Your First Day on In-Center Hemodialysis
Starting dialysis can be a little overwhelming and you probably have lots of questions. It’s natural to be a bit nervous and apprehensive when you enter the building for your first treatment. On your first day of dialysis you will be going to a facility where you will be spending several hours three times a week. You will meet your health care team and others just like you on dialysis. Many of the “dialysis pro’s” will tell you not to worry and that may be hard to believe in the beginning. When you know what to expect, our hope is that you will begin to relax and feel better about your first day on dialysis.
Entering the dialysis center
When you enter your dialysis center for the first time, you’ll generally be greeted by a receptionist who will make copies of your insurance cards and driver’s license (don’t forget to have these with you). The receptionist will also ask you to sign a waiver to have your photo taken for your medical records. You will then take a seat in the lobby and wait to be called back to your chair by one of your nurses when it is your turn to start treatment. You will only need to check in at the front desk on your first day of dialysis.
What to bring to the dialysis center
On your very first treatment it is important to bring all your medication with you so it can accurately be entered into your medical chart.
Many people get cold while on dialysis treatments. This is due to your blood being circulated outside of your body. You are encouraged to bring a blanket from home and even a pillow if you need to. You will be sitting in a chair for about four hours so you will want to wear something comfortable and loose fitting. Warm socks, a sweatshirt or sweater and perhaps a hat can help you keep warm. Take note of where your dialysis access is located. If you have a graft or fistula in your arm, be sure your sleeves are loose enough to roll up. If you have a catheter in your chest, be sure to wear a shirt that opens in the front.
There are various websites that offer sweatshirts with zippers in the arms or on the upper chest for easy access to your access site. You can also ask the receptionist for a form to call a local organization that will make you a sweatshirt for free.
You may want to bring a book or any other project that you’d like to work on while you are dialyzing. Televisions are available but are shared by two patients. Free internet access is available if you’d like to bring a laptop. If you watch videos, you will need to bring your own headphones. You will need to make sure all your electronic devices are charged before coming to treatment. There is no patient access for charging electronics.
Before dialysis treatment begins
You’ll meet one of your dialysis nurses who will weigh you before you start the treatment. Then, you’ll wash your arm if this is where your vascular access is located. Your dialysis nurse or technician will show you how to wash your vascular access. Once you are familiar with how this is done, you will do this step yourself. When your access is clean, you’ll be shown to a treatment chair that has been prepared just for you. When you get to your chair, the nurse will check your standing and seated blood pressure, listen to your lungs, take your temperature, and check your heart rate and other vital signs. You will have a few minutes to get settled in your chair with your blanket and pillow, if you have them. Each chair reclines and has a tray on the side to set the things you brought with you so everything is easy to reach.
Dialysis treatment begins
Once you are comfortably in your chair, you will be connected to the dialysis machine. If you have a fistula or graft, your nurse will wipe your vascular access with a solution to kill any bacteria. You will be connected through your vascular access with two needles connected to tubing that will be used to connect you to the machine. An arterial needle will take your blood through the dialyzer or artificial kidney, while a venous needle will return your blood to your body. You can ask for numbing medicine to be put on your access before you get the needles inserted if the needle sticks bother you. Most people get used to the needles and are not bothered by them after a while. If you have a catheter in your chest, the dialysis tubing will be connected to your catheter.
Once you are connected to the dialysis machine, your technician will start the dialysis treatment. The machine will move your blood through the dialyzer or artificial kidney to be cleaned and then returned to your body.
During dialysis treatment
While you should not feel pain or discomfort during dialysis treatment, dizziness, nausea and muscle cramps are potential side effects of low blood pressure which may happen if you reach your target weight (dry weight) and fluid is still being removed or if fluid is removed too fast. You should let your nurse know right away if you feel dizzy or experience cramping.
When dialysis treatment is over
When your treatment is finished, the staff will use a saline solution to rinse the blood that is still in the tubing and dialyzer back into your body. Your technician will then shut off the dialysis machine, take out the needles and disconnect you from the machine. You or the technician will apply pressure to your access site to prevent bleeding and apply dressings on each needle insertion site. Before you leave, your nurse will take your blood pressure and weigh you one more time. This post-treatment weight will be used the next treatment to help determine how much fluid to remove. After that, you’re free to go. If any unexpected bleeding occurs, put pressure on the site and notify your dialysis center or kidney doctor right away.