Dialysis

DISCHARGE INSTRUCTIONS AFTER RENAL DIALYSIS SESSION

Dialysis Process‍

Dialysis is a procedure of purification of blood from toxins, salts and excess fluids. Consecutive amounts of blood are pumped out of the body continuously through a device called dialysis machine.

There is also different kind of dialysis catheter

1. Central Catheter – is a plastic tube inserted into one of the central veins of the chest, neck or thigh, and the outer edge is fixed to the skin by a medical thread.
2. AV fistula – is the connecting of the artery to the vein in a specific area of the right arm or left. AV fistula needs 1–2 months to be mature before they are used for dialysis.
3. AV grafts – is a tube made from the Teflon placed under the skin to connect the artery to the vein and can be used in dialysis after 7–14 days of installation.

Discharge instructions

• Check your vascular access (Fistula, Graft) daily for any signs of infection such as redness, pus and swelling. Notify your healthcare provider if you notice these signs.
• Report to your healthcare professional if you have any signs and symptoms of catheter-related infection such as fever, chills and/or hypotension and change in mental status.
• Adherence to fluid restrictions and maintain weight as directed. (1–2kgs as ideal weight gain for each session)
• Compliance with dietary restrictions. (Potassium-rich foods, sodium and phosphorus-rich foods). Emphasize sodium compliance in patients and explain its adverse effects, such as excessive weight gain, hypertension, and peripheral edema. Minimize potassium intake levels as it can affect the heart and muscles.
• Compliance on taking home medicines on a regular basis especially anti-hypertensive and diabetes medicines, also anticoagulant medicines.

Vascular Access Care

Central Catheter Care‍

In order to avoid infection:

• Keep your catheter bandage closed, clean and dry.
• If your bandage gets open or wet notify your healthcare professional.
• DO NOT open the dressing at home. If in case it is found open, you should go to DSFH RDU for dressing change or to DSFH ER.
• AVOID soaking the catheter with soap and water during shower. The catheter should remain dry and intact.
• You should know the signs and symptoms of catheter-related infections such as fever, chills and/or hypotension and change in mental status. If such are present, you should not hesitate to go to the hospital for treatment.
• Before getting into shower make sure that your catheter access site are secure and cover it by waterproof plastic wrap.
• You should follow up with vascular surgery clinic for creation of AV fistula as this has a lower rate of bloodstream infection.

AV fistula, AV graft care (Vascular Graft)‍

In order to maintain adequate blood flow on the hand with AV fistula or AV graft you should follow the below:

• DO NOT sleep on the hand with AV fistula or AV graft
• DO NOT let anyone take blood pressure or blood samples from the hand with AV fistula or AV graft
• DO NOT carry heavy objects with the hand with AV fistula or AV graft
• AVOID blows or impact on the hand with AV fistula or AV graft
• It is important that after hemodialysis session, the dressing should be removed after 6–8 hours if there is no active bleeding at home. If bleeding occurs, patients are instructed not to panic but apply good compression until there is no noted bleeding and while the patient is transferred to the nearest hospital.
• Wash the access site with water and soap before dialysis session.
• Ensure that all staff accessing your vascular access site are preparing your skin properly and wearing mask.

Ask for your right‍

Make sure that all healthcare providers clean their hands with soap and water or alcohol-based hand sanitizer before and after caring for you or your vascular access site.

Come to emergency room in case of

• Signs and symptoms of catheter-related infections such as fever, chills and/or hypotension and change in mental status.
• Bleeding from catheter site or AV fistula.