Manitoba Renal Program

New In-Centre Hemodialysis

Patient Handbook

manitoba renal program

My dialysis schedule:

Morning

Afternoon

Evening

Monday – Wednesday – Friday

Tuesday – Thursday – Saturday

My nephrologists:

My social worker:

My dietician:

My pharmacist:

My Information

Table of Contents

About Manitoba Renal Program

• This Handbook ..........................................................................................5

• The Kidney Health-Care Team .............................................................5

• Types of Treatment ..................................................................................6

• Patient Transfers .......................................................................................8

Hemodialysis in Hospital (In-Centre)

• Tips for your First Day .............................................................................10

• During Hemodialysis ..............................................................................13

• Your Schedule ...........................................................................................14

General Hemodialysis Information

• Medication .................................................................................................16

• Problems or Concerns ............................................................................17

• Physical Activity ........................................................................................18

Additional Information

• Visitors ..........................................................................................................20

• Vacations .....................................................................................................21

• Your Family Doctor ..................................................................................21

• Surgery .........................................................................................................21

• Rules, Rights and Responsibilities .....................................................22

Support

• Support ........................................................................................................26

About Manitoba Renal Program

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About Manitoba Renal Program Manitoba Renal Program (MRP) is made up of a team of health-care professionals working together to provide the highest quality kidney care and kidney education.

MRP’s services include kidney health outreach, kidney health clinics, and dialysis programs for both home and in hospital.

Kidney health outreach is education and resources offered in the province to increase awareness of chronic kidney disease with a goal of limiting the impact of kidney disease in Manitoba.

Kidney health clinics join people diagnosed with kidney disease with an interdisciplinary team of health-care providers to provide treatment and work on preventing or delaying kidney failure.

MRP jointly operates hemodialysis units in 20 locations throughout Winnipeg and Manitoba. MRP also has home dialysis training units in Winnipeg that train and support home dialysis patients who live in all corners of the province.

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This HandbookThis handbook is an introduction for patients who will be starting or just started in-centre hemodialysis. In-centre hemodialysis is nurse-assisted hemodialysis in a hospital or dialysis unit.

The MRP health-care team is your main source for information in addition to other materials you receive at the kidney health clinic and on MRP’s website: www.kidneyhealth.ca.

If you have any questions or concerns, please don’t hesitate to ask your health-care team.

The Kidney Health-Care TeamDuring visits for appointments, you will meet with several of our health-care team members. The following is a brief description of each role.

Nurse – Renal nurses have had special education to provide expert kidney care and training for people with kidney disease. A nurse can help with your questions or problems and make suggestions for changes to help patients feel more comfortable and safe.

Dietitian – Renal dietitians will help you make food choices that are best for your needs. Your diet may differ from other patients on dialysis, so the dietitian will talk with you about your specific diet needs. If you have any questions or concerns regarding your diet feel free to talk to your renal dietitian.

Nephrologist – Nephrologists are doctors that specialize in caring for patients with kidney disease. They will track your kidney health and work with you to give medical care as needed and to improve your health.

Educator – A renal nurse educator supports and teaches nurses and dialysis aides about new equipment, procedures and techniques. The educator also may help with problems or concerns that come up during dialysis.

Manager – The patient care manager supervises and supports staff and patients to make sure treatments are given safely and according to rules and guidelines of MRP. The manager also assists with resolving problems or concerns.

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Pharmacist – A renal pharmacist reviews and updates your medication records. They also help you understand the medications prescribed and help doctors choose the right medications. Ask the health-care team if you want to speak to a pharmacist about medications.

Social Worker – A renal social worker supports patients and their families in adapting to lifestyle changes that come with kidney disease. If you are having concerns about your care or in your personal life, the social worker can support you and connect you with useful resources. Make an appointment by calling the renal social worker.

Aboriginal Liaison Coordinator – The MRP Aboriginal Liaison Coordinator provides support and information for Indigenous patients and guides staff in providing culturally safe care.

Fitness & Wellness Coordinators – The fitness and wellness coordinators are based in Winnipeg and help develop exercise programs and resources for individuals living with kidney disease or who are on dialysis. They can offer guidance and support for you if you are wishing to be more physically active.

