AL KHALIDI MEDICAL CENTER

KIDNEY DIALYSIS UNIT

Visiting and scheduling appointments

• 1st shift starts at 7 am to 11 am
• 2nd shift starts at 11 am to 4 pm
• 3rd shift starts at 4 pm to 8 pm

• Vascular Access [+]
  There are three types of vascular access:
  
  1. Arteriovenous (AV) fistula
  An AV fistula is created by directly connecting a person’s artery and vein—usually in the arm. As blood flows to the vein from the newly connected artery, the vein grows bigger and stronger. The patient is taught to do exercises—such as squeezing a rubber ball—to help the fistula strengthen and mature to get it ready for use. This takes anywhere from six weeks to four months or more. Once the fistula has matured, it can provide good blood flow for many years of hemodialysis.
  
  2. Arteriovenous (AV) graft
  The AV graft is similar to a fistula, in that it is also an under the skin connection of an artery and vein, except that with a graft, a man-made tubing connects the artery and vein. The soft, plastic-like tube is about one-half inch in diameter and is made from a type of Teflon® or Gore-Tex® material. Grafts are usually placed in the arm, but can also be placed in the thigh. Grafts do not require as much time to mature as fistulas, because the graft does not need time to enlarge before using. In most cases a graft can be used about two to six weeks after placement. Because grafts are created from materials outside of the body, they tend to have more problems than fistulas due to clotting and infections. Grafts may not last as long as a fistula and could need to be repaired or replaced each year.
  
  Caring for a fistula or graft
  Taking good care of your fistula or graft will help keep it working properly. There are a few things you can do to help prevent infections, clotting and damage to your access.
  
  • Cleanliness is important to keep out infections
  Keep your access area clean and free of any trauma. Look for signs of infection including: pain, tenderness, swelling or redness around your access area. Also, be aware of any fever and flu-like symptoms. If you do get an infection and catch it early, it can usually be treated with antibiotics.
  
  • Unrestricted blood flow helps lower the risk of clotting
  Protect your access from any restriction or trauma by:
  

  • avoiding tight clothes, jewelry or anything that may put pressure on your access
  • not sleeping on top of or resting on your access area
  • refraining from carrying purses, bags or heavy items across your access area
  • always requesting that blood be drawn from your non-access arm
  • always requesting that blood pressure be taken from your non-access arm

  
  • Learn the feel of the "thrill" or vibration of blood going through your access and check it several times a day. Call your dialysis care team immediately if the flow stops or changes. This could mean a blood clot. With quick action, many clots can be dissolved or removed.
  
  3. Central venous catheter or internal port devices (LifeSite®)
  
  Care for a catheter
  • Prevent the dressing from getting wet. When taking a bath, place some plastic cover.
  • Prevent the dressing from opening and letting the catheter be exposed.
• Low Blood Pressure [+]
  Why is blood pressure so important? As a dialysis patient, it is important to watch for a problem called hypotension, otherwise known as low blood pressure. This is a rather common condition for dialysis patients.
  

  

  
  Here are a few basic guidelines to minimize your risk of hypotension during treatment:
  
  Follow Your Diet
  Your diet helps you control sodium, potassium, and other essential electrolytes that your body uses to maintain fluid balance. Carefully following your diet will help you reduce your chances of hypotension during treatment.
  
  Monitor Fluid Intake
  It is very important to keep your fluid intake between treatments at levels prescribed by your doctor. Adding too much fluid between treatments means that more fluid must be removed during each treatment to reach your dry weight. Removing more fluid increases the rate at which the fluid is pulled out of your bloodstream, (the ultrafiltration rate or UFR), which can increase your risk for hypovolemia and hypotension during treatment.
  
  Consult Your Doctor About Your Medication Schedules
  Many dialysis patients take prescription drugs to control blood pressure. You need to carefully follow the medication schedule your doctor prescribes at all times. Also; it is a good idea to talk with your doctor about when to take your medications on dialysis versus non-dialysis days. He or she may suggest that you take your medication at different times on dialysis days, or that you hold some medications before treatment on your dialysis days. This is especially true if you have proven to be more susceptible to falling blood pressure during your treatments.
  
