Welcome to the DCH Dialysis Unit

This leaflet aims to give you an overview of what to expect when starting haemodialysis. It answers the most frequently asked questions and tells you about the unit structure and the team that will be looking after you. It also gives useful information about the service available to you and the support we can offer.

Further information and web links have been attached which you may find useful, along with contact information for the unit.

Unit philosophy

As a unit, we recognise that starting dialysis is a significant life-changing event. From the beginning to the end of every patient’s individualised journey, we will be there to guide and support every step they take, empowering them to make informed decisions regarding their care to get the best out of their life.

What determines when I start dialysis?

You will be referred to the dialysis unit by a renal consultant or a member of the pre-dialysis team when your kidney function reaches the point that you require haemodialysis.

This will be based not just on function of the kidney, but symptoms and fluid retention which causes fluid overload. There is not a set percentage of function that dictates when you start; it is individual to each patient.

Is there a waiting list?

Yes, one of the sisters from the unit will contact you once you have been placed on the list with a plan for starting dialysis, giving you a realistic timeframe. However, in the interim, if your symptoms worsen, you are encouraged to call the unit to discuss this, and it may be that you will have dialysis on the Prince of Wales ward for a short period until a slot is available.

Can I visit the unit before I start dialysis?

Yes, we do offer planned, appointment only, guided tours of the unit. These can be arranged through the low clearance nurses who liaise with the unit to arrange an appropriate time. Or you can call the unit direct to arrange.

How will I get to dialysis?

As a dialysis patient, you are entitled to free hospital transport; however, the contract the Trust has allows them to drop you up to an hour earlier and collect you up to an hour later than the time they are given. There is free parking for dialysis patients at all the units. We advise you not to drive for the first week of treatment and then re-assess to see how you feel after dialysis before deciding whether to drive. However, making the decision to provide your own transport will reduce your time and help maintain your independence. You can claim mileage allowance. This is means-tested and claims can be arranged through the renal unit administrator.

What are the times of the dialysis sessions?

The main unit consists of 11 dialysis stations and runs three sessions a day. It is a mixed sex unit, and the start times for the sessions are as follows:

• AM session: 7am
• PM session 12.30pm
• Twilight session: 6pm

We also have a dialysis pod, which is located behind the main unit and is connected via a corridor, which has seven dialysis stations. The pod is used for new patients starting dialysis as well as for those with any isolation needs. The pod runs two sessions a day and is a mixed sex unit.

The start times are:

• AM session: 8am
• PM session: 2pm

Dialysis patients need to dialyse three times a week so your slots will be either:

• Monday, Wednesday and Friday
• Tuesday, Thursday and Saturday

Patients will be allocated a day and time slot when they start. We aim to consider all personal circumstances when we allocate, but unfortunately, this is not always a possibility and, if you wish, you can be put on a waiting list to swap shifts to a more convenient time.

How does dialysis work?

Haemodialysis is the most common method used to treat kidney failure. In haemodialysis your blood is pumped through a special filter that removes toxins and extra fluids. The clean blood is then returned to your body. This helps to control your blood pressure and keep the correct balance of chemicals in your body.

One important step before starting haemodialysis is preparing vascular access, a site on your body from which your blood is removed and returned. A fistula is the most common type. Some patients may have other forms of access, such as grafts. Dialysis catheters are also used, but only if you require dialysis as a matter of urgency and have not yet had alternative access formation. Their use is only a temporary measure.

Further details of the procedures of fistula formation will be given to you via the renal access team.

What happens when I start dialysis?

You will be contacted by phone for a consultation with one of the renal sisters prior to starting dialysis and to be given your treatment times. Information and a letter will be posted out to you. You will be advised not to take any blood pressure tablets before you attend your dialysis sessions.

