Download Dialysis Brochure - Royal Victoria Regional Health Centre

DIET
LIVING WITH DIALYSIS
WHAT CAN I DO WHILE I AM HAVING TREATMENT?
Eating properly is important when you are on dialysis. To feel well, you need to eat
the right food. Your dietitian will help you plan a diet for your special needs.
You can do some activities while having dialysis. For example, you may wish
to:
 Utilize our entertainment system, T.V., phone, Internet
($2.00 per visit)
 Read
 Knit
 Do a crossword
 Have visitors
 Play cards
Keep in mind that you cannot stand up during your treatments. Your nurse
can talk to you about how active you can be during your dialysis.
SNACKS
RVH will provide coffee, tea, juice, or ice for the patients. Occasionally,
cookies will be supplied.
VISITORS
Visitors are welcome in the Renal Clinic. We ask visitors to leave the unit:
 When a patient is going on or coming off dialysis
 If there is an emergency in the unit
WHY DO I NEED TO BE ON A SPECIAL DIET?
Because your kidneys are not able to get rid of enough waste products and fluids,
your blood and your body now have special needs. You will need to limit fluids and
change your intake of certain foods in your diet. How well you feel will depend on:
1. Eating the right kind and amounts of food from your diet
2. Having the hemodialysis treatments your doctor orders for you
3. Taking the medications your doctor orders for you.
Your diet is very important to your care. It is important that you have the right
amount of nutrients, fluids, vitamins, and minerals each day. Some of the nutrients
you may have to modify are potassium, phosphorus, calcium, protein and sodium.
Your dietitian will help you plan your meals to make sure you get the proper
balance.
FLUID
On dialysis, you may require a fluid restriction. The goal of fluid restriction is to
help you feel comfortable before, during, and after your dialysis sessions. Even
though your dialysis gets rid of excess fluid and waste in the body, it is not as
effective as healthy kidneys. Going over your recommended fluid allowance can
lead to too much fluid building up in your body between treatments. This build up
causes swelling and increases your blood pressure, which makes your heart work
harder. Too much fluid can build up in the lungs, making it difficult for you to
breathe. Some people experience muscle cramping during dialysis when they gain
too much fluid weight. Taking off too much fluid can also cause a drop in blood
pressure, which can leave you feeling nauseated, dizzy, and weak after your
treatment.
If you require a fluid restriction, here are a few hints:
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Use crushed ice mixed with very small amounts of fluid
Use smaller cups and glasses
Suck on hard candies or chew gum
Rinse your mouth and brush teeth often
Eat frozen grapes and other fruits that are low in potassium
Eat less salt so you do not get thirsty
Count frozen foods that melt when they are at room temperature as part of
your fluid intake
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SHOULD I WEAR A MEDICAL ALERT BRACELET?
It is a good idea to wear a Medic Alert bracelet. This lets others know that you
are on dialysis. You can get an application from the Renal Clinic, Kidney
Foundation or your family doctor. When you fill out the application, make sure
you include:
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Your medical conditions such as renal patient or diabetic
The medicine you take
Your allergies
Your fistula/graft/catheter location
WHAT TESTS CAN I EXPECT TO HAVE?
We take blood from your fistula/graft or dialysis catheter once a month.
This is for your routine blood tests. Your doctor and nurse will talk to you
about these test results.
We also recommend that you have a chest x-ray and electrocardiogram
(ECG) once a year. The chest X-ray checks for changes in your heart,
lungs and bones. The ECG tells us if you are having any heart changes.
These are not painful tests.
IS IT O.K. TO TRAVEL?
You can travel if dialysis is available at that location. If you plan to travel, speak to
the Social Worker as early as possible. Arrangements are made well in advance.
HEPATITIS B
Hepatitis B is a virus that infects the liver. The Hepatitis B vaccine is given in 3
shots. When your body gets the vaccine, it makes antibodies. These antibodies
attack the Hepatitis B virus if it gets in your body. Some people already have the
antibodies and do not need the vaccine. Sometimes, the vaccine does not work. If
this happens to you, we test your blood once a year to make sure you do not have
Hepatitis B.
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LOW BLOOD PRESSURE
You may get low blood pressure near the end of your treatment. This
makes you feel dizzy, tired and cold or as if people are talking to you
through a tunnel. If you have these “funny” feelings tell your nurse. Your
nurse may:
 May give you saline
 Stop or slow down fluid removal
 Tilt your head back so that more blood gets to your head
 Give you a drink or something salty to eat
CHANGE IN APPETITE
When you first start dialysis, you may not feel like eating very much. As the
dialysis removes the toxins from your body, your appetite should return.