• Immunizations [+]
  Kidney disease is one of several conditions that can put a person at higher risk for infection. This means that those with kidney failure may need to receive more shots, or higher doses, of vaccines to assure protection.
  Types of immunizations and vaccines recommended for people on dialysis and those with chronic kidney disease:
  

  • Hepatitis B vaccine
  • Flu shot to protect against influenza
  • The pneumococcal vaccine called PPV23
• Potassium and Dialysis [+]
  Most of the body’s potassium is located inside the cells with only a small amount in the blood. For patients, the preferred range for the serum (blood) potassium is 3.5 to 5.3. meq/l.
  
  Your dialysis team helps achieve this goal by…
  

  • Monitoring your monthly blood potassium level.
  • Providing education. One key role of our dietitians is to give you information on foods that are both high and low in potassium. For patients who have low potassium level, they are advised to eat some high potassium fruits before coming to dialysis.
  • Encouraging the patient to keep their intake of high potassium foods at a safe level.
  • Knowing what potassium dialysate concentration (bath) is ordered for you (e.g. a 1K+, 2K+, 3K+.).
  • Then, prior to each treatment; checking to see that the bath hooked up to your machine is correct.
  • Instructing patient to report any unusual symptoms. As mentioned earlier, with a too low of potassium, you may notice extra heart beats or palpitations. With a too high of potassium, you may feel more tired and weak (“my legs feel like rubber”), plus your pulse rate may be slow. While there are many possible reasons for these symptoms, always report them to your dialysis team.
• Potassium, Phosphorus and the Dialysis Diet [+]
  Potassium-rich foods are limited for those on hemodialysis because potassium builds up between dialysis treatments and can cause problems such as weakness, muscle cramps, tiredness, irregular heartbeat and, worst of all, heart attack. Potassium is found mostly in fruits, vegetables and dairy products. Certain fruits and vegetables are very high in potassium while others are lower. However, eating a large amount of a low-potassium food can cause potassium to add up to dangerous levels. Be aware that most foods contain some potassium — meat, poultry, bread, pasta — so it can add up. Butter, margarine and oils are the only foods that are potassium free.
  
  Foods high in phosphorus are limited for those with chronic kidney disease (CKD) because hemodialysis removes only a small amount of phosphorus from the blood. Unless the amount of phosphorus in the diet is limited, and medicines called phosphorus binders are taken regularly, phosphorus levels can get too high. This can increase the risk of developing complications such as itching, weak and brittle bones and calcium deposits in blood vessels and organs including the heart and lungs. Phosphorus is found in almost all foods although high-protein foods, dairy products, nuts, seeds, dried beans and peas, chocolate, colas and whole grain foods contain the highest amounts. 
  

  

  
  Clearing up the potassium and phosphorus confusion
  
  Most high potassium foods come from plants. Fruits and vegetables tend to be the high potassium sources. High phosphorus foods are mainly from animals. High-protein foods, such as meats, along with dried beans and peas tend to be high in phosphorus.
  

  High Potassium
  

  • Fruits
  • Vegetables

  High Potassium & High Phosphorus
  

  • Milk
  • Dairy products
  • Nuts and seeds
  • Chocolate
  • Whole grain products

  High Phosphorus
  

  • Meat
  • Poultry
  • Fish and seafood
  • Wild game
  • Eggs
  • Dried beans and peas
• What about fluid intake? [+]
  It is recommended to limit your fluid intake between dialysis session to 1 – 1.5 liter per day. Fluid intake is not limited to what you can drink; fluid is also ‘hidden’ in some foods you eat. Being aware of the fluid in foods  such as gelatin, ice, sherbet, watermelon, sauces, gravies and other high liquid foods is important.
  
  Too much fluid gain between hemodialysis sessions can cause discomfort. You may experience swelling, shortness of breath or high blood pressure . Fluid gain can also make your hemodialysis session uncomfortable due to muscle cramping and drops in blood pressure during dialysis. Following your recommended fluid intake is an important part of feeling better before and after a dialysis session.