Inpatient Hemodialysis

 

Have You Met. . . .

 

Your Dialysis Doctor  ___________________

 

Your Primary Nurse  ____________________

 

Your Dietician  _________________________

 

Your Social Worker  _____________________

 

A Financial Counselor  ___________________

 

A Surgeon for graft or fistula placement___________________

  

What is Hemodialysis?

 

Hemodialysis means “cleaning the blood”.  Blood is moved through a machine with a special filter called a dialyzer.  The dialyzer removes wastes and extra fluids.  The clean blood is then returned to your body.  Taking out the harmful wastes, extra salt, and fluids helps control your blood pressure and keeps the proper balance of chemicals like potassium and sodium in your body.

 

What is a kidney?

 

The kidneys are two bean-shaped organs that remove unwanted chemicals and waste from the blood.  These wastes are turned into urine by the kidneys.  The kidneys are in the back of the abdomen (stomach) on both sides of the spine.

 

What is Acute Kidney Injury?

 

Acute Kidney Injury occurs when one or both kidneys suddenly stop working.  It may take only a few hours or up to a few weeks for the kidneys to fail.  Acute Kidney Injury can occur because of diabetes, hypertension, hypotension, sepsis, trauma, drugs, dehydration, liver failure, and repeated kidney infections.  Acute Kidney failure can sometimes become a long term health problem which is called chronic renal failure.

 

What is Chronic Renal failure?

 

It is a long-term disease of the kidneys.  This occurs when the kidneys are slowly working less and less until they no longer work at all.  By working less, your kidneys cannot remove unwanted chemicals and waste.

 

How does the dialyzer clean my blood?

 

The dialyzer is a large tube that has thousands of small fibers which your blood passes through.  Dialysis solution, the cleaning fluid, is pumped around these fibers.  The fibers allow wastes and extra fluids to pass from your blood into the fluid that carries them away.  The dialyzer is sometimes called the artificial kidney. 

 

How do you feel during treatment?

 

Symptoms like cramps, headaches, nausea or feeling dizzy can occur but are not common.  If you have these symptoms let your dialysis care team know how you are feeling so they can help you.

 

How long are the treatments?

 

The treatment time depends on:

• How much your kidneys are working.
• How much fluid weight you gain between treatments.
• How much you weigh.
• How much waste you have in your blood.

 

What Is a Hemodialysis Access?

 

It is either a tube that is placed or a surgical change in your blood vessels which allows access to both a vein and an artery.  It is needed to provide a safe place to connect tubing during hemodialysis. 

 

The Temporary Catheter

 

Your doctor may select a temporary catheter.  These are used for a short period of time (up to three months).  During this time, a more permanent dialysis access (either peritoneal or hemodialysis) may be placed and allowed to heal.  A temporary catheter can be used right away for treatment after the access is placed.

 

 

The Permanent Catheter

 

The permanent catheter is designed to last longer than a temporary catheter.  A permanent catheter should last a few months to a year.  This type of catheter is placed through your skin and then tunneled or threaded under your skin for a short distance before going into a large vein in your neck. 

 

 

  

The Fistula

 

An arterial-venous fistula (A-V fistula) is a surgical connection between an artery and a vein usually in your upper or lower arm.  When this connection is created, the high-pressure arterial blood rushes into the low pressure vein.  Over time the vein becomes larger and the vein wall thicker.  The blood from these veins can be used for dialysis.

 

 

 

The Graft

 

A graft is like a fistula because it is placed during a minor surgical procedure and connects an artery to a vein.  It is used for dialysis in the same way as a fistula.  The graft is made of a thin, hollow, semi-rigid tube of a man-made material placed under the skin.

 

 

 

Daily Medicine: See your Pharmacist for further instructions.
Type/Name	Purpose	Method Given
Phosphate Binders Sevelamar Phoslo Calcium Carbonate Tums	Keeps phosphorous low in the blood which keeps calcium in your bones	By mouth with meals   Do not take with iron supplements.
Multivitamin Nephrocap	To supplement elemental and trace vitamins	By mouth after dialysis
Epoietin or Darbepoetin	To increase Red Blood Cells (Hematocrit)	Intravenously with dialysis or subcutaneously
Iron Iron Sulfate Iron Sucrose	To increase iron stores in the body to help Epoetin to work and raise red blood cells (Hematocrit)	By mouth or Iron Sucrose intravenously with dialysis   Do not take with calcium supplements.
Paricalcitol Zemplar Hectorol Rocaltrol	To treat low Vitamin D levels	Intravenously with dialysis

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Monthly Lab Tests
Blood Test	Normal Value for Dialysis	Too High Cause/Side Effects/What to Do	Too Low Cause/Side Effects/What to Do
Potassium (K+)	3.5 – 4.8	Cause:  Eating too many fruits and vegetables. Side Effects:  Tiredness, irregular heartbeat, muscle weakness, tingling, death What to do:  Decrease the amount of fruits and vegetables in your diet especially bananas, tomatoes, potatoes, oranges.	Cause:  Not eating enough fruits and vegetables, lasix, vomiting, diarrhea. Side Effects:  Muscle weakness, shaking, irregular heart rate, tingling, death. What to do:  Increase fruits and vegetables in your diet i.e., one banana, tomatoes, potatoes. Change or stop lasix (if still taking this medicine).  Treat vomiting or diarrhea per doctor's advice.
Calcium (CA+)	8.5 – 10.2	Cause:  Taking too many calcium supplements (i.e. TUMS, Elemental Calcium) or vitamin supplements or hormonal imbalance. Side Effects:  Calcium deposits in tissues, arteries, or heart. What to do:  Decrease the number of calcium supplements you are taking.		Cause:  Not taking enough calcium supplements, Chronic Kidney Disease, Side Effects:  Bone disease, tingling in fingers, and may cause abdominal cramps. What to do:  Increase the number of calcium supplements
Phosphorus (PO4)	3.5 – 5.5	Cause:  Not taking calcium supplements with meals; need to take more calcium supplements.  Eating too much beans, nuts, milk, processed lunch meats, or hotdogs, "dark" sodas. Side Effects:  itching, easily broken bones, hardening of blood vessels which can cause a heart attack, problems breathing, and painful joints. What to do:  Take calcium supplements with meals, check with RN/MD about increasing the amount of calcium supplements you take.		Cause:  Taking too many calcium supplements. Side Effects: What to do:  Decrease the amount of calcium supplements you take after checking with your nurse or doctor.  Eat/drink more beans, nuts, milk, processed lunch meat or hot dogs.
Albumin	3.3-4.7	Cause:  Rare to be too high. Side Effects:  What to do:		Cause:  Not eating enough proteins and/or calories.  Recent infection. Side Effects: Swelling in ankles, muscle weakness, and/or breakdown, increase chance of infection. What to do:  Increase the amount of protein/calories you are eating. Speak to a dietitian

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 06/19/2009

Copyright © 06/19/2009 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #6910

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