Please let the nurses know if you are having difficulty eating.
CHANGES IN YOUR ENERGY LEVEL
When you first start dialysis, your energy level is low. Having less
hemoglobin in your blood or high toxin levels in your body makes you feel
this way. As the dialysis removes the toxins, your energy returns. Many
people feel tired right after dialysis but feel better about 2 hours later. Many
people return to their former activities after they start dialysis.
ANSWERS TO COMMON QUESTIONS
Central venous catheters are made with a double-lumen design with one
port designated as arterial flow (red) and the other as venous flow (blue).
 Keep catheter dressing dry
 Do not allow anyone other than the hemodialysis nurse and/or
nephrologists to access your catheter
Signs and symptoms of infection and how and to whom it should
be reported:
 Increased temperature
 Shaking, chills
 Discharge noted at exit site
 Redness at exit site
 Pain at exit site
Report these signs and symptoms to the nurse or to the nephrologists
What to do in case of accidental removal or cutting of catheter:
 Clamp the remaining tail of the catheter
 Direct pressure at insertion site with occlusive dressing
 Seek medical attention
 Call the dialysis clinic for further instructions
HOW DO I TAKE CARE OF MY FISTULA/GRAFT?
HOW CAN I GAIN SO MUCH WEIGHT IF I DON’T DRINK ANYTHING?
IMPORTANT!!!! Your fistula/graft feels as if it is buzzing. It also makes a
swishing sound called a bruit. These are normal. If they stop, call the
renal unit immediately. It may mean that your fistula/graft is clotted. We
must act quickly to save your fistula/graft.
Without knowing it, you may eat too much salt. This makes your body
retain fluid. Also, you may eat foods that have hidden water. Such foods
include: jello, soup, gravy and frozen foods that are liquid at room
temperature, like ice cream or sherbet.
Do not let anyone use your fistula/graft except the dialysis nurses and
doctors.
WHY IS IT SO HARD TO REMOVE 4-5KG IN ONE DIALYSIS
TREATMENT?
It took you 3 days to drink that much fluid. Removing it in a single
treatment puts too much strain on your heart and the rest of your body.
Repeating this frequently can lead to permanent heart damage.
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Do not let anyone:
 Take blood from your fistula/graft arm
 Start an intravenous (IV) in your fistula/graft arm
 Take blood pressure on your fistula/graft arm
Do not carry bags or purses over your fistula/graft arm.
Do not sleep on your fistula/graft arm.
Do not wear clothes with tight sleeves
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If you think your fistula/graft is infected, tell your nurse at your next dialysis.
Your fistula/graft may be infected if:
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Looks red
Feels tender
Swells
Hurts
Has fluid running from it
Protect your fistula/graft when lifting, playing sports, or working.
HOW DO I DEAL WITH COMMON PROBLEMS?
You can control or stop these problems if you catch them early. Make sure
you tell your nurse or doctor if you notice changes.
CONSTIPATION
This may be caused by some of your medicine or because you need to
drink less fluid. Talk to your doctor about laxatives that are safe for you to
take. Some laxatives you can take are: Colace, Senokot, Lactulose and
glycerine suppositories. Please do not use Metamucil without speaking to
your Doctor…..it requires you to drink extra fluid. Also speak to your
Dietitian about incorporating more fiber into your individual “eating plan”.
HOW TO CARE FOR YOUR FISTULA AFTER TREATMENTS
We put a dressing over your fistula/graft after your treatment. Remove the
dressing:
 In the evening of your treatment if your treatment was in the
morning
 The morning after dialysis if your dialysis was in the afternoon or
evening
The dressing or Band-Aid may stick to your fistula/graft, if so try soaking the
dressing with warm water. To avoid infection, remove the dressing and
keep your fistula/graft clean.
If a needle site bleeds after you leave the unit, put pressure on the site until
the bleeding stops. It is a good idea to carry a few sterile gauze squares
with you. Use the gauze squares to cover the site before you apply
pressure. If the bleeding does not stop, call the renal unit or go to the
nearest emergency department.
TOO MUCH FLUID IN YOUR BODY
If you have too much fluid in your body, you may get:
 Swollen or puffy legs, ankles, eyes or hands
 High blood pressure
 Shortness of breath
This can happen if you drink too much fluid or eat too much salt.
