Learn more about in-center hemodialysis and whether it’s right for you
- Hemodialysis Access
- How Hemodialysis Works
- Benefits and Considerations
- Getting Started
- In-Center Overnight Hemodialysis
Why Choose In-Center Hemodialysis
Hemodialysis treatments are most often done in a dialysis center—this is commonly called
In-Center Dialysis. Each in-center dialysis clinic has a healthcare team that includes nurses and patient care technicians who coordinate your care and educate you about treatment.
In-Center hemodialysis can be done in two ways
During the day: 3 times a week for 3 – 5 hours each treatment session.
At night (nocturnal dialysis): 3 times a week for approximately 8 hours each treatment session.
Introduction to Hemodialysis
Planning for Access is Important
Timing is critical. A fistula should be placed six months to a year before a patient begins dialysis if possible, to allow time for the fistula to heal and develop.
For blood to flow through the dialysis machine, you need to have an access, or entrance to the bloodstream. The access site is your lifeline; a way to reach and clean the blood. There are three access types for hemodialysis treatments: Fistula, Graft or Catheter.
Fistula access: considered the best access choice for hemodialysis
- A fistula is the most natural access because it is made with your own blood vessels, it provides the best dialysis blood flow, and it has the lowest chance of infection
- A surgeon connects one of your arteries to the vein under the skin of your arm. The surgery is commonly done in the outpatient operating room
- Fistula access should be placed 6 months to a year before you begin dialysis (if possible) to allow time for the fistula to heal and develop (mature). Your surgeon and/or kidney doctor will provide direction on the recommended timing of fistula placement.
- During treatment, two needles are placed in your fistula. These needles connect to the dialysis machine tubing so you can receive hemodialysis treatment.
Graft access: considered a good access choice, second best to Fistula access
- Surgeon connects your artery to a piece of soft, man-made plastic that acts like a vein. It’s placed under the skin of your upper arm
- Graft surgery is typically performed in an outpatient operating room
- A graft can be used several weeks after graft surgery
- During treatment, two needles are placed in the graft and connect to the dialysis machine tubing.
Catheter access (hemodialysis): considered the poorest access option, it should be avoided if possible
Most catheters are temporary, and used only until a graft or fistula is ready. The hemodialysis catheter is considered the poorest access option and should be avoided, if possible, because of the higher risk of clotting, higher chance of infection and because it can have a slower blood flow rate during dialysis.
However, there may be conditions that prevent a patient from having a fistula or graft (for example, patients whose blood vessels are not strong enough for a fistula or graft).
- A catheter, (a long plastic tube, shaped like a “Y”) is placed in the neck, chest, or groin and connected to a central vein. The other end of the tubing is outside the skin and used for hooking up to the dialysis tubing.
- Catheter access is placed by a kidney doctor (called a nephrologist) or by a surgeon. It is a short procedure that may be done either in an outpatient setting or when the patient is in the hospital.
- A catheter can be used right away after the catheter placement procedure has been completed.
- During hemodialysis treatment, the dialysis machine tubing connects to each end of the “Y” in the catheter—no needles are used for the treatment.
“Hemo” means blood, and “dialysis” means filter. Hemodialysis is how blood is filtered outside the body. In hemodialysis, a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean the patient’s blood.
During the hemodialysis treatment process, the wastes and fluid are removed from the patient’s blood:
The patient’s blood flows into the dialyzer (a plastic tube full of filters, with each filter being as thin as a hair).
Wastes in the patient’s blood flow through the filters and into a fluid called dialysate.
Once cleaned, the blood flows back into the patient.
Pressure from a pump squeezes water out of the patient’s blood and into the dialysate.
Only about a coffee cup of blood is out of the patient’s body at any one time.
Benefits of in-center daytime hemodialysis
- Treatments are done by trained nurses and technicians
- You do not need to store dialysis equipment or supplies at home
- You can meet and socialize with other hemodialysis patients who may share similar experiences
- Patients can use treatment time to read, watch TV or participate in educational programs
- With advanced planning, you can still travel
Considerations for in-center daytime hemodialysis
- You are on a a fixed schedule for dialysis treatments, which means that changes in scheduling because of work, family or other social commitments can sometimes be difficult.
- You will need to travel to and from the dialysis center, 3 times per week. You will also need to make necessary transportation arrangements.
