The Dialysis Patient

Our Dialysis Department is sympathetic to the change in health status of our patients due to kidney failure. It is a total lifestyle change which can prove difficult for anyone. Therefore as a team, we do try to make your experience as comfortable and uplifting as we possibly can

References: http://www.kidneyhealth.ca/wp/wp-content/uploads/Patient_HemoHandbook_WEB.pdf
References: https://health.ucsd.edu/specialties/nephrology/Documents/dialysis%20Patient%20Handbook.pdf

Life expectancy on Dialysis

Once an individual develops end stage renal failure, he/she will be on dialysis for the remainder of their life, unless a kidney transplant is received. The life expectancy for a person diagnosed with renal failure can vary depending on patients’ other medical conditions and compliance with treatment plans. On average, 5-10 years is the life expectancy on dialysis, however many patients have lived beyond 20 or 30 years. Speak to your healthcare team about how you can care for yourself and experience optimal health while on dialysis.

Your Appointment

We will make every effort to arrange your dialysis schedule to fit your individual needs. If the time scheduled becomes unsatisfactory, we will attempt to make changes as space becomes available. Should a "one time only" change become necessary in a special situation, we will attempt to arrange a trade for you. Please notify us as far in advance as possible

General Rules:
As per hospital policy, no camera/videos (for picture taking purposes) are allowed.
• If you were called about a treatment slot, you must arrive within 30mins. If not, the 1st patient who arrives, after the 30mins, will be given priority.
• Please make the staff aware of any agreed switch in shifts or desire to do so. However, it is not a guarantee that this will take place.
• All patients MUST be aware that emergency cases must take precedence
• Equally, if you are admitted and are stable, an emergency situation will be given priority. We solicit your understanding and cooperation.
• Machines are sometimes designated to specific patient for medical purposes. We again ask your understanding and respect of each person’s right to privacy.
(This can sometimes prevent you from changing shifts with some patients or determine where they are placed in the unit).

Patients and staff are entitled to a safe environment free from discrimination/harassment. Physical, verbal or mental abuse/violence will not be tolerated and will be dealt with according to hospital policy.

Please note that eating is NOT recommended on dialysis because it can cause a drop in blood pressure and seriously affect your treatment. If you choose to eat, limit your food to small amounts. All wrappers or uneaten food must be discarded or taken with you when you leave the unit. Breakfast, lunch and supper are provided for patients during treatments depending on the shift you are given. You can choose to take your own snack.
TIPS TO MANAGE YOUR HUNGER:
• Eat a good-sized meal before you come to dialysis so you don’t get hungry
• Pack healthy snacks or a meal to bring with you. You can eat just before or just after your dialysis.

Please take note that meal request are strictly according to hospital menu.

Your Arrival

When you arrive at the Dialysis Unit, please have a seat in our waiting area. We will call you when we are able to start your dialysis treatment. You will be weighed, and your blood pressure and temperature will be recorded prior to dialysis. You will also be required to wash your access site with a special anti-microbial skin cleanser available on the unit. Please wash/ sanitize your hands before entering or leaving the unit.

Your Wardrobe

Patients should wear comfortable clothes that allow for the access site to be easily reached. Examples include button up shirts for catheters and short sleeve shirts for fistula/graft. (Gowns are also available) Blankets will be provided for your added comfort.

Missing or Stopping Dialysis

You should not skip or shorten your treatment if at all possible. Regular dialysis is necessary for your overall health. If you are sick, it is important that you still come to dialysis. If you have chest pain or are very sick, you should visit the Emergency Room for evaluation. Inform the Dialysis Unit if this is the case. You have the right to make your own choices about your treatment as long as you are mentally well, which means you can refuse or stop dialysis permanently. If you choose to stop or skip a treatment, you may put your life in danger. Please speak to your doctor about this. If there are other issues in your life that are affecting you, please talk to your doctor or member of the renal team

References: http://www.kidneyhealth.ca/wp/wp-content/uploads/Patient_HemoHandbook_WEB.pdf

Patients Rights

When you arrive at the Dialysis Unit, please have a seat in our waiting area. We will call you when we are able to start your dialysis treatment. You will be weighed, and your blood pressure and temperature will be recorded prior to dialysis. You will also be required to wash your access site with a special anti-microbial skin cleanser available on the unit. Please wash/ sanitize your hands before entering or leaving the unit.

