Welcome to the Hemodialysis Unit

Welcome to the Hemodialysis Unit

Hemodialysis Unit (Renal Unit) Regina General Hospital

1440 14th Ave S4P 0W5

Phone: 306-766-4310 Fax: 306-766-4362

Hours of Operation

Daily 7:30 am-10:45 pm

CEAC 1362 August 2019 Regina Area

CEAC 1362 August 2019 Page 1 of 29 Regina Area

Table of Contents

Welcome …………………………………………………………………………………………………………..….. 2

About Hemodialysis ……………………………………………………………………………………….…….….2

The Hemodialysis Unit (Renal Unit) ………………………………………………………………………….3

Preparing for Hemodialysis Treatments……………………………………………………………….……4

Hemodialysis Health and Safety ………………………………………………………………………….…...6

Your Hemodialysis Schedule……………………………………………………………………………………...7

Hemodialysis Vascular Access …………………………………………………………………………………10

The Hemodialysis Machine………………………………………………………………………………………12

During Your Treatment..……………………………………………………………………………….…………13

Blood Tests, Swabs, Immunizations and Appointments……………………………………..…….16

Hemodialysis and Travelling…………………………………………………………………………………….17

Treatment Options………………………………………………………………………………………………….17

Home Hemodialysis…………………………………………………………………………………………..…...18

Peritoneal Dialysis…………………………………………………………………………………………….…….18

Your Health-Care Team……………………………………………………………………………………………19

Patient and Staff Expectations……………………………………………………………………..………….23

Glossary………………………………………………………………………………………………………………....26

Resources…………………………………………………………………………………………………………..…..27

Reference Materials...……………………………………………………………………………..….……….…27

Hemodialysis Checklist ……………………………………………………………………………………….….28

Important Numbers …………………………………………………………………………………………….…29


Welcome to the Hemodialysis Unit (Renal Unit)

This handbook was created to help answer some of the questions you may have about your hemodialysis treatment and the changes taking place in your medical care. Your health care team is here for you and will be able to help you with any questions/concerns you may have. There is also information about other dialysis therapy options that you can do in the comfort of your home. As you begin dialysis, we will help you understand your treatments, dialysis prescription, medications and blood test results. It is normal to feel nervous when you first start hemodialysis. You may feel overwhelmed. Remember you are not alone; your health care team is here to work with you. ______________________________________________________________________

We encourage all patients to take the Renal Replacement Therapy Options Class provided at the Kidney Health Center. This class provides you with general information regarding home dialysis options, transplant and in-center hemodialysis. For more information speak to the patient navigator. ______________________________________________________________________ While having hemodialysis, you may hear words or phrases that you don’t know. This booklet includes a section for some of these words with their meanings.

In this booklet you will learn:

about hemodialysis

the hemodialysis schedule

home dialysis options

what happens during hemodialysis

who is part of your care team

tests and procedures you might receive

answers to commons questions

expectations. About Hemodialysis When your kidney function deteriorates to 10 to 15% of normal, you get a buildup of toxins or wastes in your in your blood and an increase of fluid in your tissues. This makes you feel unwell and causes symptoms such as nausea, fatigue, itching, difficulty sleeping, forgetfulness, shortness of breath and sometimes swelling. Hemodialysis removes these toxins and excess fluid from your bloodstream.


Hemodialysis filters your blood through an artificial kidney (dialyzer) that is attached to the hemodialysis machine. The dialysis machine pumps your blood through the dialyzer as it removes excess fluids and waste products. In order for hemodialysis to happen, we need to access your bloodstream through a vascular access. Types of access sites include fistula (which is the best one), graft (the second best one) and a dialysis catheter. If you have a dialysis catheter DO NOT:

get it wet

put it under water i.e. swimming, hot tub or bathtub

sho wer for 6 weeks; instead sponge bath. People on hemodialysis can enjoy a good quality of life, but it is important to attend your dialysis appointments and to follow your treatment plan which includes medications, diet and fluid advice.

The Hemodialysis Unit (Renal Unit)

Our hours of operation are daily from 7:30 am – 10:45 pm. The main number is 306-766-4310.

If you call after hours, you can leave a message and someone will get back to you during work

hours the next day. If it is an emergency, call 911 or go to your closest emergency department.

Make sure you tell the emergency staff that you are a hemodialysis patient.

When you arrive at the hemodialysis unit, please report to the receptionist and remain in the

patient waiting area until you are called for your treatment. The Renal Unit has security doors

for patient and staff safety. You will have to be buzzed in to gain access to the unit.

In the waiting area, there is information about kidney disease, the kidney support group and

other topics of interest.

Washrooms

There is one patient washroom in front of the security doors and there are also other

washrooms inside the hemodialysis unit. Each washroom has a call bell in case you do not feel

well or need help. Visitors are to use the public washrooms which are located near the main

entrance beside the Admitting Department.


Scent Free Environment

The Regina General Hospital has a scent free policy. Do not wear any perfumes or products that

have a strong scent including essential oils. There are many staff and patients that have

allergies to scents.

Food and Drinks

We do not provide meals or snacks. Eat a light meal at home before hemodialysis. Eating while

having hemodialysis can make you feel unwell and lower your blood pressure. If you have

diabetes, bring a snack in case you need it during treatment.

