PATIENT EDUCATION - DIALYSIS
What is Dialysis?
Dialysis is the major treatment for kidney failure. It is
the medical word for filtering waste products and removing
fluid from your body that your kidneys are no longer able to
remove.
There are two forms of dialysis: Haemodialysis andPeritoneal
Dialysis There are two forms of dialysis: Haemodialysis
andPeritoneal Dialysis
Haemodialysis
Haemodialysis is a process by which excess waste products
and water are removed from the blood by using a dialyser,
also known as an artificial kidney. This form of
treatment means the blood is transported outside the body
through the dialyser via a specially created vein in the
forearm known as arterio-venous fistula. This process
requires the use of a machine.
In haemodialysis, the blood channels through tubing to the
dialyser. The dialyser is a bundle of hollow fibres made up
from a semi-permeable membrane. The membrane is thin film
with thousands of microscopically small holes. The holes
allow water and small dissolved substances to pass through
but retain the proteins and blood cells, which are too
large.
During the dialysis treatment the blood is allowed to flow
on one side of the membrane and dialysate solution on the
other, and exchange (diffusion) takes place from the blood
to the dialysate solution and visa-versa. The dialysate
solution has a salt composition similar to blood but without
the waste products. Usually one session takes about 4
hours.
The actual dialysis treatment is controlled and monitored by
a dialysis machine. This consists of a blood unit and fluid
unit. The pump in the blood unit pumps blood from the
patient through the dialyser and back to the patient via the
blood tubes. The fluid unit controls the mixture of the
dialysate solution.
Access
In order to have chronic haemodialysis, you need to have
surgery to create access, a way to carry the blood to the
dialyser.
The most common type of chronic access used nowadays is:
Arterio-venous (A.V) fistula and the Arterio-venous (AN)
graft.
The fistula is created internally and is used for a
prolonged length of time.
Your surgeon makes a fistula under the skin by joining an
artery and vein, allowing arterial blood to flow directly
into the vein.
Due to arterial pressure, the vein will increase in size and
thicken; it takes about 4-8 weeks for the fistula to mature.
A fistula makes it easy to put a needle into the vein to
allow blood flow through the dialyser using the blood pump.
The graft is an artificial blood vessel used to join an
artery and vein. It is used when patients own blood vessels
are too small for fistula construction.
The graft may be either straight or looped and is close to
the surface of the skin.
The graft may be of artificial material or can be obtained
from the patients own body e.g. vein in the thigh.
Temporary access can be created in cases that need urgent
dialysis and cannot wait for a few weeks for the fistula to
mature.
These include the subclavian catheter, internal jugular
catheter and arterio-venous shunt.
The subclavian catheter is a set of tubing which is inserted
into the subclavian vein near the neck.
The internal jugular catheter is placed into the veins at
the side of the neck.
The sublclavian and internal jugular catheter cannot be used
beyond a few weeks as it tends to get blocked or the site of
insertion may become infected.
The shunt is surgically created with an artificial material,
and has a short life span i.e. 6 months.
Care of the Fistula/Graft
•
Keep area clean and dry.
•
Feel for thrill sensation at both ends of fistula/graft at
least twice weekly.
•
Inspect fistula for redness, swelling, tenderness, or warmth
to touch to detect infection.
•
Avoid constrictive clothing, jewellery etc. that may block
the fistula.
•
No blood pressure, blood taking, or intravenous
administration should be done on the
fistula arm.
•
Avoid excessive pressure on puncture sites after dialysis.
•
Rotate needling sites to prevent aneurysm.
•
If injury occurs at site, apply pressure over bleeding and
seek immediate medical help.
Haemodialysis Advantages and Disadvantages
Advantages
Staff performs treatment
No equipment at home
Treatment 3 times/week
No external access
Regular contact with staff and other patients
Disadvantages
Travel to centre
Fixed dialysis times
Two needles inserted each treatment
Wastes build up between treatments
Diet and fluid restrictions
Peritoneal Dialysis
Peritoneal dialysis is performed by introducing dialysate
solution into the peritoneal (abdominal) cavity through a
silastic catheter. The natural membrane lining of the
peritoneal cavity acts as a filter where waste products and
excess fluid from the body pass through the membrane into
the dialysate solution. The dialysate solution used is
sterile and contains salts and a high content of glucose
(sugar). The glucose will cause water from the blood stream
to be drawn into the peritoneal cavity.