CRAMPS
You may get muscle cramps in your feet, lower legs and hands during or
after your treatments. This happens after you lose fluid during dialysis, or
when you reach your dry weight. Dry weight is the weight at which you
have no extra fluid in your body. To reduce the cramps, your nurse may
put saline in your dialysis line. Saline is a sterile mix of salt and water. If
you get cramps during or after your treatment, a light massage or a hot
pack on the cramp may help. After treatment, try light exercise such as
walking. Remember that you cannot stand up during your treatment.
ITCHY SKIN
Your skin can get itchy if there is too much phosphate in your blood. Many
foods contain phosphate. The dietitian teaches you what foods have a lot
of phosphate in them. To lower your phosphate, you may need to take
medicine such as calcium carbonate. Oscal, Tums or Renagel, these bind
with phosphate so that less phosphate is absorbed. Dry skin also causes
itchiness. Try using mild soap, bath oil, and skin cream to stop the itching.
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CENTRAL VENOUS CATHETER
This method is normally only used when the veins in the arms are too small
to provide enough blood for hemodialysis, or when access to the
bloodstream is needed quickly. It is used temporarily until a permanent
access is ready. A central venous catheter is a soft tube which is inserted
into a large vein. The most common used veins are the jugular vein at the
side of the neck and the subclavian vein just underneath the collarbone.
The advantage of a central venous catheter is that it can be used
immediately.
HOW DO I TAKE CARE OF MY CATHETER?
Central line catheters are not the optimum access for dialyzing due to the
increased risk of infection. With the placement of the catheter tip in the
right atrium of the heart the risk of infection is high, therefore showering is
NOT recommended. But if showering is necessary, please place a
covering over the catheter dressing to prevent it from getting wet and
contaminating it. This can consist of saran wrap (plastic wrap) taped over
the dressing. Make sure to tape all sides and the full length of the saran
wrap to prevent leakage.
I AM GETTING ARANESP, WHY IS MY HEMOGLOBIN STILL LOW?
If you have an infection, low iron or lose too much blood, your hemoglobin
gets low even if you take Aranesp. You can lose blood during a
hemodialysis treatment due to your system being clotted, fistula site
bleeding post treatment, or monthly bloodwork being taken.
WHY IS MY POTASSIUM HIGH? I DON’T EAT FOOD WITH MUCH
POTASSIUM IN IT.
You may have eaten many things with small amounts of potassium in them.
Also, you may not know about some foods that contain potassium. It all
adds up. Check with your dietitian.
WHY DO MY BONES HURT?
When your phosphorus, calcium, and parathyroid levels are out of normal
range, they can lead to problems with your bones and joints. These levels
are monitored closely. Your doctor, dietitian, or nurse can talk to you about
how to control these levels.
WHAT DO I NEED TO KNOW ABOUT TAKING MEDICATIONS?
Your doctor prescribes drugs for you to take while you are on dialysis. You
need to know :
 The reasons for taking the drugs
 How and when to take them
 Their side effects
 Which ones you cannot take right before dialysis
 Which ones you cannot take right after dialysis
If you take any other drugs, tell your nurse or nephrologists about all
other drugs that you take. This includes:
 Drugs that other doctors prescribe for you
 Drugs that you buy without a prescription such as allergy, pain,
and cold pills. These are called over the counter drugs. Talk to
your nephrologists before you take any over the counter drugs.
Your pharmacist is more than welcome to call the clinic to speak with the
nephrologists or nurse about your medications.
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Your Nephrologist may order any of the following drugs for you.
ACCESS CHOICE
ERYTHROPOIETIN/ARANESP
Aranesp helps your bones make red blood cells that increase your
hemoglobin. Your nurse gives you Aranesp through your dialysis line at the
end of each treatment. It takes 4 to 6 weeks to feel the effects of Aranesp.
You can be attached to the machine in several different ways. The most
commonly used methods are:
 Internal fistula
 Internal graft
 Central venous catheter
PHOSPHATE BINDERS
FISTULA
These include calcium carbonate, and drugs, such as Tums, Renagel or
Oscal. These drugs bind with the phosphate in your food to lower the
amount of phosphate in your body, and must be taken with food to work
properly. Keeping your phosphate levels under control helps your bones
stay strong and healthy. Take your phosphate binders with your meals or
snack. Talk to your dietitian about controlling you phosphorus levels.
The fistula is the best method for providing access to the bloodstream. To
make a fistula, an artery and a vein in your arm are surgically connected
together. Fistulas can be used about 12 weeks after surgery. You will be
encouraged to do some special exercise to help the fistula develop or
mature. One exercise you can do after your stitches are out is squeeze a
tennis ball or sponge many times daily.