We have an ice machine. Check with your nurse if it’s all right for you to have ice or ice water

during your treatment.

What to Bring

Bring a small notebook to write questions or suggestions that you have. You can bring a blanket

and a pillow. Choose ones that can be washed easily in case blood spills on it. Remember to

wash it frequently. There are blankets in the blanket warmer but there is a limited supply.

Bring something to do, watch or read during your hemodialysis treatment. Headphones are

required to listen to the television. Other options are music players, handheld games, books or

e-books, laptop or tablet. There is free Wi-Fi at the Regina General Hospital.

Visitors

Two visitors per patient are welcome in the dialysis unit at one time. Visitors may be asked to

leave temporarily in certain situations (example: hemodialysis hook up or take off time) and

during special procedures.

Preparing for Hemodialysis Treatments

Wear loose and comfortable clothing to allow us to access your dialysis site with ease. Wear

clothes that can be washed easily in case of blood or other liquid spills. You may be asked to

change into a hospital gown.

Bring all medications you are taking to your first treatment including over the counter

medications, samples of medicines from physicians, herbal medications, vitamins and

supplements.


We list all medications you are currently taking on your patient record. Please remember to let

us know if there are any changes to your medications between treatments.

Your kidney disease medications are covered by the Saskatchewan Aids to Independent Living

(SAIL) program, funded by the Saskatchewan Government. Your renal social worker signs you

up for the program as soon as you start dialysis. You will receive a letter of acceptance from the

SAIL Program through the Ministry of Health. Your community pharmacist will let you know if

you are on a medication that is not covered.

Arriving

Please arrive on time for your scheduled treatment. Coming earlier does not necessarily get you

on hemodialysis faster. You may have to wait a long time before you can start your treatment if

you come early. Every time you arrive, report to the receptionist and take a seat in the waiting

room. This keeps the treatment area clear and safer for everyone. When it is your turn,

someone will take you in to your hemodialysis station or you can go yourself if you feel

comfortable.

Weighing in

Healthy kidneys control the fluid balance in your body and dialysis does the job when your

kidneys stop working. Healthy kidneys work 24 hours a day to remove the extra fluids and

waste products. When kidneys don’t work properly, your production of urine slows down and

sometimes stops completely, so you need dialysis to remove the leftover fluid. Some patients

continue to produce lots of urine, so the machine will be set for a minimum amount of fluid to

be removed. Tracking the exact amount of fluid that goes in and comes out of your body isn’t

practical, so we use a goal or dry weight to determine how much extra fluid is left in your body.

You will weigh-in before and after every hemodialysis treatment. When you calculate your

weight, remove any heavy clothing (jacket/coat/winter boots) as this will make you weigh more

than you actual are. If you don’t want to remove your shoes/boots, make sure the nurse is

aware. If you are unable to weigh yourself, a nurse assists you. It is best to use the same scale

before and after dialysis.

Your doctor decides on your goal or dry weight. This weight is what is best for you to reach at

the end of each dialysis treatment. Hemodialysis does not remove actual body weight, only

fluid. Sometimes it takes some time to figure out your goal weight.

As you start to feel better, your appetite may improve. Your goal weight may need to be

increased as your body weight increases. Watch your weight gain closely. Let your nurse and

dietitian know if you think you might be gaining body weight.


Before you are hooked up to the dialysis machine

Tell us if you have seen any doctors or had to stay in the hospital since your last treatment or

have you had any changes to medications. Bring any new medications with you. Tell us if you

have had any unusual health events since your last treatment (example: if you have fallen or

have been feeling unwell).

Hemodialysis Health and Safety We want to give our patients the best possible care. Patients that play an active part in their own care do better and stay healthy. People with kidney disease have a weakened immune function. This makes washing your hands and the other steps described in this section especially important.

Hand washing is the best way to stop the spread of germs. Wash your hands with soap and water or hand sanitizer BEFORE:

entering the hemodialysis area

eating and drinking

touching any cuts, sores or bandages

touching your eyes, nose or mouth

leaving the waiting room

leaving the hemodialysis area. Wash your hands with soap and water or hand sanitizer AFTER:

using the washroom

coughing or blowing your nose

touching garbage or anything that may be dirty. Cough or sneeze into a tissue if possible. If you do not have a tissue, sneeze or cough into your shirt sleeve. DO NOT sneeze into your hand. If you have a cold or flu (fever, coughing, sneezing) ask a health care professional to give you a mask. We encourage you and your family to get immunized to prevent illness. It is important that you continue to see your family doctor for regular health check-ups. If you have any health concerns that are not related to kidney disease, contact your family doctor. If


