Counties Manukau Health Renal
Public Service, Nephrology
Haemodialysis is a treatment that cleans and filters your blood by removing the waste products and extra fluid that your kidneys can no longer eliminate. Haemodialysis requires a machine and an artificial kidney that is called a dialyzer. During the haemodialysis treatment your blood is pumped by the machine through tubing to the dialyzer. In the dialyzer, your blood is filtered, waste products and extra fluid are removed. The filtered or 'cleaned' blood is then returned to your body.
In order to remove and return blood to your body, an access to your blood vessels must be made. This access is made during a surgical procedure in which a fistula is created or a graft is inserted under your skin. The fistula or graft is put in the lower or upper arm if possible; other places can be used if the arm is not suitable. Your surgeon will determine which access is best for you.
If treatments must be started before a fistula is created or a graft is inserted, a temporary catheter may be placed externally (outside your body) to allow for immediate access to your blood vessels. Such a catheter is usually a temporary solution until real access can be created by the surgeon. Because of waiting lists for that procedure or in some patients who face major problems regarding creation of vascular access, a so-called tunnelled line may be inserted by a renal physician. The tunnelled line runs under the skin of the chest and is held in place by a little cuff under the skin. This catheter can stay in place for a few years if necessary.
Once your access has healed (matured) it can be used for treatment. Two needles are placed in the access at the start of each treatment and taken out at the end of each treatment. One needle is used to remove your blood for cleansing (filtering) and the other is used to return the filtered blood to your body.
Haemodialysis treatments are usually performed three times each week. The length of your treatment is decided by your doctor but usually lasts from 3 to 5 hours. The time depends on your body size, any remaining kidney function and activity level. During your treatment you can read, watch TV or socialise with others close to you in the facility.
In Counties Manukau, several types of haemodialysis treatments are offered. Patients are expected to participate in an active way to stimulate their own health. Part of that is taking responsibility for your dialysis. The so-called incentre facility (Middlemore Hospital and Western Campus) where staff do the whole treatment for the patient, is reserved for fully dependent patients. Usually these are the 'sicker' patients. The next step is to assist in building up your dialysis machine and participating in the monitoring of your treatment. This is done in Western Campus and, even stronger in the MSC satellite. As you can see, the Western Campus facility contains a mix of dependent and more autonomous care patients. The ultimate goal of many patients is to take a machine home and do the dialysis in the home environment. In order to be able to do this, these patients come first to our training facility at the Western Campus. For those who would like to dialyse at home, but do not have the infrastructure, we have 'community care facilities' in Papatoetoe (2), Māngere and Pukekohe, where patients dialyse themselves in bedrooms of houses in the community that are completely set up for this treatment. There are no staff present.