IRON
ADVANTAGES
Iron is needed to make red blood cells. Iron pills may upset your stomach
and turn your stools black. Take iron when your stomach is empty before
you go to bed. You also may get iron through the dialysis line during your
treatments. Do not take iron at the same time that you take your phosphate
binder. The phosphate binder binds with iron and makes the iron inactive.
MULTIPLE VITAMINS
These replace the vitamins that you are unable to get from your diet. They
also replace vitamins that you lose during dialysis. Take vitamins after your
treatments. Talk to your pharmacist or dietitian about taking the right
vitamin.
BLOOD PRESSURE PILLS
These are different kinds of blood pressure pills. Do not take blood
pressure pills before your treatment unless your doctor tells you to take
them. Side effects of blood pressure pills include: dizziness, swelling,
coughing, and slow heart beat. Tell your nurse if you have any of these
symptoms.
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 Reduced incidence of clotting
 Reduced incidence of infection
 Requires less daily care from patient
 Avoids potential for allergic responses to synthetic materials
 Has a great longevity (70% over 3 years)
A fistula is considered to be the ideal choice of nephrologists and
vascular surgeons.
GRAFT
A graft is another common way of providing access to your bloodstream. A
short piece of special tubing is placed under the skin to connect an artery
and a vein. Grafts can normally be used within 2 to 4 week after surgery.
ADVANTAGES
 Can be used sooner than a fistula
 Provides large surface for cannulation
 Blood flow not dependent on vein maturation
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SOCIAL WORKER
PAIN DRUGS
You or your family may have problems getting used to your dialysis. It may help to
talk to the social worker. For example, you may want help with financial issues,
drug costs, work, or getting to the renal unit. The social worker may be able to
arrange community resources to help you. Tell your nurse if you wish to talk to the
social worker.
If you need something for pain, use acetaminophen. A trade name for this drug is
Tylenol. Do not take Aspirin (ASA) unless your doctor tells you to take it.
PHARMACIST
ANTIBIOTICS
You need to take antibiotics before and after you have dental work. Dental work
includes having your teeth cleaned. The antibiotic prevents infection in your blood.
Tell your nurse or doctor when you are going to the dentist.
The pharmacist helps you understand the medication you are on. They make a list
of when you should take your medications. Example: Iron pills should not be
taken with Calcium pills. They will inform you of the side effects of these
medications and when and how to take your medications.
DIETITIAN
The dietitian will explain the importance of controlling your eating habits and food
choices and will work with you to develop an individualized eating plan that meets
your special needs. The renal dietitian’s main goal is to help people make wise
food choices and learn how to include their favourite foods in their “eating plan”
when possible. To construct this plan, the dietitian will ask you questions about
your eating habits and food choices. Then other information is considered, like
blood test results, medical history, and current health concerns. Although your
“eating plan” may be easy to understand, it’s not always easy to follow. It is
important that you understand why your dietitian might encourage certain food and
drink limits. Healthy kidneys work 24 hours a day to remove waste products from
the blood that build up mainly from the foods we eat. Since your blood is not being
constantly cleaned, it is important that you limit the amount and certain types of
foods and fluids you consume each day. Your dietitian can recommend healthful
food choices that reduce the amount of waste and fluids that build up in your body.
By making better food choices, you will have more comfortable dialysis treatments,
better long-term health, and an overall ability to have an active and healthier
lifestyle. You will feel better and be more able to do the activities you like. The
dietitian is based in Barrie and is available in the unit on Wednesday and Thursday.
Feel free to call the unit with any questions or concerns.
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CLIENT SERVICES
TREATMENT OPTIONS
DIALYSIS CLINIC ADVISORY COUNCIL
SELF-CARE
PURPOSE:
Self-care clients learn to set-up their dialysis machines. Some patients put
their needles in, but this is not a requirement. With self-care, you have
more control over your treatments. If you want to learn more about selfcare, speak to your nurse or nephrologists.
To strengthen health links with the community and with RVH by:
 Sharing information
 Identifying health needs of consumers
 Addressing opportunities for improvement on both an inpatient and
outpatient basis
 Promote public awareness of prevention of kidney disease in
partnership with other community agencies
 Promoting awareness at RVH of our clinic and fostering better
relationships with appropriate departments
MEMBERSHIP
Each council will have members representing:
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YOUR CAREGIVERS
DOCTORS
A Nephrologist is a doctor with special education in kidney diseases. The
doctor plans your medical treatment. If you need to speak to your doctor,
or have an urgent issue or need a prescription, please tell your nurse.