A peritoneal dialysis procedure is called an exchange
because used solution is removed and replaced with fresh
solution. You connect long tubing set to the short tubing
you are wearing (attached to catheter). The lower bag is for
draining used solution from the peritoneal cavity and when
empty, you are ready to fill with fresh dialysate solution
from the upper bag. The fluid surrounds the internal
organs; it does not go into the stomach or other organs. The
dialysate solution is left in the peritoneal cavity for
several hours to collect waste products and excess fluid
from the blood.
The most common forms of peritoneal dialysis used today are
C.A.PD. and A.PD.
Continuous ambulatory peritoneal dialysis (C.A.PD.)
functions much like the kidneys do. Constantly cleaning the
blood as long as there is dialysate solution in the
cavity. Typically you do exchanges four times a day i.e.
when awaking, lunch time, late afternoon, and bedtime (every
5-6hours).
C.A.PD. gives you constant dialysis, 24 hours a day seven
days a week.
Automated Peritoneal Dialysis (A.PD.) is dialysis at home
with a cycler machine.
Each night before you go to sleep, you connect your set to a
long tubing set, attached to dialysate bags on the cycler.
The machine does the exchanges while you sleep. The machine
is quiet and does not wake you. The tubing is long enough
for you to sleep comfortably and walk several feet.
The peritoneal catheter called a tenckhoff is a small soft
tube; it is placed into the peritoneal cavity surgically.
You will typically stay overnight in hospital. Just a few
inches of the catheter is outside your body. Most is inside
you body. The catheter is left in place so dialysis can be
done. It provides a small opening in which dialysate
solution can be placed.
Training for Peritoneal Dialysis is provided on a national
basis at all National Renal Care units and is normally done
as an out-patient.
Patients on Peritoneal Dialysis lead very normal lives; many
patients continue to work, go to school or are active in the
community and can even travel.
Disposables are delivered to your home or your travel
destination free of charge.
Advantages and Disadvantages
Advantages
Self-care
No needles
Greater independence
Flexible diet
Flexible schedule
Blood pressure control
Blood sugar control
Less stress on body
Disadvantages
Daily exchanges
No off days
Permanent catheter
Some risk of infection
Some possible weight gain
Living with Dialysis
The dependence on artificial life support devices, adherence
to strict medical regimes and increase in financial
obligations and a decrease in physical and social
functioning, frequently result in feelings of depression,
anxiety, worthlessness and hostility. All members of your
family unit are affected by your renal disease. Family
members may need to assume new roles. For the person who is
ill, losing former roles either temporary or permanently,
can be frightening and depressing. These include
unemployment or being too ill to do family chores, to name a
few. There are changes in roles or lifestyles that may occur
in your own family.
Family members may need to be responsible for you at first
but continuing to treat you as if you are too sick to care
for you can place a huge burden on the family. Due to your
illness you may need to depend on your family at first, this
may be hard to accept, especially if you are a very
independent person.
Sex may be a difficult topic to many, but it is important to
discuss it in order to understand the physical and emotional
changes that occur with renal failure. A chronic illness
such as renal failure will change one's desire for sexual
intimacy. For men impotence or the inability to maintain an
erection may occur and women may experience difficulty with
arousal. Men and women may just show a lack of interest,
which can strain a sexual relationship. It is important to
talk these concerns over with your doctor or nurse. Being a
kidney patient doesn't mean you can't have a satisfying
relationship.
Kidney failure and the treatment may be difficult to accept
at first however with time, support and education you can
adjust. You must learn to live with dialysis as part of
your life. Learn is the key word for you as a dialysis
patient if you are going to make the most of life. You will
need to learn to understand and accept your illness and
learn what it means to be a kidney patient. You will need to
learn to eat and drink the right things, to take medication
and exercise appropriately.
Communication is vital, talk about your feelings and
experiences with someone you trust. Talking and sharing
about what is happening to you will decrease your feelings
of loneliness and increase your feelings of being supported
and loved. Share your thoughts and feelings with family,
friends and your medical treatment team. Talking to other
patients is helpful. Once you are feeling better it will
be important to return to as many of your past activities as
possible. With your doctors permission you may return to
work, your hobbies, clubs etc. Getting back into old
routines will help you feel that sense of normality again.
In conclusion your overall physical and mental adjustment
depends upon you.
