The hemodialysis unit serves 25-30 people per shift, sitting in bays, or areas of four to six people under the care of one technician. The chairs are side by side, about five feet apart. A few nurses oversee the whole unit, and a nephrologist or nurse practitioner comes in “regularly”. I think that’s monthly. The wide-open room is loud. There are so many beeps. Different tones and frequency of beeps mean different things. Alarms often mean high or low blood pressure, issues with connectivity or low sodium bicarbonate in the machine. Others indicate the beginning, middle and end of monthly access flow tests, which determine if the dialysis access provides sufficient blood flow for adequate dialysis. Insufficient flow can indicate a blood clot, which will be addressed in a later post.
The machines have little lights like traffic signals on top that are red, yellow, or green. Green means good. Yellow means something is not optimal, and red is an alarm. Some beeps trigger a red light. On the second visit, I had hiccups and kept setting off the machine and a cacophony of beeps and red lights. So the tech complained that the machine kept going off and she had to walk over and look for the problem. No matter how I tried, I could not stop those hiccups. I felt guilty. Add to that: READY TO BE RELEASED from the tubes connected to my chest and the blood pressure cuff that remained on my arm for the three-hour treatment. It squeezed to measure blood pressure every 20 or 30 minutes. Sometimes the pressures didn’t take, so the cuff tightened again and again. Frequency was determined by how volatile the blood pressure was. (continued below)
It took only a couple of visits to learn that patients should wear old clothes. A tech ruined my favorite comfy pants when she spilled bleach on my leg. Technicians sometimes spill blood from the tubing and stain shirts and pants. Hydrogen peroxide is effective in removing blood, but it wears a hole in the material if not rinsed well within a few minutes.
Below are some tips I developed after being there and doing THAT. I shared them with Amy, the nurse I liked so well, and the doctors in my current unit in an effort to help other new patients. These tips would have helped me had I known them in advance. I hope they will help you or someone you love.
NOTES FOR PATIENTS WHO WILL RECEIVE A SUBCLAVIAN CATHETER
- A subclavian catheter is for emergency or short-term use because it goes directly to the heart.
- Your catheter will be placed in your upper chest under your collar bone by a radiologist (doctor) at the hospital. You might need to arrive early for blood work, but the procedure takes less than an hour.
- You will receive medication during the procedure, so be sure to have someone drive you home.
- Ask your kidney doctor if you will need hemodialysis the same day the catheter is placed. If dialysis is done within a day or so of placement, the dialysis will not hurt, but the area of placement will be tender.
- You will need to keep the catheter dry at all times.
- Neither showering nor swimming is permitted in order to keep the catheter area dry.
- Your catheter bandage will be replaced weekly during dialysis.
- Do not sleep on the side of the catheter.
- Also, be sure to wear a shirt that provides access to the catheter without having to undress. A button-up blouse or shirt is best.
Perhaps most important is to let those who love and care for you reach out. You don’t have to be strong as you face this life altering diagnosis. I have learned that people like me because they know I am a human who sometimes needs support, just like they do. When I read about people I admire, I relate when they are most vulnerable. “It’s okay, to not be okay.”
If you or someone you care about is facing dialysis, please share your experiences and concerns. This is a forum for learning and inspiration. Please share your stories and questions. What are your experiences and challenges with dialysis?