Haemodialysis at Oxford

The Oxford main Dialysis Unit runs 3 dialysis sessions a day, six days a week, from Monday to Saturday. The morning, afternoon and twilight (evening) shifts are always full and the unit can appear a busy, bustling place, with patients, staff and visitors constantly coming and going.

On arrival in the unit, you should report to the ward clerk and sit in the waiting area until the nurse calls you. Whilst waiting, you may feel able to weigh yourself in preparation for your dialysis. You will be shown how to do this correctly and how to record the information.

You will be allocated a particular dialysis session during the week e.g. Monday, Wednesday, Friday afternoons. You may be asked to move to a different session to accommodate other patients, or transport requirements. If you have a particular request because of work or home
commitments, please ask the nurses or the ward clerk who will try to accommodate your needs. This is not always possible because the unit is running at full capacity. If you occasionally wish to juggle your dialysis sessions to fit in with social arrangements, or other one off events,
speak to the nurses, giving plenty of notice and they will do their best to accommodate your request. Holidays are possible once you are stable and settled onto dialysis. Please speak to the nurses who will be pleased to give you further information.

As you become settled and confident, you may wish to participate more in your treatment preparation, for example, collecting equipment, recording your weight, blood pressure and other details on your chart. In the future, you may feel that home dialysis treatment is an option to you, if so, you should discuss this with the nurses, your family and with your consultant.

Refreshments

Sandwiches are available at lunch and supper time. You may wish to bring a light snack with you instead of or in addition to these to eat whilst you are waiting for treatment or for transport. Please check with the nurse that it is suitable for you to eat whilst having treatment, as this can occasionally make you feel unwell. If you are taking medicines such as antibiotics or phosphate binders which need to be taken with meals, please remember to bring them in with you.

The hospital canteen provides good food and snacks, but is 5 minutes walk from the unit. It is open from 07.00 – 17.00 Monday - Friday and 07.00 – 14.15 weekends. There is also a self-service snack machine, available at all times, in the canteen. The League of Friends, located near the main hospital entrance, sells snacks, cards and toiletries; it is open Monday – Friday 09.45 – 16.30.

Phone Calls

The discreet use of mobile phones is permitted in the unit, please check with staff first as it may interfere with some medical equipment.

The overhead bedside Patient Line system has television, radio and telephone. The cards for the system are available from the Patient Line machines which are situated in the hospital corridors. Relatives are welcome to telephone the unit desk for enquiries, but we would ask that these calls be kept to a minimum.

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Besides the nurses and healthcare assistants, there are a number of different staff members contributing to patient care on the unit including the dieticians, doctors, pharmacists, access nurses, social workers and other specialist personnel. If you wish to see any of them, please inform the nurses who will arrange a visit.

Different nurses wear different uniforms. Those you are likely to see in the unit are:
Matron - Navy uniform with red trim
Ward Manager - Navy uniform with white trim
Senior Staff Nurse - White dress/tunic with blue trim
Staff Nurse - White dress/tunic with blue trim
Health Care Assistant - Light blue dress/tunic with white trim
Student Nurse -Turquoise dress/white tunic with turquoise trim
Ward Clerk - Mufti

Allocation and Teams

After the first few dialysis sessions you will be allocated to a nursing “team”, red, blue or green and to an individual “named” nurse who is responsible for planning your care. You may not be cared for by this nurse directly on every shift, but he/she is responsible for looking at your blood results and your dialysis requirements on a regular basis and liaising with you and with the other members of the team caring for you.

You may like to chat to your “named” nurse about any worries or concerns you have, although any of the other staff are happy to pass on any messages or to deal with issues themselves.

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Blood Results and Other Tests

Every month you will have blood samples taken to check that you are dialysing adequately. This is routine for all patients and enables the nursing, medical and dietary staff to ensure that you are making good progress and following the correct diets, taking the correct medicines and dialysing efficiently. Your blood will also be regularly tested for the hepatitis B and C virus.

You will also have routine swabs taken from your nose and access site to check for any germs that may be growing and need treating, including the MRSA (Methicillin Resistant Staphylococcus Aureas) bacterium. Again this is all routine for every patient and you should not be alarmed or embarrassed.

Vascular Access

“Vascular Access” refers to the access to your bloodstream to allow blood to travel through soft tubes to the dialysis machine. The machine cleans the blood as it passes through a special filter, called a dialyzer or artificial kidney.

Vascular access is created by minor surgery. As a haemodialysis patient, your access is one of the following:
A fistula, an access made by joining an artery and vein in your arm;
A Haemodialysis catheter, a pair of soft tubes that are placed in a large vein and tunneled out under the skin on your chest;
A temporary catheter, a temporary plastic tube passed in to the large veins in your neck. This is usually in place for less than two weeks.

Whether your access is a fistula, haemodialysis catheter or temporary catheter, you should take good care of it. The access team and the nurses will teach you the steps of good access care.
Sometimes, your access may become infected. The following symptoms MAY suggest infection:
Fever
Pain
Redness and/or swelling
Bleeding (If this occurs, apply pressure to the site with a clean dressing/cloth and seek help)
Oozing of pus from the site

If you experience any of these, or have any concerns regarding your access site, it is very important that you contact the renal unit.
If an infection occurs, your doctor will prescribe antibiotics for you.

If you have a fistula created you will be taught to check that it is working. If your fistula develops a clot, you may need to go to the hospital for treatment.

Medicines

If you have been taking medicines before you started dialysis, they may be changed when you start treatment, and will be reviewed by the medical staff in the unit or at your clinic visit. You may be asked to bring all your medicines into dialysis or to the clinic with you to be checked. Please ask if you are unsure about anything.

Diet

A good diet and fluid control play an important part in treatment. Nurses are happy to give dietary advice, but the dietician is regularly available to come and see you or to speak to you on the phone if you have any worries when you are at home. See Contacts.

You will be given leaflets outlining your dietary advice. But even if you have already spoken to a dietician, you are not expected to remember everything first time round! As your health improves and you feel better, your eating patterns may change and you may feel that you need further advice or help.

Occasionally dietary issues emerge when your nurse is checking your blood results. She may then refer you to a dietician.

Clinic Appointments

You will be seen regularly in clinic by your consultant or one of his medical team. This usually occurs every 2 – 3 months. If you are unsure when your next appointment is, or who your consultant is, please speak to the ward clerk or the nurse.

Other Medical Problems

Your General Practitioner can deal with most medical problems, please make an appointment to see him/her. If in doubt, phone the unit or check with the nurses. If your problem relates to your kidney failure or treatment, the nurses will refer you to the doctor on call for the unit.

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Transport

Hospital transport is only available if you cannot drive yourself to the hospital, get someone to bring you, or come on public transport. However, hospital transport can be arranged on a temporary basis, whilst you are unwell or unable to transport yourself. This is arranged by the ward clerk and is planned around specific dialysis shifts i.e. 07.30 – 13.00 or 13.00 – 18.00. It is unfortunately not individualized and
may add waiting times to your dialysis treatment times. Transport cannot be provided for patients on the twilight shift.

A petrol mileage allowance can be claimed by patients driving or being driven to and from dialysis. Please see the ward clerk for details.
Patients on certain benefits may be able to get help with travel expenses.

Parking Permits

For long term patients and in other special circumstances, it may be possible to apply for a parking permit. These are limited to one per family. Please speak to the ward clerk if you think you are entitled to one.

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Updated 03/06/2008