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What should I expect on my first day of In-Center Hemodialysis?

If you’re worried or apprehensive about your first day of dialysis, this is completely normal. You might have accepted the need for dialysis at this point but actually starting dialysis makes it real. Expect a period of adjustment for both you and your dialysis team as you get to know each other and learn what works best for you. Learn as much as possible to help you prepare for your first day. Your dialysis center team should be reaching out to you with information to help you prepare for your first day. The information below is meant to reinforce what you learn from you dialysis team or be used as a reference for you or your care partner.


Preparing for your first day at In-Center Hemodialysis


Below are answers to questions you might have and a review of what will happen before, during and after dialysis.


What can I do to prepare for my first day?

Both you and your care partner(s) should read the information that the dialysis center provides you ahead of time. If possible, get a tour of the dialysis center before your first day so you can understand the layout of the center and take this off your list of concerns.


Ask your doctor or dialysis center contact for lidocaine ointment or another numbing agent to help alleviate any potential pain when the dialysis needle is inserted. Pick this up before your first day.


What can I do during dialysis?

Reading, watching television, listening to music, taking care of bills, creating a to-do list, catching up on work and sleeping are a few of the things you can do while you’re dialyzing. You can also set up a group game with the other people dialyzing around you.


What should I wear?

You should wear comfortable clothes with easy access to the dialysis connection. Take into consideration where your dialysis access point is located. If you have a fistula in your arm, it’s easiest to wear a short-sleeve or a long-sleeve shirt that rolls up and stays in place easily with a button for example. If you have a catheter in your chest, a button-down shirt that opens in the front is easiest.


Dialysis center treatment rooms can feel cold to you either from the temperature in the room to keep the machines running well or from the dialysis treatment since your blood is circulating outside of your body to be filtered. It is important to bring additional layers of clothing to help warm you such as a blanket, a hat, socks and a sweatshirt that opens in the front. All of these are good to have in the bag you bring to the dialysis center.


Consistency in what you wear is important as your weight will determine the amount of water that is taken off during your dialysis session. You do not want to arrive one day with heavier clothes and another day with lighter clothes and shoes for example.


What should I bring with me?

A zippered bag with key items to keep you comfortable is highly recommended.


Sample List of Items You Might Bring:

  • Blanket

  • Zip-up sweatshirt

  • Hat

  • Small pillow

  • Nutritious health bar (ask for recommendation from dialysis nutritionist)

  • Small pad and pen (or Smartphone) to keep track of your weight and take notes

  • Reading materials: Magazine, newspaper, book, kindle/tablet

  • Headset/earphones so you can listen to tv in room or movies on a tablet

  • Smartphone to play games on, either alone or in a group with your fellow dialyzers

  • Sandwich for after dialysis


The night before dialysis

In addition to having your bag ready to go, get a good night’s sleep. This will help you adjust to new circumstances. Ensure that you have 8 hours minimum (including time to fall asleep) allotted for your sleep time. Turning down the lights and not watching tv or using your phone extensively an hour before bedtime, reducing the temperature in the room to make it cooler, and keeping the room dark can all help you get a restful night of sleep. Additionally, a hot shower or meditative slow breathing exercise before bed can be relaxing and help you fall asleep faster.


Your first day of dialysis overview


On the day of dialysis

Thirty minutes to an hour before you leave for dialysis, smooth the lidocaine ointment on your arm around the fistula area and have someone wrap it for you with saran wrap to keep it from rubbing off. Don’t forget your dialysis center bag with all your items to help you stay comfortable and pass the time.


First day of on-site activities

When you first enter the center let the receptionist know you are there. You will most likely wait a few minutes or longer for the dialysis team to set up your chair once they know you have arrived. If you haven’t met the dialysis team beforehand or filled out the necessary paperwork, you will do that at this time. Your dialysis team includes nurses, technicians, a registered dietitian and a social worker who are all renal professionals. Your nephrologist will come to see you typically once per month. The rest of the team will see you every time you have a treatment.