Technologists – The technologists take care of the operation and safety of dialysis machines and other health-care equipment. They also look after the water treatment system necessary for dialysis.

Transition Coordinator – The transition coordinator works with you to provide information about kidney dialysis treatment options and helps you if you are moving from one type of treatment to another.

Types of Treatment AvailableWhen the time comes that kidneys can no longer function on their own, the health-care team will suggest treatment to maintain health. Everyone is different and a health-care provider will talk about options that might be best for your needs.

In-Centre Hemodialysis

Hemodialysis is when blood is cleaned outside of the body using a machine and artificial kidney filter. In-Centre hemodialysis treatments are usually scheduled three times a week at a dialysis unit in a health-care facility.

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Peritoneal Dialysis

Peritoneal dialysis (PD) is a form of dialysis done at home either by the patient or a caregiver. For patients residing in Winnipeg, MRP can also provide help with PD in a patient’s home. During PD, the blood is cleaned inside the body, using it as a natural filter. A solution is put into the belly area with a tube (catheter) and is drained and refilled to remove waste from the body. It is a more gentle form of dialysis that lets your kidneys hold onto their remaining function longer. For this reason, it may be preferred that patients use PD as their first type of dialysis treatment. A patient on PD dialyzes seven days a week, usually overnight while asleep. Patients only need to visit the PD clinic every two to four months for assessment by health-care team members.

Home Hemodialysis

Home hemodialysis is a great option for many patients. For most patients, the home hemodialysis machine used is much simpler than the one used in hospital hemodialysis and can be set up in less than 15 minutes. The home will be outfitted with a hemodialysis machine at no cost to the patient. There are little to no special renovations to your home required and costs for power or water as a result of operating the machine at home are reimbursed. Patients set their own dialysis schedule which is either overnight, while sleeping, or during the day. Patients choosing this option can do dialysis more often and for longer times than in hospital, often leading to improved health, a more flexible diet and less medication. Once training is complete, patients only need to visit the home dialysis clinic once every one to two months for assessment by health-care team members.

Transplant

Talk to the health-care team to learn if you are a candidate for kidney transplant. Manitoba has its own kidney transplant program that performs both living and deceased donor transplants for people with kidney disease. Individuals must be considered eligible for a kidney transplant by their nephrologist before being evaluated by the transplant team. There is a waiting list for kidney transplants in Manitoba for those who do not have a living donor.

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End of Life Care

Some patients choose not to have dialysis. If a patient chooses not to have treatment, they will die sooner than if they chose dialysis. This can be a very difficult decision but often your quality of life on dialysis might not be what was expected. Patients may want to try dialysis for a trial period to see if it makes them feel better. The patient has the right to stop treatment at any time. If a patient chooses not to continue treatment, our health-care team will continue to offer care and support and connect them with additional support as needed.

Patient TransfersWhile Manitoba Renal Program provides kidney health care for individuals from all across Manitoba, new dialysis patients start their hemodialysis treatment in Winnipeg or Brandon. To ensure continued access for new dialysis patients, we may transfer other suitable 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.

We understand that transferring to another hospital is a big change and we will do our best to help make this a smooth transition.

When choosing patients to transfer from one dialysis unit to another, the health care team takes into consideration many facts. We look at the patient’s medical stability, length of time the patient has been on dialysis and patient’s postal code.

While we try our best to accommodate your wishes, we also have to meet the health-care needs of all our patients. Because of this your dialysis times and days, as well as your dialysis unit, may need to change.

All MRP dialysis centres provide the same standard of quality patient care and your dialysis care records will travel with you to the new site.

Hemodialysis In Hospital

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Tips For Your First DayYour Vascular Access Site

“Vascular access” is how your bloodstream will be accessed so that dialysis can be performed. Vascular accesses are pathways to the blood stream created by vascular surgeons. Your health-care team will talk about all the access options available and inform you about which option is best for you.

Often the vascular access has to be created and stable for a period of time (sometimes weeks) before it can be used for dialysis. You will be given information on how to care for your access site which is important in order to prevent infection. Signs of infection include redness and/or tenderness at the site, and/or fever. If you have concerns or questions, ask your nurse for information about caring for you access site.

What to Wear During Dialysis

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.

Getting There

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.

