In-Centre (Hospital) Hemodialysis

Hemodialysis is when blood is cleaned outside of the body using a machine and artificial kidney filter.

In-centre hemodialysis is usually done three times a week in a dialysis unit. There are 20 dialysis units across Manitoba. Nurses connect patients onto a hemodialysis machine and patients receive treatment for about four hours. This may be in the morning, afternoon or evening.

How a Hemodialysis Machine Works

Blood is pulled out of the body through a vascular access. A vascular access is created to be able to access the blood in the body. The blood then runs through a tube into the machine, which houses a dialyzer and a special fluid solution.

The dialyzer is a circular tube filled with hundreds and hundreds of tiny hollow “strings.” Each of these strings are like a straw. Along the sides of the straw are even smaller holes, or pores, which allow the patients’ wastes to be filtered out. Blood passes through the inside of these straws. On the outside of the straws is fluid. The fluid (bath) is made specifically for each patient. The bath is what draws, or pulls, the waste products away from the blood. It is this action that cleans the blood.

The blood is then returned to the body through a different tube and the process happens continuously for about four hours.

What is Vascular Access?

Blood is pulled away from the patient and returned to the patient at a very fast rate. In order to accomplish this, a vascular access is required. Vascular accesses are created by physicians, most often vascular surgeons.

The different types of vascular accesses are:

Fistulas: created surgically by attaching an artery directly to a vein. The artery then enlarges the vein so that needles can be placed in the vein

Grafts: created surgically by attaching an artery to a vein using a piece of specially created tubing under the skin. The tubing portion is where needles are usually placed for each treatment

Central Venous Catheters: a soft type of tubing that is inserted directly into the patients’ blood stream. This tubing stays in place from treatment to treatment. Once inserted, no further needles are needed to provide hemodialysis treatment

Each patient will have one spot, or site that will pull the “dirty” blood, or blood with higher amounts of waste products, away and another site that will return the blood once it has been cleaned, or passed through the dialyzer.

Dialysis Routine

Your weight, blood pressure and temperature are taken before and after treatment. Skin around your access site with be cleaned with antiseptic. During treatment, your nurse will regularly check in with you. If you experience any unusual feelings during or after treatment, such as lightheadedness, headache, dizziness, nausea, blurred vision, loss of hearing or leg cramps, notify your nurse immediately.

More Information About Hospital Hemodialysis

Most patients who are receiving a hemodialysis treatment do not feel anything unusual, and pass the time watching TV, reading, sleeping or visiting with others. Many patients are fatigued when they complete a treatment and often return home to have a rest.

You may not get the same station each time you dialyze since we must accommodate the changing needs of all patients and keep patients safe. If you have a safety concern for yourself about any station, please discuss this with your nurse.

Infection Control

Your health-care team takes care to limit the risk of infection in the dialysis units. Equipment is disinfected regularly and dialysis tubes and filters are only used once then thrown away. Staff wears protective equipment and washes their hands between caring for patients. Please talk to your nurse if you are worried the risk of infection when receiving care/treatment.

At first, you are likely to be scheduled into a daytime spot until you are comfortable with dialysis. Following this you may be moved to a different time slot. Depending on the unit, there may be three time slots available: mornings, afternoons and evenings.

Your health-care team will try to accommodate your schedule request but cannot guarantee you will get your wanted time slot. There are many factors that may affect your request for a schedule change. If you need to switch your treatment time for a special occasion, please contact your dialysis unit. If you know you will be late for your treatment, please call the unit and let them know when you will arrive.

While the Manitoba Renal Program provides kidney health care for people from all across Manitoba, new dialysis patients start their hemodialysis treatment in Winnipeg or Brandon. To ensure continued access for new and hospitalized dialysis patients, we may transfer other dialysis patients to another dialysis centre. This transfer might be to another dialysis centre in Winnipeg or a dialysis centre in another regional health authority.

When choosing patients to transfer from one dialysis unit to another, the health-care team takes into consideration many factors. We understand that transferring to another site is a change but please know you will still receive the highest quality kidney health care. We will do our best to give you as much notice as possible and help you resolve any concerns before the transfer.

Wear comfortable, washable clothes that allow for your vascular access site to be easily reached. Examples include button up shirts for catheters and short-sleeve shirts for a fistula or graft. There are also hospital gowns available. Blankets can be provided to help make you more comfortable.

For your first three to six treatments it is best to have someone drive you instead of driving yourself. You may feel tired or light-headed after dialysis initially, but once you become used to dialysis, you may start driving yourself. If you are unable to drive, your health-care team may be able to refer you to a variety of transportation options available to you.

For entertainment there are televisions at each station. Please bring your own headphones to listen to the TV. Some patients read, sleep, visit, write or listen to music while receiving dialysis. Some units have volunteers who visit to talk or play cards/games with patients. Talk to your nurse or social worker if you would like a volunteer to visit. Electronics are permitted in the unit but you are encouraged to use headphones.

We encourage you to bring a healthy meal or snack to eat after dialysis treatment. Ask a health-care team member if it is safe to eat a snack during dialysis. Eating on dialysis is sometimes not advised because it may cause a drop in blood pressure and may seriously affect your treatment. If you have diabetes it is important to bring a juice or sugar snack with you to dialysis in case you have a low blood sugar before, during or after your dialysis treatment. Your renal dietitian can provide more information about suitable snacks and food for individuals receiving in-centre hemodialysis.

Washrooms are available to use before and after your dialysis treatments. The need to go for a bowel movement while on dialysis can have serious, harmful effects during your treatment by affecting your blood pressure. Therefore the nurses cannot interrupt your treatment to allow you to attend the bathroom. If you are having constant issues with constipation or diarrhea, make sure to talk to your doctor or nurse.

We encourage you to attend all treatments and stay for your full treatment times. Regular dialysis is necessary for your overall health. If you are sick, it is important that you still come to dialysis. Research shows that patients who miss or shorten dialysis treatments are more likely to be hospitalized. You have the right to make your own choices about your treatment, which means you can refuse or stop dialysis permanently. If you choose to stop or skip a treatment, you may put your life in danger. If you are considering stopping dialysis please speak to your doctor or social worker so they can offer the appropriate support services in regards to your decision.

If there is bad weather or another emergency that is preventing you from getting to your dialysis appointment, call the unit and let them know.

Due to COVID-19, the hemodialysis units have a “no-visitor” policy in place to ensure the safety of our patients and our staff. If you desire or require the presence of a caregiver during your treatment, please call the Hemodialysis Unit charge nurse in advance.

Read our Vacation Planning page for more information on travel and dialysis.