Dialysis Centers - What to Expect?

Introduction:

Dialysis is a medical procedure used mainly to treat renal disorders and other conditions that require removing waste products and excess fluids from the blood for the patient's survival. In this procedure, the waste products and the excess fluids are removed from the body with the aid of an external machine. Kidneys naturally filter the blood by removing waste products, salts, and excess fluid from the body and excreting them in the urine. They also maintain the fluid-electrolyte balance and the acid-base balance in the body.

When the kidneys fail to function temporarily (acute conditions) or permanently (renal failure), dialysis is the treatment option for those patients. It is done as an emergency procedure to prevent mortality in severe cases. Dialysis can be carried out at centers or hospitals under the supervision of the nephrologist, the trained dialysis technicians, and the nurses. It can be done at home once the patient or the attendee is well-trained to perform the procedure.

What Is a Dialysis Center?

A dialysis center is a place where dialysis is carried out. It offers dialysis treatment to people affected with renal disorders, renal failure, and other conditions necessitating dialysis.

What Are the Types of Dialysis?

There are three types of dialysis based on the method, it includes:

• In-center hemodialysis.

• At-home hemodialysis.

• Peritoneal dialysis.

Dialysis can be categorized into two types based on the duration:

• Short-term dialysis.

• Long-term dialysis.

What Is Hemodialysis?

Hemodialysis is a therapeutic procedure done to remove toxic wastes and fluid from the body. In this process, the entire blood is circulated and filtered externally in a machine called a dialyzer. The filtered blood is then resent to the body. Dialysis can be carried out at a dialysis center or at home under the supervision of healthcare professionals.

What Is Peritoneal Dialysis?

Peritoneal dialysis differs from hemodialysis significantly. In peritoneal dialysis, the peritoneal membrane (lining of the abdomen) acts as a filter to remove the excess fluid and waste products from the body. There is no need for an external dialysis unit.

What Is Short-Term Dialysis?

Short-term dialysis is indicated in patients with temporary kidney damage or acute kidney injury, which can be reversed. In such cases, dialysis is carried out for a short period of time until the kidney resumes its normal function.

What Is Long-Term Dialysis?

Long-term or permanent dialysis is indicated in patients with stage five renal failure, where the kidneys completely lose their function and are not reversible. In such cases, dialysis is continued throughout the lifetime of the patent.

What Are the Conditions that Commonly Necessitates Dialysis?

The conditions include the following:

• Renal failure (end-stage renal disease).

• Hyperkalemia (increased potassium levels).

• Hyperuricemia (increased serum urate levels).

• Fluid overload.

• Acidosis.

What Are the Preparatory Procedures Done Before the Start of Incenter-Dialysis?

The main procedure that is done before starting the dialysis is to gain access to reach the blood vessels. This is done by placing a catheter into a large vein in the neck, leg, or chest in case of short-term dialysis. In patients requiring long-term dialysis treatment, minor surgery is carried out to create AV (arterio-venous) fistula by joining one of the arteries to the vein and thereby creating permanent access.

How Is the Dialysis Treatment Scheduled?

The dialysis treatment is scheduled based on several factors, such as the stage of renal failure, associated conditions, and the patient's age. Usually, the appointments are scheduled as three sessions in a week or once in two days. Each appointment may take up to three to four hours depending on the factors such as the functioning ability of the kidneys, the water content in the body, how much wastes are to be removed, the body weight, and the dialysis machine used in the treatment. The appointments should not be missed or skipped as they would cause life-threatening issues.

What to Expect When One Arrives For the First Time at the Dialysis Center?

The trained nurses and the technicians in the center would guide the patient through the procedure once the patient arrive at the dialysis center. The steps are as follows:

1. First, the trained personnel will check the patient's weight.

2. They will clean the area where the vascular access is placed.

3. Then they will take the patient to the chair where the dialysis is carried out.

4. They will check all the vital signs, such as blood pressure, temperature, heartbeat, and respiratory rate.

5. Then the needle to allow the blood to flow in and out is placed in the access area by the dialysis technician.

6. This needle is connected to the tube, which is connected to the dialysis machine.

7. Then the machine is set to start the dialysis process.

8. The blood from the body will flow through the needle into the tube connecting the dialysis machine.

9. The blood passes through the filter in the machine, gets filtered, and then re-enters the body.

10. Each session will take up to three to four hours, during which the blood pressure and the proper functioning of the dialysis machine will be monitored by the dialysis technician.

11. Once the procedure is done, the dialysis technician will use saline solution to wash the blood that is left out in the tube and the dialyzer.

12. Once the procedure is done, the dialysis machine is stopped, the needle is removed from the patient's hand, and the access area is covered with a dressing.

What Do the Alarms From the Dialysing Machine Indicate?

The dialyzing machine keeps a check on the patient's blood pressure, the blood flow through the filter, the pressure created by the flowing blood into the machine, the dialysate mixture, and the level of the solution in the dialyzer that cleans the patient's body. Any alteration or fault in this would result in an alarm from the machine to alert the technicians.

What Can One Do During the Dialysis Procedure?

During the three to four hours of treatment, the patient can watch television, use a laptop, or mobile phone, read the newspaper, or talk with the healthcare provider. The patient can take a nap, have coffee or milk or have some food in between.

What to Expect After the Treatment?

The patient will generally feel tired, and the other associated symptoms include:

• Nausea.

• Vomiting.

• Hypotension (decreased blood pressure).

• Dizziness.

• Cramping of hands and feet.

• Headache.

All these symptoms will slowly vanish after two to three hours, and the patient becomes normal.

What Is the Role of Renal Dieticians In Dialysis Centers?

Renal dieticians advise the patient regarding the water and fluid limit per day based on the fluid weight gain before treatment and the amount of fluid removed during treatment. They also advise the patients on the foods to be added to their daily diet. Patients should strictly follow the fluid and dietary limits as insisted by the renal dieticians, as too much water intake would increase the risk of complications.

What Are the Alarming Signs For Which the Patient Should Seek Medical Help?

The alarming signs include the following:

• Continuous itching.

• Diarrhea.

• Constipation.

• Drowsiness.

• Difficulty breathing.

• Fever above 100.5 degrees Fahrenheit.

• Bleeding from the vascular access site.

• Swelling of the arm where the catheter is placed.

• Redness, swelling, pain, or pus in the access site.

• Cold and numb hands.

Conclusion:

Dialysis is one of the most effective treatment options for people with renal failure. Most people choose to receive treatment from the dialysis center as it provides a safer environment for the patient, where trained personnel, technicians, and doctors would be available to carry out the procedure. Initially, the patient might feel a little nervous and anxious, but they will gradually become better after two to three sessions.