Waiting Area

Please remain in the waiting area until a member of the dialysis staff calls you for your appointment. We want to make sure your station is clean and ready before you receive care.

Valuables

Keep your valuables with you at all times. MRP, and the health-care facility, cannot guarantee the security of your items.

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Hand Hygiene

In order to help stop the spread of bacteria in the unit please carefully wash your hands or use hand sanitizer before entering and after leaving the unit. This will help keep you and other our patients healthy.

Entertainment

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.

Food & Drinks

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.

Bathroom Breaks

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.

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Dialysis Routine

Your weight, blood pressure and temperature are taken before and after treatment. Skin around your access site will 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. You also need to keep your vascular access line visible during dialysis treatment.

During DialysisYour Station

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.

Your ScheduleAt 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 which will become your regular dialysis treatment spot. There are 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, such as medical status, transportation needs, employment/work status, homecare services, the length of time of the request and how long you have been on hemodialysis. If you need to switch your treatment time for

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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.

Missing or Stopping Dialysis

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.

Bad Weather or Emergencies

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.

GeneralHemodialysis Information

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MedicationDuring your visits to the kidney health clinic, your health-care team will keep track of your medications. Once you start dialysis your nephrologists, pharmacists and nurses will review your medications and their dosages. Staff will explain any changes to you. If you have changes made to your medication by another doctor, tell the nursing staff. Your renal pharmacist is a part of your health-care team and is available if you have any questions about your medications.

Non-Prescription Medications

Always talk to your pharmacist, doctor or nurse before taking non-prescription medications such as laxatives, antacids, pain pills or herbal remedies. These can be harmful to people on dialysis. Always notify your nurse or pharmacist if there are any changes in your medication or if you are no are longer taking a medication.

Your List of Medications

Bring your list of medications with you if you are going to the emergency room, admitted to hospital or have an appointment with a doctor.

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Problems or ConcernsMedical Problems While at Home

If you experience health issues while at home call the dialysis unit. If you have a serious concern, go to your local hospital’s emergency department. Make sure they know you are a hemodialysis patient and take your medications with you.

Renal Social Worker

Your renal social worker is available to help you adapt to lifestyle changes that come with dialysis. If you are having issues with your care or in your personal life, the social worker can help connect you with useful resources. Some areas the social worker may be able to help with are counselling, education, helping address social and financial concerns and home care referrals. Renal social workers can also consult with your employer about impacts/changes that may need to occur with your employment.

Patient Representative Committee

The MRP Patient Representative Committee is a committee formed by patients with an MRP facilitator. Regular meetings are held where patients can discuss concerns and get feedback. Information gathered from the committee is shared with MRP management to help resolve issues or concerns. Patients are not obligated to attend any meetings but receive a small honorarium for every meeting they attend. Call 204-787-3286 or visit kidneyhealth.ca to find out more about the committee and the next meeting.

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Physical ActivityPhysical activity helps keep our bodies and minds healthy. Having an active lifestyle is important for patients with kidney disease. It helps in having more energy to do daily activities.

Some benefits of staying active include improved energy, muscle strength, flexibility, endurance, blood pressure and quality of life. Patients should always check with their doctor before beginning new exercises and activities.

MRP offers exercise programs for patients with kidney disease. These include Lean, Keen Kidney Machines, Biking on Dialysis and the Renal Exercise Counselling Clinic for renal patients. To learn more call our Fitness & Wellness Coordinator at 204-631-3039. Patients outside of Winnipeg can also talk to their health-care providers about resources within your health-care facility and community. Also visit www.kidneyhealth.ca for more information.

Additional Information

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VisitorsYou may have up to two visitors at a time during your dialysis treatment. We ask that visitors wait until you have started your dialysis before they enter the unit, and wait in the waiting room while your treatment is finishing. All visitors should wash their hands or use hand sanitizer before entering and after leaving the dialysis unit. Please make sure your visitors are respectful and do not interfere with unit staffs’ duties. Visitors who have cold or flu-like symptoms should not visit.

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VacationsPatients who want to travel have to plan in advance. If you are planning a vacation let your nurse and social worker know as soon as possible. If your destination is in Canada, we will try to help you arrange dialysis treatments in that province or territory. Travel within Canada requires at least six to eight weeks’ notice. There are no additional costs to receive dialysis at other units in Canada (with the only exception being private clinics in Quebec).