you do not have a family doctor, we can provide you with a list of doctors accepting new patients. As previously mentioned it is very important to let us know if you have any changes to your health status. Tell your nurse if you have been to an emergency department or any other specialist appointment between hemodialysis sessions. Always tell us if there has been any change to your medications. Fall Prevention During and after hemodialysis patients can feel light headed and unsteady on their feet. Please wear shoes with non-slip soles. After hemodialysis, give yourself time to sit up for a bit before you stand. If you feel unsteady, sit back down and let us know. During your first visit, we check to see if you are at risk of falling. Let us know if you have any difficulties getting from sitting to standing or moving around. If you have a mobility aid (walker or cane), bring it to dialysis treatments. If you need help to get around please ask. Transportation To and From Hemodialysis Hemodialysis can make you feel tired. Please plan to have someone drop you off and pick you up, especially in the beginning. You will soon know how hemodialysis makes you feel after the treatment is done. If you do drive yourself and do not feel well enough to drive home, tell your nurse. We help you make arrangements for a safe ride home. The Hemodialysis Unit receptionist gives you a parking pass at the end of each dialysis treatment. This pass only works for the 14th Ave Main Entrance parking lot. Parking passes will not be given if you are an inpatient in the hospital. Other transportation services are available to you for a cost. Please speak to the Renal Social Worker to assist you in finding available transportation. The Renal Program does not cover transportation costs.

Your Hemodialysis Schedule We will give you a temporary schedule when you start hemodialysis. This schedule may change. Your permanent schedule will be determined based on your medical needs, where you live and other issues that can influence your care.


Your treatment days, times and location may change based on the needs of the unit. No one owns a certain time or day. We try to keep patients schedules consistent, if at all possible. Please arrive on time for your scheduled treatment. Not everyone can start as soon as they arrive. We bring you into the unit as soon as we can. Once we bring you into the unit we can take 30 minutes or more to start your treatment. Our nurses always attend to the patients based on their medical and dialysis needs. There may be times your dialysis must be delayed because of issues with other patients or the dialysis machine. Thank you for your patience. Plan for another 30 minutes at the end of your hemodialysis to finish your treatment and for us to make sure you are well enough to go home. How long will hemodialysis take? Your doctor decides how often and how long you dialyze based on the following:

the results of your blood test

your body size

the amounts of fluid gained between hemodialysis treatments (this is measured by weight gain)

how well your fistula, graft, or catheter is working

our standards of care and current research.

This may change over time. Your doctor may recommend longer treatments or more treatments in a week.

Arrive on time for your dialysis appointments. If you arrive late, you may cause the next patient to be started late. If you continuously show up late, your treatment time will be changed to the evening run. ______________________________________________________________________ Do I have to stay on the hemodialysis machine for the whole time?

Our goal is to try and keep you as healthy as possible. While on hemodialysis, many people ask

us if the time can be shortened. It is important that you stay for your full treatment as

prescribed by your doctor. Hemodialysis treatments can only replace a small part (less than 5 to

10%) of normal kidney function of your kidneys. This is far below the 100% of normal kidney

function.


Skipping treatments and shortening dialysis time carry risks and complications including:

worsening of anemia and bone disease

cardiac complications - cardiac arrhythmia, cardiac arrest or death due to high

potassium levels

cramping and low blood pressure during your next dialysis treatment due to removing

the extra built up fluid caused by missing a treatment

fluid overload/shortness of breath from fluid in the lungs that may require an

emergency visit and emergency dialysis in the Intensive Care Unit (ICU).

It is important to understand that you may not immediately experience any problems, but

studies show that inadequate dialysis shortens your life expectancy.

If you don’t get enough dialysis, your blood holds onto more waste products. Overtime it can

affect your overall health. In general, you do better with more dialysis than less.

Shortening your hemodialysis treatment time by 15 minutes each treatment loses 39 hours of

dialysis time in a year. Missing one treatment per week equals 52 treatments per year. This is

the same as missing over four months of treatments.

What if I need to miss a hemodialysis treatment?

It is best not to miss treatments, but if you absolutely must miss your treatment, please call the

unit as soon as possible. We can use the time for another person’s treatment and may be able

to reschedule your treatment.

What if I feel too sick to go to hemodialysis?

The reason for feeling sick maybe related to your kidney disease so you should still come for

dialysis. If you feel sick, call the dialysis unit and get instructions from them. If you have a

severe problem such as shortness of breath, chest pain, abdominal pain, unusual weakness or

excessive bleeding, call 911 or go to your nearest emergency department.

If you were admitted to the hospital, please ask your nurse at the hospital to call the

hemodialysis unit. We will arrange for you to receive your next hemodialysis treatment.

What if the weather/road conditions make it unsafe to come to hemodialysis?

If you feel that it is unsafe to come to hemodialysis, call the dialysis unit as soon as possible.

This will allow us to move patients around and possibly accommodate you later in the day

should weather conditions improve.

CEAC 1362 August 2019

Page 10 of 29 Regina Area

What if I want to change my hemodialysis schedule?

Please do your best to keep all your hemodialysis appointments. However, if you need to

change your schedule, please give us as much notice as possible. We try our best to

accommodate requests but there are many patients and only so many dialysis spots. If we

cannot accommodate your request immediately, we put your name on a waitlist.

How do we access your blood for the hemodialysis treatment?

We use a vascular access to move your blood in and out of your body. Depending on which type

of vascular access you have you will either be hooked up to the dialysis tubing with needles or

with the dialysis catheter. Your blood is then pulled through the tubing by a pump on the

dialysis machine. Your blood does not go inside the machine; it is only in the tubing and the

dialyzer (artificial kidney). Please feel free to ask questions. It is all right if you don’t remember

all the answers as it can be very overwhelming to be given so much information at once.

