Thursday, 28 August 2008

Ok so I'm always blabbing on about family, nights out and university so I thought I would tell you more about life on dialysis (that is the name of the blog after all!) I've probably told some of you this before, and showed you some of the links before but I'll post them again anyway.

First of all, here is a picture of me on dialysis! (ignore the chocy sticking out of my bag, its one of my weaknesses)

So I go for Haemodialysis or HD 3 times a week for 3 hours Monday, Wednesday and Friday on the twilight shift. I ring up the unit at around 3.30pm to see what time my machine will be ready as this sometimes varies. Mostly it is around 5.30 so I get to the unit at 5.15 as I have to take my blood pressure and weigh myself before going on the machine. I have to weigh myself because as well as cleaning the blood the dialysis machine also removes excess fluid, the amount of fluid removed depends on your dry weight. A dry weight is your weight without any excess fluid. Mine at the minute is 67kg. (1 kilogram = 1 litre of fluid) So if I go in at 68kg I would have to remove 1 litre of fluid and an extra 500mls of washback (that is saline used to wash the blood back after dialysis) so my total fluid removal would be 1500mls. This part of the process is called ultrafiltration and the amount varies from session to session usually on a Wednesday and Friday I would take off 2litres and on a Monday nearly 3litres due to the extra day of fluid because of the weekend. This is the reason that I am on such a strict fluid restriction of 500mls a day.

So here is a picture of where I weigh myself and take my blood pressure.

Heamodialysis consists of me having two needles (quite big ones) inserted into my fistula in my upper arm. They are a bit painful when they are inserted but during the dialysis session I can’t feel a thing. So a fistula is a surgically enlarged vein attached to an artery I have two scars where each needle is inserted (they aren’t inserted in exactly the same place every time, but not far off, causing quite big lumps on my arms). Heres a picture of one of the needles that is used.

I have to keep my arm very still during the dialysis session to ensure the needles stay in the right place. I think I’ve shown you this before but if you want to see how a fistula is made and used click here, it probably explains it better than me.

This provides access to the bloodstream for haemodialysis. The fistula buzzes all the time which is a good thing as this means the blood is flowing through it freely. One needle is to carry blood out of my arm and the other to carry blood back to me after.

So as well as removing fluid like I’ve already talked about, the machine’s main job is to remove toxins from my blood by cleaning it. While in the filtering system the blood flows through tubes made of a membrane that allows the waste products (which are much smaller than blood cells) to pass out through it. The waste products pass through the membrane into a dialysis solution (dialysate), then out of the machine. The "clean" blood is carried on through and returned safely to the body.

This happens over and over again throughout the dialysis session. Each time the "clean" blood is returned to the body, it picks up more waste products from the cells it circulates through, and brings these newly-collected toxins back to the dialyser (or artificial kidney – which is the white tube with the blue top and bottom on the picture) to be removed.

Fresh dialysate is passed through continuously to make the rate of the cleaning process as fast as possible.

Click here to see a picture of dialysis in action....

My machine is called Sneezy...

there are 6 beds at the unit, and 8 machines (2 spare) so they are named after snow white and each of the 7 dwarfs.

Here is a picture of the screen of my machine...

the information it shows is the amount of fluid I have removed up until that point, the time left on the machine, the amount of fluid I will take off by the end of the session and the rate it is being taken off (how much each hour) It also tells me how much blood is flowing through the machine at that moment, and how much blood has been cleaned altogether which could be over 50litres!!!

The grey round things are the pumps that spin and push the blood round, this can go at different speeds depending on the strength of your fistula and other factors. My pump speed is usually around 330, the highest I have gone is 350. The higher the pump speed the better the dialysis and the better my clearance which is how well I am dialyzing (mine is usually in the region of 70%) The machine also shows the pressure of the blood going into my arm by using a lights system, if the pressure gets too high or low the machine will beep. At the end of the dialysis session, the blood that is left in the tubes is washed back to me using saline, shown here...

So basically that’s dialysis in a nutshell. The main question I get asked is do you feel anything and does it hurt, the needles hurt a tiny bit going in but that’s it, I don’t feel a thing, I don’t feel the blood going in or out. I just sit back and let the machine do all the work I usually just watch the tele (all the soaps) whilst I’m on the machine and this passes the time. I would go to sleep if I could but there is constant hustle and bustle and machines beeping! The machine beeps if I accidentally lean on the tubes (containing the blood), if I move my arm by mistake or most importantly when the dialysis has finished.

So if you’ve got any other questions, just ask and I’ll do my best to explain.


Tinypoppet said...

I found that really fascinating to read honey, thank you for explaining in such clear detail. You say your machine is called Sneezy (which I love ;)) does that mean you always have the same machine? If so is there a reason for that?

Obviously you never do but what would happen if you missed a dialysis session?

Think those are the only daft questions I can think of ;) xxx

Holly said...

They always try and keep patients on the same machine and on the same bed, I suppose this is to prevent infection and cross contamination. All the machines are fully disinfected and cleaned after use and obviously the tubes/artificial kidneys used a sterile and thrown out after use too. Beds and tables are obviously washed down too.

I missed a dialysis session once as I went away for a weekend so dialysed Thursday night and didn't receive dialysis till Monday night. Nothing serious will happen (you wont die) but I didn't feel great and could tell that the toxins were building up in my body and I felt I needed dialysis. I personally will never do that again as I felt so rotton. Glad you found the post useful and I hope your little "kidleys" are behaving themselves

much love xxx

Anonymous said...

Brought back soo many memories &mixed emotions of Rach on haemo etc....

so hoping a transplant call will come soon for you........

best wishes Elaine & Rach xx

Jac said...

Fantastic post! I'm a doctor (supposedly ;-) and you just taught me a great deal about dialysis that I didn't know :-) You explained that so clearly - thank you!
Jac xx

Holly said...

Brilliant post - it's really interesting to see your unit, it's a quite different from mine. Oh and I love the way your machines have dwarf names!
Hope you are well xxx

Oli said...

What a great blog - I think it's great to help people understand what you have to go through.

One thing, though - when I was dialysed in Harefield post-op, it always made me really, really cold, do you find that, too?