• Reference Number: HEY-895/2020
• Departments: Renal Service
• Last Updated: 30 September 2020

Introduction

This leaflet has been produced to give you the necessary information you require for your haemodialysis.  Most of the information given in this leaflet will have been discussed with you at your clinic appointments.  This information however, gives clear instructions on the arrangements that are needed when you start haemodialysis, including dates and times known as ‘slots’.

Some spaces may be left blank; these are for you to complete when the final details are known and which may be given to you over the telephone.  Please keep this close to hand and bring it with you to your appointments.

If after reading this you have any concerns or require further explanation, please contact the Pre-Dialysis Nurse Practitioners on telephone number (01482) 608974.

Should you have any concerns once you have started haemodialysis, please speak to your Haemodialysis Named Nurse, Team Leader or Clinic Manager.  You will be informed who these are once you have started.

Dialysis Unit Contact Numbers:

How is the decision to start haemodialysis made?

The decision to start you on haemodialysis has been made because your kidney function is at a low level and you may also have started to have symptoms such as oedema (a build-up of fluid in your system) or issues with raised potassium levels.

Your level of kidney function is ………………………………………………………

The symptoms you have informed us of are……………………………………….

When you were examined you were found to have ………………………………

Therefore, the decision has been made for you to start dialysis.

If a decision has been made following your attendance at the clinic, we will generally call you the following day to inform you of this.

If it is out of the clinic setting following recent blood tests, we will call you as soon as we are aware of the results and have discussed these with the consultant.

DATE AND TIME OF FIRST DIALYSIS SESSION:

(This section is for you to complete)

FURTHER NOTES YOU MAY WANT TO MAKE

How do I prepare for starting haemodialysis?

Please read the information leaflet and review those that have already been provided.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you.

If you have a fistula it should have been checked and assessed as being useable and may have also been scanned.  Despite this, there may still be some difficulty needling the fistula at first and also there may be some bruising, which can be quite extensive and may result in:

• delaying the commencement of dialysis
• using 1 needle

or

• having to have a dialysis line inserted into a vein in your neck as a temporary measure until the issue with the fistula is resolved.

If you do not have a fistula a dialysis line will be required. This may also be the case if your fistula is not ready for use or there have been failed attempts at using the fistula. If this is necessary, it will be discussed with you and any questions answered.  We may also need to arrange for you to have further tests done at this point.

These will be to check:

• your blood clotting
• hepatitis and HIV screening bloods, which are done routinely before commencement on dialysis.

We will also need to make sure you have an up to date MRSA screen – this is when swabs are taken from the nose, axilla (armpit) and groin.  MRSA stands for Methicillin Resistant Staphylococcus aureus.  Staphylococcus aureus is a bacteria (germ), which is found in up to 40% of the population.  When it is present it is usually found on people’s skin, nose and throat.  We can provide further information about this if you require.

What will happen?

Your arrival at the unit will be expected; the receptionist or another member of staff will ask you to take a seat and will let the nurses know you have arrived.  If the receptionist is not present, please take a seat and the nurses will come and get you at or near to your appointment time.

The nurse looking after you will be an experienced registered nurse and she will start by explaining your treatment and the processes and answer any questions you may have.  You will also be asked to sign a consent form for your treatment.  The nurse will then start your dialysis and talk you through the process and again explain each stage.

Your first dialysis session is generally for 2 hours. We will build up your dialysis hours each session until you are on 4 hours, 3 times a week.

Dialysis sessions must not be missed or shortened as this is detrimental to your health and well being.

Remember dialysis is not a short-term treatment, it is ‘lifelong’.

You will have had other options explained to you in the clinic setting such as peritoneal dialysis, transplant or conservative (non-dialysis treatment). Changing your treatment to one of these options is the only indication for not having dialysis.

During dialysis the nurse will make regular checks on you and also record your blood pressure and pulse.  It would help if you wear clothes that will make it easy to get to your ‘access’ (fistula, graft or dialysis line) and use it safely.  If you are a diabetic, your blood glucose levels will also be checked.

Drinks, sandwiches and biscuits are provided but you may also want to bring something ‘pack-up’ style of your own choice. No food warming facilities are available.

Please let us know if there is anything in your daily life that you may need support with or flexibility to continue your dialysis sessions.  For example college, work, caring for others and any other appointments or ‘special’ events that are planned.

What happens afterwards?

After your dialysis session has finished, the nurse will talk you through the process of coming off dialysis and make sure that your fistula or graft has stopped bleeding.  They will tape gauze over the area where the needles have been; you will need to keep this dry and keep it on until the next day.  After dialysis you will be asked to wait in reception until your transport or lift arrives to take you home.   Remember you need to continue to attend for your dialysis ‘slots’ at the dates and times given.

It is very difficult to say how patients will feel on dialysis in the first week or so but patients have commented as below:

• “I felt washed out in the early days” – resting for a period following dialysis may help
• “My energy levels improved”
• “I felt no change but then again I didn’t feel unwell when I started”
• “It wasn’t as bad as I expected”

Additional Information

Transport

Providing your own transport for some of the journeys, or all, is beneficial for you.  It reduces any waiting time that may occur with provided transport and therefore reduces the time away from home on your dialysis days.  If you need transport, this will be ordered for you.  We need a minimum of 24 hours’ notice to book transport.  You will need to be ready 2 hours before your time if living in Hull and longer if you are from outside the Hull area.

If you are a driver and wish to drive, please discuss this with your nurse so that a decision over your ability to do so can be made.  Parking is free and available.  A permit will be provided.

Transfer to a Dialysis unit nearer to home

If you have not started your dialysis at the centre nearest to your home, Hull Dialysis Unit will aim to transfer patients to their nearest unit as soon as it is possible.  The decision to do so is based on several factors including: access, general fitness and spaces available at that unit.

Please be aware if you are having dialysis in a unit nearer to your home and your clinical situation (health or mobility) changes, it might be necessary to transfer your dialysis treatment back to the Hull dialysis Unit. This will be discussed with you.

Sometimes it might also be necessary to alter your dialysis slot times and again this will be discussed with you

ARNESP or other erthropoientin stimulating agent (ESA)

If you are having Aranesp injections, you need to continue with these until you have used your supply.  The dialysis staff will be aware of this and of the date of your last injection.  They will arrange for this to be given during your dialysis and you will no longer have to inject yourself.  The delivery will be cancelled by the anaemia nurse.  If a district nurse gives you the injection, she will be informed to continue as above until the supply is used.

Hepatitis B vaccination

If you have commenced Hepatitis B vaccinations at your doctor’s surgery, you must complete the course but they need to be given on your non-dialysis days.   Details of the vaccination dates should be given to the dialysis staff.  If you have not started the vaccinations, this will be arranged by the dialysis unit staff and the reasons for this will be explained to you.

Outpatient Appointments

Once on dialysis, your outpatient appointments will be with the consultant responsible for the care of patients having haemodialysis.   These are held in the dialysis unit.  You should be seen within 2 – 4 weeks of starting dialysis.  If you have not heard within 4 weeks, please inform your dialysis nurse.

Any existing appointment in the Low Clearance Clinic will be cancelled.

Any dialysis related issues that may occur before your appointment will be dealt with by the nursing staff who will gain advice from the doctors if required.  If you are being prepared for transplantation, this will continue and the transplant nurses will be aware that you have started dialysis.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.