3 types of Hemodialysis Vascular Access

FISTULA

*Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved.

Arterial Venous Fistula (AVF) - An AVF (commonly referred to as a fistula) is the joining of an

artery and a vein through a surgical procedure. The filling of blood in the vein will allow for

dialysis needles to be inserted once it has had time to mature (develop). This takes

approximately 6 weeks to mature but can take longer.



When we have a doctor’s order to use your fistula, we only use one needle to begin dialysis for

a minimum of 3 treatments. If there are no problems during the first three treatments we insert

two needles.

Fistulas are considered to be the best way to access the bloodstream for hemodialysis.

GRAFT


Arterial Venous Graft (AVG) - The AVG (commonly referred to as a graft) is made by using an

artificial material to surgically join an artery and a vein. It can be used 2 weeks after surgery.

If you have a graft, we insert two needles into your graft to begin dialysis. One needle takes the

blood out of your body and the other returns clean blood to your body.

To keep your fistula or graft working properly, we place the needles into different parts of the

fistula or graft with each treatment. You should not feel any pain once the needles are in place.

Tell your nurse if you experience pain or discomfort during your treatment.



DIALYSIS CATHETER/CENTRAL VENOUS CATHETER (CVC)


A dialysis catheter is a tube inserted into a vein in the neck or chest to provide vascular access

for hemodialysis.

If you have a dialysis catheter one end of the catheter takes the blood out of your body and the

other end puts the blood back into your body.

The Hemodialysis Machine and Treatment



During Your Treatment

The dialysis machine circulates blood from the body to the hemodialysis machine by way of a

flexible plastic tube and returns it to the body. The blood is cleaned by the artificial kidney,

called a dialyzer, which filters the blood after it has entered the machine. During the

hemodialysis procedure, fluids and waste products are removed from the blood before the

blood is returned to the body.

During hemodialysis, about 1 cup or 250 mls of blood is outside the body at any time. You do

not feel the blood moving out and back into your body.

Most patients receive a blood thinner during dialysis, this prevents the blood from clotting.

Make sure you tell your nurse if you have fallen as we may hold the blood thinner for that

treatment.

You may experience low blood pressure during hemodialysis. Tell us right away if you feel:

dizzy or faint

restless

sweaty or feeling warmer than usual

sick to your stomach/nauseated

you need to move your bowels

your heart is racing

have blurred vision.

If Low Blood Pressure Occurs

Low blood pressure can occur due to the amount of blood out of your body and due to the

amount of fluid the machine is trying to remove out of your blood. It can take some time to

figure out what your dry weight is and how much fluid we should remove. Some patients are

able to pass lots of urine and others pass very little. We are trying to find the balance where

your body feels good and all the extra fluid is removed.

Tell your nurse if the amount you urinate changes as we may need to adjust how much fluid we

remove.

If your blood pressure becomes low, we lower the head of your chair or bed to lay you down

flat and give you oxygen. We may raise the foot of the chair or bed to move blood back towards

your head and heart. We can give you some extra fluid through the hemodialysis machine.



Other symptoms such as nausea, muscle cramps and/or headache can also occur. If you feel

anything unusual, let us know right away so we can help you.

You can help yourself by keeping to your diet and fluid limits between treatments. The nurses

and dietitian will talk to you about your diet and fluid limitations, as everyone is different.

Going over your fluid limits increases the amount of fluid that must be removed. This large

amount of fluid removal can cause low blood pressure, cramps and nausea.

After Your Treatment

When your dialysis treatment is finished, your nurse removes the needles. If you have a fistula

or graft, the nurse applies pressure to the needle sites for at least 10 minutes to stop the

bleeding. If you have a dialysis catheter, the nurse disconnects you and flushes your lines with

normal saline to ensure they are free of blood.

Before you leave, we check your heart rate, temperature and blood pressure in both standing

and sitting positions.

Some people have low blood pressure after the treatment. If you feel faint, dizzy or lightheaded

after hemodialysis, sit down right away and tell one of us that you are not feeling well.

For your safety, we do not let you leave until you are feeling better. If you do not recover right

away, we may arrange for you to go to another area for care. You have to weigh yourself before

you leave. Remember to wear the same clothing and use the same scale as when you weighed

in. We want to check that the right amount of fluid weight was removed.

Carry packets of gauze with you in case your needle site starts to bleed after you leave the unit.

Some people have them in the glove box in their car.

At home

Care of your access site after dialysis:

If your access starts to bleed after you leave the hemodialysis unit:

apply firm pressure over the needle sites again for 10 min; do not peek under the gauze

during this time

check after 10 min to make sure the bleeding has stopped

tape a clean gauze pad over the area or use an adhesive bandage (e.g. Band-Aid®) if that

is all you have; do not remove for 4-6 hours.

make your nurse aware at your next hemodialysis treatment.



If the bleeding does not stop:

continue to put firm pressure on the access needle site

call for help to anyone that is at home with you

if the bleeding does not stop or starts to get worse do not panic; continue applying

pressure and call 911 for an ambulance.