You have the right to:

-be informed about your care
-be treated with respect and dignity

• ask questions and get answer in a timely manner
• ask about your health care provider’s experience and credentials and speak freely with the team
• to take appropriate action if you are not satisfied with the care you or someone you care about receives – 1st step—speak with your caregiver/supervisor
• to participate in the decision as to the type of treatment selected for you.
• to be informed about the reason for various tests you must take and be instructed as to the meaning of your blood chemistries
• to be fully informed concerning your suitability as a candidate for a kidney transplant.
• to be informed of all the advantages and disadvantages of all ESRD treatment modalities or have family members or support group involved in educational sessions.
• to be informed in specific terms about what to do in case of emergencies.
• to have access to psychological, social work, dietary and rehabilitation services.
• to have the right to seek other medical options.
• to be fully informed regarding any research programs in which you are involved.
• If you have a language barrier or hearing difficulty, you should have an interpreter available to you.
• to be informed about new developments pertaining to your care as they occur. ( a nurse has been assigned to you and will discuss lab works or treatment educational matters as they arise)
• to cut your treatment time (not advised) however you will be required to sign a form, which will be scanned to your file for medical record purposes.
References: https://health.ucsd.edu/specialties/nephrology/Documents/dialysis%20Patient%20Handbook.pdf
Patient Responsibilities-

You have responsibilities to:

 be active in your treatment/care
 treat other patients, staff and visitors with respect and dignity
 tell your health care team about changes in your health, medication, address or phone number.
 arrive for treatment on time or tell us if you cannot get to the unit on time
 follow guidelines regarding medications, fluid limits and diet
 to bring in all your medications at least once monthly for review by the nursing staff.
 Inform us of any medical problems that may arise.
 Take care of your graft or fistula. The nurse will instruct you and provide further information on this.
 WASH your hands and your access site before starting dialysis
(Also, clients are expected to assist in compressing fistula site after removal of needle- (within reason of physical ability); gloves will be provided. Please note: this is a universal practice
 Follow your individual dietary and fluid restrictions.
 Follow through with routine appointments that will be scheduled according to your physician's orders.
 Know that smoking has been shown to shorten the life of patients with decreased kidney function, as it does of those with normal kidney function
 Treat all members of the healthcare team with courtesy and consideration.

Assigning Shifts

Shifts are assigned based on work schedule, isolation cases with personal preference being the last option. With all the different cases to be considered, please be aware that changing shifts with other patients will not be possible. Again, explanation will be limited in protection of client information.

Shifts Hours:
Dialysis Unit on both sites provides services as follows;
• Five days a week, Monday to Saturday from 6 a.m. to about 8 p.m.
• Up to three shifts per day.

Bad Weather or Emergencies

If there is bad weather or another emergency that is preventing you from getting to your dialysis appointment, please call the unit and let us know. You will be informed of any changes in the dialysis schedule due to severe weather.

Visitation Rules

During your treatment, visitors are welcome at the discretion of the Charge Nurse. You may have up to two visitors at a time. We ask that visitors wait until you have started your dialysis before they enter the unit, and waits in the waiting room while you finish up. All visitors should wash hands or use hand sanitizer before entering and after leaving the dialysis unit. Please make sure your visitors are respectful and do not interfere with unit staffs’ duties. Visitors who have cold or flu-like or gastrointestinal symptoms such as diarrhea should not visit the dialysis unit.

TRAVELING ABROAD

With a little planning, you can absolutely travel for business or pleasure. All it takes is a little extra effort to make sure you can continue dialysis treatment while you’re away. Speak with your healthcare team at the unit way ahead of travel, so that whatever tests and health records the overseas unit requires can be prepared on time. Please be reminded, once you have travelled abroad and have undergone dialysis treatment at another healthcare institution, a routine swab for MDRO/Culture and sensitivity MUST be done upon your return. We also test for exposure to infections during dialysis such as hepatitis B.

Have a backup plan Sometimes you can plan everything perfectly and still get thrown a curveball. Talk to your doctor about what to do in case something unexpected happens while you’re away from home—and let your travel companions know how to help. If you run into challenges, call your doctor or social worker for guidance.

Entertainment

Televisions are available for your enjoyment while you are on dialysis. A television is provided for each individual patient. You are required to use earphones to avoid disturbing other patients and MOST importantly, that the alarms on your machine can be heard quickly.
We encourage you to bring your own craftwork (if your access allows) or reading materials as well. We also are pleased to announce that we have wireless services available at a cost.

LAB WORK

Laboratory studies will be done on a routine basis once a month, usually during the second full week of the month. These studies will help us evaluate the adequacy of your dialysis as well as your compliance with recommendations for diet and medications. The blood will be drawn in the Dialysis Unit. In addition, periodic X-rays of your bones and chest may be done to follow your progress. Electrocardiograms (ECG) are done as needed. Other studies are done as ordered by the physician.

Blood Transfusion

Do you know your blood type? This is important for all! Concerning blood transfusion, we will ask each client to sign a consent form, which will be reviewed quarterly, should the need for such services be required. Once there is a need for transfusion, we implore you to ask your relative to donate on your behalf. Please note that your relative may not be the same match, but it is vital to help with the demand in the blood bank.