Travel outside of Canada takes more time to plan. It is up to you or your family to contact the destination dialysis centre to arrange dates for dialysis. At that time you can ask the unit to send transfer forms to us to complete. Tests are often required for this process so please allow plenty of time for these to be organized. Units outside of Canada charge various fees that are the responsibility of the patient. Be sure to get the costs or additional fees in writing beforehand. You must assume all the costs of the dialysis treatment outside Canada but can provide receipts to Manitoba Health for a set amount of reimbursement, which is usually only a portion of each dialysis treatment.

Your Family DoctorYou should continue to see your family doctor for problems not related to your kidney disease. Let your kidney health-care team know if your family doctor has put you on any new medication or has referred you to a specialist. If you see a specialist or have a test done, ask that copies of the report be sent to both your family doctor and the dialysis unit.

SurgeryIf you need to have any type of surgery please let your kidney health-care team know. We may need to change your scheduled dialysis and/or make sure medications used for dialysis do not interfere with surgery. If you are having out of town surgery, tell your nurse as soon as possible so arrangements can be made.

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Rules, Rights and ResponsibilitiesGeneral Rules

• We try to respect your confidentiality. Due to a lack of space between dialysis stations, sometimes information may be overheard. We ask that you respect the confidentiality of other patients by not sharing any information you happen to overhear.

• You have a set appointment time that health-care staff tries to honour but sometimes you may not be called to come in at the exact time of your appointment. We ask you to be patient and we will have you in as soon as we can.

• Patients are not provided meals during dialysis. Unless there is an exceptional circumstance, patients should bring their own snack.

• Please refrain from wearing perfume, cologne or body spray when you come for treatment and please ask your visitors to abide by this rule as well. The hospital is scent free.

• Patients and staff are entitled to a safe environment free from any form of discrimination or harassment. Physical, verbal or mental abuse or violence will not be tolerated and will be dealt with according to hospital policy.

Patient Rights

You have a right to:

• be informed about your care • be treated with respect and dignity• review your chart (in-patients can see their chart within 24 hours,

out-patients can make a request and pay a fee to Medical Records to see their health information)

• speak to any member of the interdisciplinary team as needed• ask questions and get answers in a timely manner• a second opinion if you wish to seek one• ask about your health care provider’s experience and credentials• to take action if you are not satisfied with the care you or someone

you care about receives – the first step is talking with your caregiver or supervisor

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Patient Responsibilities

You have the responsibility to:

• be an active participant in your care• treat other patients, staff and visitors with respect and dignity• tell your health care team about changes in your health or

medication, address, phone number or Manitoba Health Number• arrive for treatment on time or tell us if you cannot get to the unit

on time• follow the health-care team’s recommendations regarding

medications, fluid limits and diet choices or let the doctor know if for some reason you cannot

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Support

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SupportThere are a variety of supports and resources for individuals living with kidney disease.

The Manitoba Renal Program has many resources and tools available for you online at www.kidneyhealth.ca. As well, Manitoba Renal Program has educational events to help bring together patients and provide information.

Our Patient Representative Committee is a place where patients can share their concerns and be heard. More information on this committee is found in the “Problems & Concerns” section. Your renal social worker can also help connect you with supports in your community.

The Kidney Foundation of Canada – Manitoba Chapter has an active community of individuals raising awareness of kidney disease and providing support to individuals with kidney disease. Their wide range of resources includes brochures and booklets, events, support groups, peer groups and online tools. Call 204-989-0800 or 1-800-729-7176 to find out how they can assist you, or visit their website at www.kidney.ca.

WRHA Indigenous Health – Services for Indigenous Patients

Services include Indigenous language interpretation, advocacy, discharge planning, spiritual/cultural care as well as other general support. You can call WRHA Indigenous Health at 1-877-940-8880. WRHA Indigenous Health works as part of your health-care team.

Notes:

For more information contact Manitoba Renal Program:A570 Seven Oaks General Hospital Phone: 204.632.3607Fax: 204.632.6168kidneyhealth@wrha.mb.ca

Manitoba Renal Program works to prevent kidney disease, promote kidney health and provide kidney health services to Manitobans.

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© Copyright 2016 Manitoba Renal Program