Save Your Veins

If you have a fistula or graft, save your access arm for dialysis (this is usually your non dominant

arm) and let others know this. Do not take blood pressures on this arm. Do not have blood

work taken from this arm. Do not have an intravenous started in this arm. If bloodwork must be

drawn, make sure they use the arm that does not have a fistula/graft and that it should be

taken from the veins on the top of the hand if possible. It is all right to tell health care workers

this, as not everyone knows what a fistula and graft are.

We provide Save the Veins wristbands, ask your nurse to get you one.

Everyday access care

Check your fistula, graft, or dialysis catheter every day:

Fistula or graft: feel for a buzzing sensation (called the “thrill”) under the skin.

Central line: check that all clamps are closed and the caps are on. If you have pain or

swelling around the neckline you may have an infection. Let your nurse know.

Call the hemodialysis unit right away if:

You can’t feel the “thrill” or if it feels or looks different than usual.

There is pain, redness or swelling in your access arm or along your dialysis catheter.

There is oozing or drainage from your fistula, graft or dialysis catheter exit site.

You have noticeable swelling in your access arm or around your dialysis catheter, neck

or face.

You have a fever and have any of the symptoms listed above.

Your catheter seems to be getting longer. This could mean that it is coming out.

Your catheter is accidentally pulled and there is bleeding around the exit site.

Your pet bites your catheter or you accidentally cut it somehow. You should never use

scissors around your catheter dressing.



Blood Tests, Swabs, Immunizations and Appointments

Blood tests

We do many blood tests for the first three treatments, monthly and as needed. The doctor

might order blood tests more often depending on the results from these tests. We use the

results of your blood test to plan your treatment, diet and what medication to take. i.e. if your

iron is low you will receive IV iron.

Your nurse will explain your blood work and any medications they give to you. Please ask if

you have any questions.

We do blood tests for hepatitis and human immunodeficiency virus (HIV) when you first start

hemodialysis. We repeat these tests every year or more often, if required.

You can request copies of your routine bloodwork. You will be asked to sign a Request for

Access to Personal Health Information document. If you want a copy of your entire chart, there

is a process through Health Information Management System (HIMS).

Swabs

We take swabs to check for Antibiotic Resistant Organisms (ARO) during your first treatment.

Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococci

(VRE) are types of bacteria that are antibiotic resistant that we check for. We repeat these

tests every year and more often if necessary. See the glossary for more information on MRSA

and VRE.

Immunizations

Immunizations (vaccinations) protect you from other diseases. You will receive the Hepatitis B

vaccine in hemodialysis. The vaccine helps lower the risk of contracting Hepatitis B. There are a

series of 3 hepatitis B vaccines given; the first one is given soon after you start hemodialysis, 1

month after the first dose and at 6 months. Your blood will be tested to see if you are immune.

If you are not immune you will be given another series of 3 vaccines. The vaccine is given by an

injection (needle) into the shoulder muscle.

The hemodialysis unit will also offer the influenza vaccine to all renal patients prior to flu

season. There will be a notice put up in the patient waiting room as to when the vaccine will be

offered.



Appointments with Your Nephrologist (kidney specialist)

While you are on hemodialysis, your nephrologist may see you in the dialysis unit or may ask

you to make an appointment to see them in their office. It is up to you to arrange how to get to

and from the appointments.

Hemodialysis and Traveling

Hemodialysis patients can travel if their nephrologist feels that they are stable. Ask your kidney

specialist prior to making any travel arrangements. You will need to make your own

arrangements for dialysis at the center where you will be visiting. You need to call the unit you

wish to go to and be accepted before we get involved. Your home unit coordinates your

treatment with the hemodialysis centre you choose. We need at least one month’s notice to

prepare your travel paperwork. Consideration is always given for emergent situations or

unforeseen circumstances. It is recommended that you give as much notice as possible to avoid

disappointment. If you are travelling in Canada your dialysis treatment costs are covered but

you have to take your medications with you as they are not always covered by other provinces.

Please ask your nurse for the patient handout on Travel Tips CEAC # 0388 if you are planning to

travel.

If you don’t make travel arrangements and show up at a dialysis unit unannounced, you will

likely be sent to their emergency department. They will check your bloodwork and, depending

on those results, they may refuse to dialyze you. They will send you home.

Treatment Options

There are other treatment options, talk to your nephrologist to see which one is right for you.

The Renal Program currently offers a Renal Replacement Therapy Options Class offered through

the Chronic Kidney Disease Program located at 235 Albert St North. Please speak to your

bedside nurse or speak to the Patient Navigator for more information. The class will educate

and give you a basic understanding in the options below.

Home Dialysis

Your nephrologist (kidney doctor) assesses if you are medically stable to perform your dialysis

at home. Patients are provided with education and training to perform their dialysis

independently within their home. Home Dialysis allows more independence, control of

treatment schedules and numerous other health benefits. There are two types of home dialysis:

http://rhdintranet/ceac/public/brochures/0388.pdf



Home Hemodialysis

This option is only suitable for some patients. You and your support person are trained to do

hemodialysis at home. The training takes approximately 6-8 weeks at the Kidney Health Centre

in Regina. Your home will be outfitted with a hemodialysis machine and all the supplies you

need to do your own dialysis 5-6 times per week. There are additional health benefits when a

person is on home hemodialysis in comparison to in-centre hemodialysis because home

hemodialysis is done more frequently. Benefits include independence, flexibility of schedule

and for nocturnal (night-time) home hemodialysis: a less restricted diet, the potential to

decrease the amount of medications you have to take and improved blood pressure.