Set up for treatment

A dialysis team member will take you inside the dialysis room and the first thing they will do is weigh you. This is an important step as it determines how much fluid to take from you during dialysis (always wear the same layer of clothes and shoes and write down your weight in your own notebook or mobile app to keep track).


After being weighed, you will be taken to your dialysis chair where the dialysis technician or nurse will take your blood pressure, clean the vascular access area to kill any bacteria, and set you up for dialysis by inserting the needles and tubing into your access point and putting tape on it to keep it in place. The tubing is then connected to the dialysis machine. Once the time has been calculated on the machine, your dialysis team member will let you know the total time for the day. Ask for them to turn the machine to face you so you can see the time directly. If this isn’t possible, you can set a countdown timer on your phone to track the time remaining.


What to expect during dialysis

Nurses and technicians are your care partners. Let them know what you are feeling. They can help treat any symptoms you have and prevent them from getting worse. They are there to help you, so let them.


You might experience the following:

  • Your blood pressure may go down at times

  • You might feel cold

  • You might hear alarms from the dialysis machine go off

  • You might feel foggy and not as clear-minded as you would like

  • You might just fall asleep and be woken up by the nurse or technician


If you experience any of the following, let your care team know:

  • Dizziness, nausea, or muscle cramps

  • Headache

  • Feeling faint


What if I need the bathroom during dialysis?

Press the call button or get your dialysis team member’s attention, and they will unhook you from the machine so you can go to the bathroom. Make sure you wash your hands well before you leave the bathroom and minimize touching anything until you are set up again at the dialysis machine.


Can I eat during dialysis?

It is not recommended that you eat during dialysis in the U.S. for multiple reasons. There is concern that it can lower your blood pressure and potentially result in poor quality of dialysis; cause nausea, vomiting and cramping; and can be a potential choking hazard. Therefore, it is recommended to eat before and after dialysis versus during dialysis.


With that said, some dialysis centers do allow it, as there is recognition that more detailed studies are needed to fully understand the effects of eating during dialysis. Having a small nutrition bar that your dialysis center nutritionist recommends in your bag is a good idea. Sometimes, the dialysis center might even have them handy in case you absolutely need to eat something during dialysis and don’t have food with you. It is also good to pack a snack for after dialysis because you might be hungry as you wait for your transportation.


Finishing treatment

When your treatment is completed, the nurse or technician will rinse your blood out of the dialysis machine and back into your body with a bag of salt water (saline). Once this is complete, they will turn off the machine and take out the needles. They will place a dressing over the site where the needle was inserted to prevent bleeding and typically ask you to apply pressure for a short time. At this point, they will take your blood pressure. If your blood pressure is too low, they might give you something to drink to help stabilize you before having you get up and walk. When you are ready to leave, they will take a post-treatment weight which will be used as a reference for the next time you come for treatment to help determine how much fluid to remove.


Note, you might have a different person take care of you at the end of the dialysis session depending on the staffing schedule. It’s good to watch when they take the needles out. You want this to be as gentle as possible with no pressure to keep the fistula or graft in as good condition as possible.


How will I feel after dialysis?

You will probably feel tired, washed out and maybe a bit foggy in thought. This is completely normal. Allow yourself to take a good long nap once you get home and let your body recoup.


How can I help the dialysis team do their best when working with me?

  • Always wear the same type of clothes and shoes when you get weighed. This will improve your dialysis consistency as your weight is a determining factor in how much fluid your technician or dialysis nurse will take off during dialysis. This is a critical factor and every little bit of consistency you can include is important. For example, you don’t want to wear several layers of clothes one day and only one layer of clothes another day because this will affect your weight. Since dialysis calculations are based on weight, additional layers of clothes can ultimately affect your dialysis treatment.

  • Bring in any changes to medications and provide this to your dialysis nurse and technician when you arrive.

  • Communicate with them any discomfort or issues you have and ask to speak with the nutritionist or social worker as needed.


Reference


Feeding during dialysis—risks and uncertainties. Rajiv Agarwal and Panagiotis Georgianos. Nephrology Dialysis Transplantation, Volume 33, Issue 6, June 2018, Pages 917–922, https://doi.org/10.1093/ndt/gfx195. PMID: 28633456


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