There are 2 nephrologists available at the unit:
Dr. Derek Benjamin
Dr. Murali Krishnan
based in Barrie
based in Barrie
Hospital services
Community providers – Kidney Foundation, ANAF
Consumers – patient
Spouse of patient
Previous patient (transplanted)
Current clinic volunteers
Regional Centre (OSMH) – Nurse Educator
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ABOUT YOUR DIALYSIS
TERMS OF REFERENCE
You need to come to the clinic 3 -6 times a week for dialysis. Each
treatment takes 3 – 5 hours depending on your treatment time.
Every effort is made to plan your treatments around your work schedule,
but there is a waiting list for preferred shifts. If you have a special event,
there is a white board in the client locker room that you can put your
request on. Medical appointments related to your dialysis will be arranged
by the clinic.
We ask that you do not come into the dialysis area before your treatment.
When you arrive, please wait in the waiting room. There is a T.V. to watch
and magazines to read until you are called in. When your machine is
ready, a staff member will call for you.
We try to start your treatment on time. Sometimes, we have medical
emergencies or equipment problems that cause delays. We appreciate
your patience when these delays do happen.
Council members will:
 Promote collaboration to ensure the establishment and maintenance
of strong links between the hospital and community
 Contribute to the education of all members regarding issues and
developments in the hospital and in the community
 Identify health needs and recommend ways to address these needs
– (identify gaps in service)
 Assist with the evaluation of the effectiveness and quality of service
provided – offer opportunities for improvement
Councils consistently provide input into RVH’s CQI initiatives and strategic
planning processes. It was acknowledged in the past accreditation reports
that Community Advisory Councils were a wonderful support and benefit for
patient care.
Your schedule is:
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NOTES:
ABOUT THE RENAL CLINIC
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WHEN IS THE CLINIC OPEN?
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Monday to Saturday 0700 am to 11:00 pm
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WHERE CAN I PARK?
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Dialysis clients can park on the west side of the white building. There are 4
designated wheelchair parking located in the front of the unit. The clinic is
wheelchair accessible.
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Parking at the Dialysis unit is free.
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If your dialysis is in the afternoon or in the evening, please do not arrive at
the clinic more than 15 minutes before your treatment. This makes access
to parking easier.
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MAIN CONTACTS AT THE CLINIC
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RVH Hemo Dialysis
728-9090 Ext. 24500
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Gary Foisie
Manager, Renal Services
(705) 728-9090 Ext. 24550
Derek Benjamin
Nephrologist
(705) 728-9843
Danielle Pento
Administrative Assistant
(705) 728-9090 ext 24509
Dr. Murali Krishnan
Nephrologist
(705) 728-1962
Cathy Goodfellow
Resource Nurse
(705) 728-9090 ext 24505
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CONTENTS
About the RVH Dialysis Clinic………………………………………………....2
Hours………………………………………………………………….....2
Parking ……………………………………………………………...…..2
About yourDialysis………………………………………………...……………3
Treatment Options……………………………………..……………………….4
Self Care……………………………………………...…………………4
Your caregivers…………………………………..…………………….4
Social Worker…………………………………………..……………………….5
Pharmacist……………………………………………………………………….5
Dietitian…………………………………………………………………………..5
Access Choice…………………………………………………………………..6
Fistula……………………………………………………………………6
Graft……………………………………………….……………………..6
Central Venous Catheter…………………………………….…………………7
How Do I Take Care of my Fistula/Graft……………………………………..8
What Tests Can I Expect………………………………..……………………10
Living with Dialysis…………………………………………………….………11
Diet ……………………………………………………………………………..12
Fluid …………………………………………………………………………….12
Should I Wear A Medical Alert Bracelet…………………………………….13
Is it O.K. to Travel…………………………………………………………… 13
Hepatitis B…………………………………………………………..…………13
How To Deal With Common Problems…………….…….…………………14
Low Blood Pressure…………………………………………..………………15
Common Questions……………………………………..……………………15
Medications……………………………………………..………………16/17/18
Dialysis Advisory Council……………………..………………………………19
Terms of Reference………………………………………………...…………20
WHAT YOU NEED TO
KNOW ABOUT
HEMODIALYSIS
If at any time you have a concern or complaint, please contact:
Patient Representative
728-9090 ext. 44510