Peritoneal Dialysis

Peritoneal dialysis (PD) is a form of dialysis done at home either by the patient or a caregiver. It

is similar to hemodialysis but the blood is cleaned inside your body rather than outside in a

machine. It is a gentler form of dialysis, therefore your kidneys may hold on to their remaining

function longer. Patients may be required to do the procedure manually several times a day, on

a daily basis, or they may connect to a cycler. The cycler performs the treatment automatically

during the night while the patient is asleep.

PD is relatively easy to learn. The training is approximately one week but can be extended if a

patient needs more time. Peritoneal dialysis allows for a significantly less restricted diet,

greater flexibility in one’s personal schedule and greater ability to travel.

In-Center Hemodialysis

Your dialysis treatment is provided in the Hemodialysis Unit at the Regina General Hospital and

Wascana Rehabilitation Centre.

Your blood is cleansed of waste/toxins by using a dialysis machine. Your blood is passed

through tubing connected to a dialyzer (artificial kidney) which acts like a kidney by removing

wastes and extra fluid from your blood. Most patients require dialysis 3 to 4 times each week

for 3 to 4 hours at a time.

In addition to the Regina Qu’Appelle Health Region In-Centre Units, there are five satellite

dialysis units in operation in Southern Saskatchewan to provide hemodialysis closer to the

patient’s home. Satellite units are located in: Yorkton, Moose Jaw, Fort Qu’Appelle, Swift

Current and Estevan. If you are interested in dialyzing in a satellite unit, inform your doctor or

nurse to be put in contact with the patient navigator. It can take some time to get into a



satellite as they have limited spots. Your nephrologist must feel you are medically stable to

dialyze in a satellite unit. Your health must remain stable to continue dialyzing in a satellite unit.

If you become unstable, you must return to the RGH Renal Unit to be reassessed. Please ask

your nurse to print off CEAC #1249 Satellite Dialysis, for more information.

Transplant

If you are interested in a transplant, talk to your nephrologist or nurse. The Saskatchewan

Transplant Program has offices in Saskatoon and Regina. All transplants are done in Saskatoon

with transplant follow up care follow up care shared between the two sites. Individuals must be

considered eligible and are referred to the transplant program for assessment.

You will not be considered for an transplant assessment until you have stopped smoking.

Comfort Care

At any point, you have the right to choose no dialysis/ treatment. If you choose no treatment,

your life will end. This can be a very difficult decision but sometimes your quality of life on

dialysis might not be what you expect or is worse. Everyone has a different experience

depending on their personal health situation. You may want to try dialysis for a trial period to

see if it makes you feel better. You have the right to stop treatment if you are mentally able to

make that decision. Our renal team will continue to offer care and support and connect you with

additional support if you decide to do this.

Your Health-Care Team

You will meet and work with members of your health care team frequently during your

hemodialysis visits. Ask your health team members if you have any questions. The following is a

brief description of each role.

You and Your family

You are the most important part of the team.

Your role is to provide accurate health information to the other team members and to stay

informed about your condition.

You and the team work together to ensure you receive the best possible treatment.

It is your responsibility to follow the plan of care with support from the other team

members.

http://rhdintranet/ceac/public/brochures/1249.pdf



Nephrologist (Kidney Specialist, Kidney Doctor)

A nephrologist is a doctor who has advanced education related to the diseases of the kidney. You

will have one primary nephrologist that follows you. They assess and manage your kidney disease. Appointments with your nephrologist may occur in their office, while you are receiving dialysis or by telehealth if you live out of town. If you are admitted to the hospital, you may not see your nephrologist as they take turns on call. The on call nephrologist updates your primary nephrologist regarding any changes made to your care.

Family Doctor

Your family doctor works with your nephrologist in regards to your kidney related concerns and

your other health concerns. You should see your family doctor for other non-kidney related

concerns.

Critical Care Associate (CCA)

The Renal Unit has a doctor on site that works with our Nephrologist to provide you with the best possible care. This doctor deals with issues that may arise while you are on dialysis.

Manager

The manager oversees the daily operations of the unit and handles any concerns regarding staff and patients.

Nurses Our nurses take care of you during your treatment. This includes providing education, assessing you, connecting you to the machine, monitoring alarms, providing required medications, taking you off the machine and making sure you are well enough to go home. Hemodialysis nurses have specialized training and are able to answer any questions regarding hemodialysis and kidney disease. We have nurses on call every night. The nephrologist calls them back for emergencies and urgent needs. If you have any questions or concerns about your treatment, please ask your nurse.



Unit Coordinator The unit coordinator assists the manager in the daily operations and flow of the unit. The unit coordinator ensures all supplies are ordered and works directly with the charge nurse to ensure the unit is running smoothly.

Charge Nurse

These nurses are in charge of running the unit. There is always a charge nurse. If you have

concerns regarding your care or last minute scheduling issues, please let the charge nurse know.

