Patient education: Preparing for hemodialysis (The Basics)

What is hemodialysis? — Hemodialysis is a treatment for kidney failure. Normally, the kidneys work to filter blood and remove waste and excess salt and water. Kidney failure, also called "end-stage kidney disease," is when the kidneys can no longer filter blood properly.

With hemodialysis, a machine takes over the job of the kidneys. The machine pumps blood out of the body, filters it, and returns it to the body (figure 1). People have hemodialysis at least 3 times a week.

When do I prepare for hemodialysis? — You need to start preparing at least a few months before you begin hemodialysis treatment.

How do I prepare for hemodialysis? — You prepare for hemodialysis by talking with your doctor and making certain choices.

Before you start hemodialysis, you need to choose where to have it:

●Most people can choose between having hemodialysis at a dialysis center (in a hospital or clinic) or at home.

●If you plan to have hemodialysis at home, you need to get your home ready. You will need a dialysis machine and supplies. You might need to make changes to your home's plumbing or electricity.

You also need to prepare your body for hemodialysis ahead of time. Your doctor will create an "access." An access is a way for the blood to leave and return to your body during hemodialysis. The best type of access is created under the skin, usually in the lower part of the arm. Some types of access need time to heal before the access can be used.

There are 3 different types of access:

●Arteriovenous ("AV") fistula – Most people get this type of access (figure 2). To make this access, a doctor does surgery to connect an artery directly to a vein. An AV fistula needs to heal for 2 to 4 months or more before it can be used for dialysis.

●AV graft – To make this access, a doctor uses a rubber tube to connect an artery to a vein (figure 3). An AV graft needs to heal for 2 weeks before it can be used for dialysis.

●Central venous catheter – To make this access, a doctor puts a tube in a large vein (usually in the neck) (figure 4). This access is usually used only short term or if people don't have any other access. It doesn't work as well as an AV fistula or AV graft.

How do I take care of my access? — That depends on the type of access you have.

If you have a central venous catheter:

●The dialysis nurse will cover the catheter site with a clean dressing and bandage each time you have dialysis. Keep the dressing and bandage in place until the next dialysis session.

●Keep the catheter covered. Your doctor or nurse will tell you if it is safe for you to shower. Do not put the area underwater, since this can cause an infection.

If you have an AV fistula or graft:

●Wash it with soap and warm water every day and before each dialysis treatment.

●Check it every day to make sure that it's working normally and blood is flowing through it. When your access is working normally, you should be able to feel a vibration (called a "thrill") over the area.

●Be careful with the arm that has the fistula or graft. It's important that you not get an injury on that arm.

●Do not scratch or pick at your access.

●Do not wear tight clothes, a watch, or jewelry on the arm with the access.

●Do not carry anything heavy like a bag, purse, or child on the arm with the access.

●Do not sleep on the arm with the access.

●Do not let anyone start an IV (a thin tube that goes into a vein), take blood from, or measure blood pressure in the arm with the access.

When should I call the doctor? — Call for advice if:

●You have symptoms of infection. These include a fever of 100.4°F (38°C) or higher, chills, as well as redness, drainage, warmth, or pain over the access.

●Your access arm or hand is pale, painful, or cold during treatment.

●You have bleeding from your access site that does not stop after 20 minutes of gentle pressure.

●You don't feel a vibration – This could mean that your access has stopped working or closed up.

More on this topic

Patient education: Hemodialysis (The Basics)
Patient education: Chronic kidney disease (The Basics)
Patient education: Choosing between dialysis and kidney transplant (The Basics)
Patient education: Dialysis and diet (The Basics)
Patient education: Low-sodium diet (The Basics)
Patient education: Peritoneal dialysis (The Basics)
Patient education: Kidney transplant (The Basics)
Patient education: Planning for a kidney transplant (The Basics)
Patient education: Low-potassium diet (The Basics)
Patient education: Hemodialysis catheter placement (The Basics)
Patient education: End-stage kidney disease (kidney failure) (The Basics)
Patient education: How to care for a hemodialysis catheter (The Basics)
Patient education: Arteriovenous vascular access for hemodialysis (The Basics)

Patient education: Chronic kidney disease (Beyond the Basics)
Patient education: Hemodialysis (Beyond the Basics)
Patient education: Dialysis or kidney transplantation — which is right for me? (Beyond the Basics)
Patient education: Low-sodium diet (Beyond the Basics)
Patient education: Low-potassium diet (Beyond the Basics)