- You must commit time—each treatment usually lasts 4 hours or more, plus travel time.
Learn from patients who chose in-center hemodialysis
Sometimes, it helps to know that others have walked
your path as well.
Getting started with in–center hemodialysis treatment
Before choosing or starting in-center hemodialysis treatment, it may be helpful to learn details about you can expect during a typical treatment session.
What to Expect with In-Center Hemodialysis.
What you can expect
If you choose daytime treatment, you will receive a schedule with dates and times for treatment. A standard daytime hemodialysis treatment occurs 3 times a week for approximately 4 hours a session.
If you choose overnight (nocturnal) hemodialysis treatments, your schedule will provide dates and times for nighttime treatment 3 times a week for approximately 8 hours a night.
- When you arrive at the facility, you will be greeted by a staff person in the lobby or reception area and accompanied to a dialysis treatment room.
- Your weight will be checked. This lets the Patient Care Technician know how much fluid has been gained from the previous dialysis treatment—and how much needs to be removed during current treatment.
- You will wash your hands and access site to prevent infection.
- Your vital signs, such as blood pressure and pulse, are taken by the Patient Care Technician. They will also check, clean and prepare your access site so you are ready for dialysis treatment. They will also draw blood samples through your access site.
- Needles are placed into fistula or graft access site. If you have a catheter, the two catheter ends are connected to the dialysis machine tubing.
- You are ready to start treatment! The Patient Care Technician programs the hemodialysis machine with your fluid goal and turns on the pump so that treatment can begin. A timer will be set.
- At this time, you can choose to rest, read, watch TV or do something else that helps pass the time during the course of your treatment.
Completing a treatment session
- The dialysis machine will indicate when the prescribed dialysis treatment is complete.
- The staff uses saline to rinse your blood back into your body, shuts off the machine and takes out the needles.
- Blood pressure is checked to be sure you aren’t feeling faint or dizzy
- You are weighed once again, providing a record of how much weight and fluid has been removed during dialysis treatment.
Treatment is complete! Once you are ready, you can leave.
Get your full treatment
Most hemodialysis treatments take at least four hours; overnight treatment can last twice as long. Your prescribed length of treatment time is not a suggestion. All of this time is needed to help you feel better! Missing even part of a treatment can lead to more illness, hospital stays and a shorter life.
In-Center Overnight (Nocturnal) Dialysis
Many patients who begin dialysis start at an in-center dialysis facility. The patient goes to the dialysis facility 3 days a week for about 3–5 hours at a time. For some patients, this time commitment can make it hard to keep a normal, active schedule and balance work, families, school and hobbies.
In-center nocturnal (overnight) hemodialysis allows patients to be treated in a dialysis facility at night, while sleeping or resting. Some dialysis facilities offer this treatment 8 hours a night, 3 times a week.
Nocturnal hemodialysis treatment offers a longer dialysis treatment for patients. In fact, it’s about twice as much treatment as a patient receiving daily in-center hemodialysis treatment. Since nocturnal treatment occurs over a longer period of time, fluids are removed more slowly, resulting in a more gentle treatment for most patients that may be easier on the heart. Studies suggest that nighttime dialysis patients may be able to better control their blood pressure and mineral levels, resulting in fewer dietary restrictions.
Benefits of in-center nocturnal (overnight) hemodialysis
- Allows more time during the day for things you may want to do, such as going to work, school or spending time with family and friends.
- Because overnight hemodialysis treatment occurs over a longer period of time, patients can experience an increase in energy levels and feel better overall
- You may have more of a normal diet and less fluid restrictions (on dialysis days).
- Can reduce some of your medications (blood pressure, phosphorous binders, etc.)
- Helps to protect your heart, bones, joints and nerves from long-term damage
Considerations for in-center nocturnal (overnight) hemodialysis
- You are required to spend 3 nights a week away from home to receive dialysis treatment and responsible for your transportation to the clinic
- Some patients have difficulty sleeping during nighttime treatment
- Nocturnal in-center hemodialysis option may not be available in all areas
If you are interested in learning more about in-center nocturnal dialysis, talk to your kidney doctor. Your doctor will need to prescribe this type of treatment option.
Considering In-Center Noctural Hemodialysis?
In-center nocturnal hemodialysis is an increasingly popular treatment choice, and Fresenius Medical Care offers it in a number of locations nationwide, including most metro areas.