other complications.

Follow your health care team's instructions about caring for your access site.

• Two large needles are inserted for each treatment.

• The needles are too large for a normal vein.

• One needle removes the blood so that it can be filtered of waste products and extra fluid.

• The filtered “clean blood” is returned through the second needle.

ARTERIOVENOUS (AV) FISTULA

AV fistulas can take between 6-12 weeks to mature.

AV GRAFT

What you can expect • You can receive hemodialysis in a dialysis center, at home, or in a hospital. The frequency of treatment varies, depending on your situation: • In-center hemodialysis. Most people receive hemodialysis three times a week in sessions of 3 to 5 hours each.

• Simpler hemodialysis machines have made home hemodialysis less cumbersome, with special training and someone to help you, you may be able to do hemodialysis at home. You may even be able to do the procedure at night while you sleep.

• There are dialysis centers located throughout the United States and in some other countries, so you can travel to many areas and still receive your hemodialysis on schedule.

• Peritoneal dialysis uses the inside lining of your abdomen (the peritoneum) as the filter.

• Like the kidneys, the peritoneum contains thousands of tiny blood vessels, making it a useful filtering device.

• Dialysate fluid is instilled into the peritoneal cavity through the catheter. As blood passes through the blood vessels lining the peritoneal cavity, waste products and excess fluid are drawn out of the blood and into the dialysis fluid.

• The used fluid is drained into a bag a few hours later and replaced with fresh Dialysate fluid.

• Peritoneal dialysis treatments can be done at home, at work or while you travel.

The dialysis solution flows from the bag to the catheter and into the peritoneal cavity

Dialysis solution absorbs waste and extra fluids from the body

Draining the fluid

What you can expect During peritoneal dialysis: • The cleansing fluid called dialysate flows into the abdomen. It stays there for a prescribed amount of time. This is called the dwell time. Your healthcare provider decides how long it lasts.

• Dextrose sugar in the dialysate helps filter waste, chemicals, and extra fluid in the blood.

• When the dwell time is over, dialysate — along with waste products drawn from your blood — drains into a bag. The used solution can then be disposed of in the bathroom.

How you prepare • You'll need an outpatient procedure to have a catheter placed in your abdomen, often near the belly button.

The catheter is the tube that carries cleansing fluid in and out of your abdomen.

• After the catheter is placed, your healthcare provider will probably recommend that you wait at least two weeks before you start peritoneal dialysis treatments. This gives the catheter site time to heal. In urgent situations, it may be used sooner.

• You'll also receive training on how to use the peritoneal dialysis equipment.

This is an external view of peritoneal dialysis catheter placement.

The process of filling and then draining your abdomen is called an exchange. Different types of peritoneal dialysis have different schedules of exchange. The two main types are: • Continuous ambulatory peritoneal dialysis (CAPD) • Continuous cycling peritoneal dialysis (CCPD aka APD)

Continuous ambulatory peritoneal dialysis (CAPD)

You fill your abdomen with dialysate, let it remain there for the dwell time, and then drain the fluid. Gravity moves the fluid through the catheter and into and out of your abdomen.

With CAPD: • You may need 3 to 5 exchanges during the day, each exchange takes approximately 30 minutes.

• You can do the exchanges at home, work, or another clean, dry place.

• You're free to do your regular activities while the dialysate fluid is inside your body.

Continuous cycling peritoneal dialysis (CCPD or APD) Another name for this is automated peritoneal dialysis (APD). This method uses a machine called an automated cycler. The machine does the exchanges for you at night while you sleep. It fills your abdomen with dialysate and lets it dwell there. Then it drains the fluid into a sterile bag you empty in the morning.

With CCPD: • Setup takes approximately 15 minutes.

• You stay attached to the machine while it exchanges for you at night.