Hemodialysis Access: What to Expect at Home

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Your Recovery

Hemodialysis is a way to remove wastes from the blood when your kidneys can no longer do the job. It is not a cure, but it can help you live longer and feel better. It is a lifesaving treatment when you have kidney failure. Hemodialysis is often called dialysis. Your doctor created a place (called an access) in your arm for your blood to flow in and out of your body during your dialysis sessions.

Your arm will probably be bruised and swollen. It may hurt. The cut (incision) may bleed. The pain and bleeding will get better over several days. You will probably need only over-the-counter pain medicine. You can reduce swelling by propping your arm on 1 or 2 pillows and keeping your elbow straight.

You will have stitches. These may dissolve on their own, or your doctor will tell you when to come in to have them removed. You should also be able to return to work in a few days.

You may feel some coolness or numbness in your hand. These feelings usually go away in a few weeks. Your doctor may suggest squeezing a soft object. This will strengthen your access and may make hemodialysis faster and easier.

You should always be able to feel blood rushing through the fistula or graft. It feels like a slight vibration when you put your fingers on the skin over the fistula or graft. This feeling is called a thrill or pulse.

This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.

How can you care for yourself at home?

Activity

  • Rest when you feel tired. Getting enough sleep will help you recover. Do not lie on or sleep on the arm with the access.
  • Avoid activities such as washing windows or gardening that put stress on the arm with the access.
  • You may use your arm, but do not lift anything that weighs more than about 7 kilograms. This may include a child, heavy grocery bags, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
  • You can shower, but keep the access dry for the first 2 days. Cover the area with a plastic bag to keep it dry.
  • Do not soak or scrub the incision until it has healed.
  • Wear an arm guard to protect the area if you play sports or work with your arms.
  • You may drive when your doctor says it is okay. This is usually in 1 to 2 days.
  • Most people are able to return to work about 1 or 2 days after surgery.

Diet

  • Follow an eating plan that is good for your kidneys. A nutritionist or dietitian can help you make a meal plan that is right for you. You may need to limit protein, salt, fluids, and certain foods.

Medicines

  • Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
  • If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if and when to start taking those medicines again. Make sure that you understand exactly what your doctor wants you to do.
  • Be safe with medicines. Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take acetaminophen (Tylenol). Do not take ibuprofen (Advil, Motrin) or naproxen (Aleve), or similar medicines, unless your doctor tells you to. They may make chronic kidney disease worse.
    • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
  • If you think your pain medicine is making you sick to your stomach:
    • Take your medicine after meals (unless your doctor has told you not to).
    • Ask your doctor for a different pain medicine.
  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

  • Keep the area dry for 2 days. After 2 days, wash the area with soap and water every day, and always before dialysis.
  • Do not soak or scrub the incision until it has healed.
  • If you have a bandage, change it every day or as your doctor recommends. Your doctor will tell you when you can remove it.

Exercise

  • Squeeze a soft ball or other object as your doctor tells you. This will help blood flow through the access and help prevent blood clots.

Elevation

  • Prop up the sore arm on a pillow anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This will help reduce swelling.

Other instructions

  • Every day, check your access for a pulse or thrill in the fistula or graft area. A thrill is a vibration. To feel a pulse or thrill, place the first two fingers of your hand over the access.
  • Do not bump your arm.
  • Do not wear tight clothing, jewellery, or anything else that may squeeze the access.
  • Use your other arm to have blood drawn or blood pressure taken.
  • Do not put cream or lotion on or near the access.
  • Make sure all doctors you deal with know you have a vascular access.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have severe trouble breathing.
  • You have sudden chest pain and shortness of breath, or you cough up blood.
  • You have a rapid pulse or heartbeat.

Call your doctor or nurse call line now or seek immediate medical care if:

  • Your hand or arm is cold or dark-coloured.
  • You have sudden bulging around your access.
  • You have no pulse or thrill in your access, or you hear no sound of blood in your access.
  • Bleeding after dialysis lasts longer than usual.
  • You have severe pain that does not get better after you take pain medicine.
  • You have a fever over 38°C.
  • You have loose stitches, or your incision comes open.
  • You are bleeding from the incision more than you had been.
  • You have signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the incision.
    • Pus draining from the incision.
    • Swollen lymph nodes in your neck, armpits, or groin.
    • A fever.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if you have any problems.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

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