Your first week of dialysis

• We recommend loose clothing be worn, as this allows easy access to the fistula or neckline. We ask all dialysis patients to weigh themselves before and after dialysis, as this helps us assess whether fluid needs to be removed on dialysis, and how much
• You will enter the unit via a waiting area and be greeted by a member of the team who will explain the routine
• We will ask you to wash your hands and, if you have a fistula, to wash your fistula arm
• You will have your blood pressure, pulse and temperature taken before and during dialysis
• After dialysis we do a standing blood pressure test before you leave
• We ask all patients to do a lateral flow test (testing for COVID-19) on a Monday or Tuesday before attending your session. If you are unable to do this, please speak to a member of the team who can assist you
• Your first dialysis will be for two hours, the second for three hours and the third and all subsequent sessions will be for four hours, three times a week. The first two shorter sessions will start a little later than usual, as we will ensure the other patients are already on dialysis so we can spend one-to-one time getting you used to the routine and answering any questions you may have
• Every dialysis station has either a bed or dialysis chair, and you will be given instructions on how to operate them safely. Every station also has a side table on which to place personal belongings and a TV which is free to use and has a subtitles function.

What should I bring to dialysis?

• A blanket. You can feel cold on dialysis, so whilst we provide hospital blankets, some patients prefer to bring their own soft fleece blankets
• The unit has a TV at each dialysis station. You will need to provide your own headphones. The TV use a 1.5mm audio jack
• Books or magazines
• You can also bring your own tablet or laptop and connect to the hospital’s Wi-Fi
• Light snacks and a drink. However, we recommend you do not eat during the first couple of sessions to allow your body to adjust. If you are diabetic and on transport, we recommend you bring additional food in case of transport delays
• We serve hot drinks, on a Monday or Tuesday, after our weekly COVID-19 lateral flowteat. Once we are sure all patients have tested negative, face coverings can be removed
• If you have an existing DNAR (“Do Not Attempt Resuscitation”) or an advance directive including ‘Allow Natural Death’, please make us aware and we will require a copy for our documentation. Also, if on transport, you are required to carry the original with you during transportation
• Face mask. Due to the current global pandemic, COVID-19, we still require patients to remain masked during treatment. Masks can be removed only when drinking or eating. They will be provided at the end of every session for you to wear the following session
• List of questions and a note pad and pen to write down any information you may need

Does dialysis hurt?

We aim to make dialysis as comfortable as possible and will talk through what will happen as we proceed with treatment. When inserting the needles, we do offer anaesthetic spray which can help reduce any pain.

Are there any side effects of dialysis treatment?

Established patients generally feel well during dialysis but it can take time for your body to get used to the treatment. You may experience headaches, nausea, sickness and cramps and your blood pressure may drop causing you to feel dizzy. If you do experience these during your session, please alert the nursing team so we can manage your symptoms.

How often will I see a renal consultant?

Once you start dialysis you will continue to see a designated renal consultant in a face-to-face appointment every three months in the unit in which you dialyse. If you feel you need to see a renal consultant, or have any other renal-related issues, please speak to a member of the team who will be able to advise.

Do I have to start dialysis in Dorset County Hospital (DCH)?

Yes, all patients start dialysis in Dorchester. This is the main unit where the consultant nephrologists are based. They will decide your prescription for dialysis and monitor you as you start dialysis. Once stable, and your dialysis access is well-managed, you will have a face-to-face consultation with a Nephrologist who will approve transfer and you can be placed on the waiting list to move to a satellite unit closer to your home.

When will I move to a unit closer to my home?

If you do not live in the catchment area for DCH, (Dorchester, Weymouth or Portland), you will most likely be moved to one of our satellite units. Unfortunately, we are unable to give you an estimate of how long this will take as it is dependent on many different factors, but you will be kept updated as to where you are on the waiting list. We are also unable to determine which time slot you will be moved to, but we do our best to accommodate choice as much as reasonably practicable.

Unfortunately, it is not possible to keep every patient at DCH due to the demand of the service and pressure of new patients needing to start. You may, therefore, be asked to move even if DCH is the closest unit for you.

Can I learn about my own dialysis treatment?

Yes, we offer all patients the opportunity to participate in their treatment; this is referred to as ‘shared care’. There are many different levels of shared care, and it is the patient’s choice to what extent they wish to be involved. For individuals who are interested, there are opportunities to become independent at home on dialysis. With the support of family and friends, you will be trained by our home dialysis team to safely dialyse in your own home. If you are interested in these services, please talk to a member of the team.

Can I still go on holiday once I start dialysis?

