UNDERSTANDINGUnderstanding YOUR HEMODIALYSISYour OPTIONS Hemodialysis Access Options This educational activity is supported by a donation by Amgen, Inc UNDERSTANDING YOUR HEMODIALYSIS OPTIONS Hemodialysis is a treatment for access people whose kidneys are no longer involves working. The treatment removes making a waste products and fluid from the connection blood using an artificial kidney between an machine. It is the most common artery and a treatment for people who have end- vein under stage renal disease (ESRD), or whose the skin. A kidneys no longer work. surgeon will make There are four types of hemodialysis your fistula treatment options. AAKP created this or graft brochure to explain each of your by sewing treatment options, and to show you one of your the pros and cons of each option. arteries to Mayo Clinic Foundation for one of your Education and Research veins. It’s CREATING AN ACCESS a simple medical procedure. Your surgeon Before you begin hemodialysis chooses which artery and vein to treatment, a surgeon must create connect depending on how fast your an access for the machine. Don’t be blood flows through the artery and afraid. Access for the machine will vein. be at a place on your body close to a vein and artery. It allows access A catheter is the other type of to your blood stream. Blood goes access. A catheter is a thin, flexible from your body through the access tube that can be put through a small and to the dialysis machine. Once hole in your body. A surgeon inserts inside the artificial kidney machine, the catheter through your skin into the machine cleans the blood and a large vein in the neck, chest or returns the clean blood back to groin. It may look a little scary, but your body through a separate tube. it is a safe procedure. The tube or Some people call the vascular access catheter sticks out through your skin site your “lifeline.” all day and every day. Doctors use catheters on people who need short- You have three access options: a term dialysis. It can also be used fistula, a graft, or a catheter. Fistulas on people who are on long-term and grafts are permanent accesses, dialysis and no longer have a place meaning doctors expect them to to insert a fistula or graft. If you last a very long time. A permanent This educational activity is supported by a donation by Amgen, Inc American Association of Kidney Patients: Understanding Your Hemodialysis Options 3 would like more information about correctly. Once your doctor clears the different kinds of access for you, you can talk to your health dialysis, please read “Understanding care team about other hemodialysis Your Hemodialysis Access Options” treatment options. There are three brochure, which is available by types of hemodialysis treatment: calling AAKP at 800-749-2257 or by conventional hemodialysis, short visiting www.aakp.org/education/ daily hemodialysis and nocturnal brochures.html. (nightly) hemodialysis. It might look like there is a lot of You can use conventional blood outside your body during hemodialysis at a dialysis facility dialysis but don’t be alarmed. or a hospital out-patient unit. The Actually, there is only about one cup treatment is three or four times a of blood in the tubing and dialyzer week. This is the most common type at any time during the treatment. of hemodialysis. It is what most You cannot feel blood being people think of when they hear pumped-out to the machine. the term hemodialysis. Patients using conventional hemodialysis Dialysis machines have many gauges are treated three times a week. and alarms. You may find this Each treatment is, on average, overwhelming at first. The machine four hours in length. Your kidney makes sure your treatment is safe doctor, or nephrologist, prescribes by monitoring the pressure in the length of your treatment. your veins. It also monitors how The time you spend during each quickly your blood moves through treatment depends on your body the tubing and how much water is size, laboratory results and medical removed during the treatment. condition. YOUR HEMODIALYSIS Another option for hemodialysis treatment is short daily OPTIONS hemodialysis. As the name implies, You can perform hemodialysis in a you can use this type of treatment dialysis unit or at home. You will five to six times per week for a short begin your dialysis treatments in a amount of time. Patients usually do this treatment at home. dialysis center because your doctor needs to keep an eye on your health status in the beginning. Your doctor Nocturnal or nightly hemodialysis is also needs to keep a close eye on the third type of hemodialysis. You your access to ensure it is working can use this treatment during the American Association of Kidney Patients: Understanding Your Hemodialysis Options 4 night while you sleep. It is available many people, it is helpful to tour a in the home and in some dialysis dialysis unit to see how it looks and centers. sounds before beginning treatment. Most dialysis centers are designed Home therapies, including short as an open area with reclining daily and nocturnal, may not be chairs along the wall and a dialysis available in all areas. If you need machine beside each chair. There help in finding a facility in your area are usually televisions in the center which provides this treatment, visit of the room or a small television at the AAKP website and click on the each chair. Find a Dialysis Center button at the top of the page. An example of a fixed conventional hemodialysis schedule is, Monday, IN-CENTER Wednesday and Friday from 9:00 a.m. to 1:00 p.m. Conventional Hemodialysis Most ESRD patients are treated at a dialysis facility (called in-center conventional hemodialysis) three times a week. You will see many health care specialists at the clinic including doctors, nurses, dialysis technicians and a few others. Nurses and technicians place the access needles and tubing, and monitor the machines. Most dialysis centers have technicians who help begin and end the dialysis HOME treatment. Dialysis technicians also monitor your vital signs during the Conventional Home Hemodialysis treatment, clean the equipment You may also do conventional after each use, and order supplies. hemodialysis in your home. This You also have the opportunity treatment option requires help from to interact with other patients a partner. In this setting, a nurse experiencing the same treatment. trains you and a partner on how to use a hemodialysis machine. There are common elements in each Training generally lasts four to 12 dialysis unit. However, each dialysis weeks and is done while you are unit looks and runs differently. For receiving treatments at the center. American Association of Kidney Patients: Understanding Your Hemodialysis Options 5 You must make sure you have the needed equipment and supplies. After the treatment is finished, you are also responsible for cleaning up and disposing of the used supplies. When you perform at home, the dialysis company will deliver your equipment and supplies to you. Sometimes the amount of supplies is quite large. You must have a home with enough space for the Each time you are treated during equipment and storage of supplies. the training process, you and your There must be suitable electrical partner will gradually take on more outlets and plumbing to make the responsibility with the treatment. dialysis solution and to drain the Once you, your partner and the machine. The home hemodialysis training staff are confident in your trainer will check for these abilities to perform the treatment requirements. at home, you can begin home hemodialysis. A dialysis nurse will train you and your partner to insert needles into You will need to choose a your access for dialysis. You may dependable partner. This person also give yourself some injections will need to be with you and if necessary, but you will go to the assist you each time you dialyze. center for other injections and for a It is important for you to choose monthly check-up. someone with whom you can work well. It needs to be someone who Even if you dialyze at home, you can stay calm and help you to solve still have access to the same problems when issues arise. professional team as someone who dialyzes in a facility. There When you dialyze at home, you will be a training nurse available are in charge of many things the by telephone at all times who can people in the dialysis center would answer questions, assist you in do. You are responsible for setting dealing with problems, arrange for up and preparing your machine technical support of the machine for treatment. You will also have and advise you. It is also likely that a to clean the machine afterwards. training nurse will visit you at home 6 American Association of Kidney Patients: Understanding Your Hemodialysis Options once a year to advise and observe of fluid that gathers in the body hemodialysis sessions. between treatments. Therefore, less fluid is removed during the next While dialyzing at home in a familiar treatment. This usually decreases place can be more comfortable and symptoms often experienced both less of a disruption to your life, this during and after conventional treatment option may cause extra hemodialysis treatments. Symptoms stress for your family members might include headache, nausea and/or helper who must be present and vomiting, cramping, low blood during treatments and sometimes pressure and tiredness after dialysis. assist with them. To prevent “burn Short daily hemodialysis matches out” of the family member or normal kidney function more closely helper, it is important to focus on than conventional hemodialysis taking care of yourself.