Access Nurse

The access nurse talks with you about your options for vascular access. The vascular access nurse works closely with the hemodialysis nurse to ensure your vascular access is working properly. The access nurse:

organizes the creation of your vascular dialysis access.

provides ongoing education on your access and is able to answer any concerns regarding your access.

does ongoing assessment of your access.

brings you into clinic if they have any concerns about your access.

provides education and support to the nurses.

Patient Navigator

The patient navigator is the primary contact for new patients and families. This nurse helps

educate and provides ongoing support to patients and families. Initial education of treatment

options is provided by the navigator. He/she is there to ensure there is a smooth transition if the

patient transfers to a different treatment option or a different dialysis unit. Patient/family

concerns can be brought to the navigator. If you want to transfer to a Satellite Dialysis Unit please

make the patient navigator aware.

MEDEC (Metabolic and Diabetes Education Centre) Nurse

Provides diabetes education and assessment for diabetic patients.

Tells your dialysis nurse if you would like to see a MEDEC nurse.

Helps support you in managing good blood glucose control.

Is available for education, counselling and reviews blood work, medications and blood sugars with you to create an individualized diabetes care plan.



Patient Scheduler

The patient scheduler works with you to try to accommodate any requests you may have in

regards to your schedule. The scheduler works closely with the receptionist and the patient

navigator. If you have travel requests and/or plan on needing a change in your schedule please

ask to speak to the patient scheduler.

Social Worker

The social worker provides counselling services to you and your family and helps you adjust to the changes that may arise with kidney failure. He/she provides you with information about community resources and support such as: transportation, accommodation, financial assistance, home support services and occupational rehabilitation. If you wish to speak to a social worker, ask your nurse to make the social worker aware.

Pharmacist

Our pharmacist regularly reviews your medications to make sure they continue to be the right ones for you. They answer any questions you may have in regards to the medications you are taking. The pharmacist monitors your bloodwork and makes adjustments to your medications with approval from your nephrologist.

Dietitian

Your diet is an important part of your treatment. Your dietitian works with you and your family to help choose foods that fit your life. Your bloodwork is monitored and some food that you eat may have to be adjusted depending on blood work results. The dietician provides renal diet education for you and your family which could include the following:

potassium and sodium control

fluid balance

combining Diabetes/Kidney Disease diet

phosphorus and calcium balance

managing cholesterol levels

maintaining a healthy weight

preventing malnutrition.

Receptionist

Registers you on your arrival to the dialysis unit.

Makes the nurses aware that you have arrived for your treatment.

Tells you when you can go into the unit for your dialysis treatment.

Works with the patient scheduler to try to accommodate any requests you may have.



Unit Secretary

Organizes the office.

Prepares charts.

Performs office duties.

Answers the phone.

Unit Support Workers

Keep the dialysis unit running smoothly.

Stock supplies.

Take blood work to the lab.

Clean the dialysis machines.

Clinical Engineers

Maintain and fix the hemodialysis machines.

Patient and Staff Expectations What you can expect from us

Respect A welcoming and respectful relationship with you and your family is essential to your care. We value the diversity of our patients and work with you to create a plan of care that is respectful of your needs. Confidentiality We keep your personal health information confidential. We only share information with those team members who are involved in your care. Due to the lack of space sometimes personal information can be overheard by other patients. We ask you to keep any information that you may hear confidential (private) and respect other patient’s privacy. Support We know this is not an easy time for you. There is a lot of learning and a lot happening. We are here to support you with your dialysis needs. Feel free to ask questions. In addition, many of our patients have been helped by the Kidney Foundation of Canada through The Kidney



Connect Peer Support Program (1-866-390-PEER (7337) or visit www.kidney.ca/peer-support. There are also pamphlets located in the patient waiting room). Education We give all of our patients and their families an opportunity to get involved in their hemodialysis care. Our Chronic Kidney Disease Program offers a Renal Replacement Therapy Options Class that anyone can attend. In this class you can meet with members of the team who will answer any questions you may have. Patient Education materials are also available in the patient waiting room. In addition, there is a list of trusted websites included at the back of this book. Communication If you do not speak or understand English well enough to have conversations about your health or to make medical decisions we can book an interpreter to help us communicate. You do not pay for this service. We recommend bringing a friend or relative who speaks English with you to your dialysis appointment If you have concerns about your care and safety, we would like to hear from you. We are committed to working together to address concerns and find a reasonable solution. If you have a complaint, please speak first to the person who provided the service or to the charge nurse and/or manager of the unit. If you still have a concern and would like to make a formal complaint, please contact: Patient Advocate Services Toll free outside of Regina: 1-866-411-7272 Regina Residents: 306-766-3232

What we expect from you Respect

Please treat other patients, visitors and staff with kindness and dignity.

Arrive on time for your dialysis appointment.

Violence in any form will not be tolerated.

Take responsibility for your behavior and actions.

Respect others privacy.

Speak respectfully.

Use headphones while watching TV.