Yes, once stable on dialysis, and with the renal consultant’s approval, dialysis patients can travel. Most dialysis centres require patients to have been on dialysis for over six months before they will accept them on holiday. It is primarily the patient’s responsibility to locate a holiday dialysis centre; however, there is, in certain situations, funding available to help toward the cost of dialysis outside the UK. Dorset County Hospital have a holiday dialysis co-ordinator who will be able to give further information and guidance. We strongly advise you to secure the dialysis before booking your holiday. Travel to the unit will be your responsibility whilst on holiday. Once you have located somewhere, you will need to inform
us so we can liaise with the other unit and complete any necessary paperwork. We ask for at least six weeks’ notice.

Can I use the toilet while I am at dialysis?

Yes. We will need to disconnect you from the machine and your needles will remain in your arm. The timer on the machine will be paused until you are reconnected.

How do I manage my renal diet, fluid restriction and blood results?

All renal patients have access to our renal dietitians who you will see regularly during your time with us. They provide individualised advice to suit your existing dietary needs. When you start dialysis, some patients may need to be placed on a fluid restriction. This depends on how much urine you pass and if you have any signs of fluid retention. Your fluid allowance will be closely monitored, and individualised advice will be given.

Blood tests will be taken once a month and reviewed by the renal team. All renal patients are offered the opportunity to sign up for a service called ‘Patient View’. This is a secure, online platform where you will be able to access your latest blood results and find information about understanding your own blood results, which can aid in making any necessary changes.

When you start dialysis, you will be given information about how to sign up for renal Patient View. If you require any further advice, please speak to a member of the team.

Checklist of information you will need/be given at first dialysis session

• You will be asked to provide your next of kin contact details. Please bring them to your first session
• You will be asked if your GP details are up to date
• Information leaflet from the dietitians
• Renal Patient View information leaflet
• Understanding Blood Results leaflet
• If you have a current Do Not Attempt Resuscitation (DNAR) please bring this with you on your first session, so that we can make a copy for you records.
• Dorset Kidney Patient Association information
• Holistic assessment tool for completion
• A bleed pack will be given to you; this contains gauze, tape, and an information leaflet on the process you need to follow if you have a bleed from the fistula at home
• If you are on Aranesp injections for anaemia, we will ask you to bring them in with you to your first session. This medication will now be given to you whilst on dialysis by the dialysis nurses. Your home delivery account will be closed, and the medication will be supplied by the dialysis unit.

Emergencies

In an emergency that requires you to be admitted to hospital, please inform whoever is caring for you that you are a dialysis patient. This is so that the renal team can be informed of your admission.

You should go through the usual channels if you become unwell at home – GP, 111 or 999 depending on the emergency.

If the situation is a non-emergency. but is dialysis-related, you can contact the unit and speak to a member of the team. Opening times are Monday to Saturday 6.30am to 11pm (closed on Sundays). If you need to contact out of these time you can call the Prince of Wales Ward, both numbers are provided below.

The team

Senior Sister Claire Thompson: claire.thompson@dchft.nhs.uk
Deputy Sister Hannah Whitten
Ward Administrator Jo Munn

The team is made up of registered nurses, dialysis practitioners and health care assistants. All members of the team are trained to a high standard and have completed dialysis competencies. We pride ourselves in being a rich learning environment and we have student nurses join us for placements.

Contact numbers

Dorchester Dialysis Unit: 01305 255345 or 01305 254754
Prince of Wales Ward: 01305 255139
Renal secretaries: 01305 255567 or 01305 255269
Access nurse: 01305 255605
Home Dialysis team: 01305 253440 or 01305 255372
Transplant team: 01305 254546
Low clearance nurses: 01305 254782

Useful websites

www.kidneycareuk.org

www.kidney.org.uk/chronic-kidney-disease

www.nhs.uk/conditions/dialysis

www.kidney.org/atoz/content/dialysisinfo

ukkidney.org/patients/information-resources/patient-information-leaflets

www.shareddialysis-care.org.uk/shared-care

About this leaflet

Author: Rachel Saunders, Registered Nurse Apprentice
Written: July 2022
Approved: September 2022
Review date: September 2025
Edition: v1

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk