How does hemodialysis in a center work?
Hemodialysis uses a machine to clean your blood that contains a very fine filter called a dialyzer. The dialyzer removes waste and excess water from your blood, while allowing necessary proteins to return to your body. Dialysis centers have many of these machines and trained dialysis professionals to help assist you throughout treatment.
Getting started at a dialysis center
It takes careful planning to start hemodialysis, so it’s smart to do your research far in advance of when you want to begin treatment. In fact, your doctor may refer you for next steps six months before your dialysis start date. This is necessary to talk about the pros and cons, as well as something called vascular access. Placement of a vascular access is an outpatient surgical procedure that creates a pathway for blood to leave and return to your body during hemodialysis. A vascular access is usually created under the skin in the lower part of the non-dominant arm.
Vascular access options
There are three different types of vascular access. It's good to understand them so you can be confident when talking to your care team about what's right for you. The choice of dialysis access is individualized to your needs.
- Fistula: The most common and preferred type of access. It lasts the longest and has the lowest potential for complications like infections and blood clots. To make a fistula, a surgeon will join an artery to a vein under your skin to make a bigger blood vessel. Healing time is approximately one to four months.
- Graft: If a fistula isn’t right for you, your surgeon may recommend a graft, where they’d use a piece of soft tube to join an artery and a vein in your arm. Healing time is approximately two weeks.
- Catheter: This type of vascular access is generally for temporary use, like if you needed to start dialysis and your fistula was still healing. Catheters have the highest risk of infection and the poorest function compared with other access types. They should only be used if a fistula or graft cannot be maintained. A catheter is placed by inserting a soft tube into a large vein in your neck or chest.
What to expect with in-center treatment
In-center treatment usually happens three days a week, and your appointments are scheduled by the dialysis center. You will need to find transportation to and from your sessions, so be sure to add commute time when planning your days around treatment. Some doctors recommend that you have someone else drive you home after your first few treatments so you can get used to how it feels.
Each session lasts between three and five hours. Some centers offer an overnight treatment option where you sleep at the center while on dialysis. A typical dialysis session might go like this:
- Checking in: A nurse will log your weight, along with your pulse, temperature and blood pressure.
- Getting comfortable: You’ll sit in a chair (where you’ll stay for the duration of your treatment) and connect to the dialysis machine.
- Starting treatment: A technician will clean the area where your vascular access is placed and insert the needles to begin treatment.
- During treatment: The dialysis nurse will check your blood pressure to make sure it doesn’t get too low, which could cause muscle cramping and nausea. During this time, you can read, watch TV, use your tablet or laptop, talk to others receiving treatment, or sleep. It’s important to stay on dialysis for the entire amount of time your doctor prescribes.
- After treatment: You’ll be disconnected from the machine, and the nurse will once again take your pulse, temperature and blood pressure. You may feel light-headed, so be careful when standing. Many people feel tired and need to sleep when they return home from the center.
Learn more about in-center dialysis, including how it works and pros and cons to be aware of.