Do not use any scented products such as perfume, cologne or aftershave.

http://www.kidney.ca/peer-support



Confidentiality While you’re receiving dialysis, you may hear conversations that are private. We ask you to respect the privacy of each patient on our unit and not talk to anyone else about what you hear. Get involved While on hemodialysis, we encourage you to take part in caring for yourself. Tell us about your health and let us know if there are any worries or concerns about your disease or care. Please do not hesitate to ask questions from any member of your health care team.

______________________________________________________________________________

You are the person most responsible for your care. Be involved.

__________________________________________________________________



Glossary

Anemia - is a condition that occurs when your body is not making enough red blood cells. Red

blood cells contain hemoglobin, which helps carry oxygen throughout the body. If your

hemoglobin is low your cells do not receive enough oxygen. You may feel weak, cold and short

of breath if your hemoglobin gets too low.

Arterial Venous Fistula (AVF) - An AVF (commonly referred to as a fistula) is the joining of an

artery and a vein through a surgical procedure. The filling of blood in the vein will allow for

dialysis needles to be inserted eventually once it has had time to mature. This takes

approximately 6 weeks.

Arterial Venous Graft (AVG) - The AVG (commonly referred to as a graft) is made by using an

artificial material to surgically join an artery and a vein. It can be used 2 weeks after surgery.

Dialyzer - a special filter that removes wastes, often referred to as a ‘kidney’

Dry Weight/Target weight - this is the weight decided by your kidney doctor that is best for you

to reach at the end of your treatment.

Edema - collection of fluid in the body tissues; swelling which is often soft and compressible.

This means you can make dents in your skin when you press down on the swelling.

Fluid overload - this means that you have too much extra fluid circulating throughout your

body that your kidneys can no longer get rid of. This extra fluid can damage the heart over time.

This fluid can also be found as swelling in your legs.

Hemodialysis - to have your blood filtered through a dialysis machine.

Hook up - the time when you are connected to the dialysis machine by your nurse.

Methicillin-resistant Staphylococcus aureus (MRSA) - is a type of bacteria that is commonly

found on our bodies. In some cases, it can become resistant to antibiotics. When this happens,

it is called MRSA. As a hemodialysis patient, you will be swabbed in your nose and your groin to

check for this.

Take off - the time when you are disconnected from dialysis by your nurse.

Uremia - A term used to refer to symptoms associated with kidney failure such as feeling tired

(fatigue), nauseated, itchy or loss of appetite.

Vancomycin-Resistant Enterococci (VRE) – this is a type of bacteria that is commonly found in

the large intestine and does not generally cause problems. Sometimes these bacteria will go

away on their own. In rare cases, it can cause infections that need to be treated with

antibiotics. Sometimes this bacteria becomes resistant to the antibiotic vancomycin. When this

happens, the bacteria are called VRE.



Resources

BC Renal Agency – bcrenalagency.ca/patients

Get-Away Dialysis at getawaydialysis.com

Global Dialysis at globaldialysis.com

Kidney Campus at kidneycampus.ca

Kidney Connect Peer Support Program at kidney.ca/peer-support

Kidney Dialysis (Peritoneal Dialysis Information) at kidneydialysis.ca

Kidney Foundation of Canada – kidney.ca

Smokers Helpline – smokerhelpline.ca

Spice It Up! Renal Friendly Recipes – myspiceitup.ca

Travel Websites at nephron.com

Reference Materials

CEAC 0592 Arterial Venous Fistula/Graft

CEAC 0593 Hemodialysis – Cuffed Catheters

The BC Renal Agency

The Manitoba Renal Program website: kidneyhealth.ca

Mayo Foundation Illustrations, “Used with permission of the Mayo Foundation for Medical

Education and Research, all rights reserved.”

We would like to thank the numerous patients who read and gave their

ideas/feedback in developing this patient handbook.

http://www.bcrenalagency.ca/patients

http://www.getawaydialysis.com/

http://www.globaldialysis.com/

http://www.kidneycampus.ca/

http://www.kidney.ca/peer-support

http://www.kidney.ca/

http://www.myspiceitup.ca/



Hemodialysis Checklist

Preparing for every visit

□ Wear shoes with slip-resistant soles.

□ Wear loose fitting clothes that are easy to wash.

□ Bring any new medications for us to check.

□ Bring a book, electronic device and headphones.

□ Bring a list of questions you might have.

At Every visit

□ Arrive on time for your scheduled hemodialysis start time.

□ Weigh yourself before and after the treatment if you are able.

□ Tell us about any changes to your medications.

□ Tell us about any changes in your health, if you have seen a doctor, been to the emergency

room or been admitted to a hospital.

□ Wash your hands with soap or sanitizer before and after treatment.

□ Clean up after yourself.

□ Make sure you have extra gauze. Some patients keep it in the glove box of their vehicle.

□ ______________________________________________________

□ ______________________________________________________

Regular Checks

□ Check your fistula, graft or dialysis catheter every day.

□ See your family doctor for regular check-ups.

□ See your dentist for regular check-ups.



Important Numbers

Renal Unit Charge Nurse (main number) phone# 306-766-4310 fax# 306-766-4362

Receptionist: 306-766-3686

Patient Scheduler: 306-766-3469

CEAC 1362 August 2019 Regina Area

Documents

Welcome to the Hemodialysis Unit