Name of the Procedure:

Dialysis Services for End-Stage Renal Disease (ESRD), Less Than a Full Month, Per Day (for patients 20 years of age and older)

Summary

Dialysis is a medical procedure to remove waste products and excess fluid from the blood when the kidneys can no longer perform these functions naturally. This specific service covers dialysis treatments given for less than a full month on a per-day basis for adult patients aged 20 and older.

Purpose

Dialysis is used to treat patients with End-Stage Renal Disease (ESRD), a condition where the kidneys have lost the ability to function adequately. The primary goal is to manage symptoms and prevent complications by filtering waste products and excess fluids from the blood.

Indications

• Severe kidney failure or ESRD
• Symptoms of uremia such as nausea, fatigue, swelling, or difficulty breathing
• Blood tests indicating poor kidney function (e.g., elevated creatinine, urea)

Preparation

• No specific fasting required, but dietary restrictions may be advised
• Medication adjustments may be necessary; consult with your healthcare team
• Routine blood tests to assess kidney function and overall health status
• Access site evaluation to ensure it is ready and functional for dialysis

Procedure Description

1. Preparation: Patient is positioned comfortably, and the access site (usually an arm or central vein) is cleaned.
2. Connecting to the Machine: Needles are inserted into the fistula or graft, or a catheter is connected if a central line is used.
3. Filtration Process: Blood flows from the patient's body to the dialysis machine, where it is filtered through a dialyzer (artificial kidney) to remove waste products and extra fluid.
4. Monitoring: During the treatment, healthcare staff will monitor vital signs and the dialysis machine to ensure the procedure is proceeding correctly.
5. Completion: After filtration, blood is returned to the patient’s body, and the access site is carefully disconnected and dressed.

Duration

Each dialysis session typically lasts between 3 to 4 hours, conducted several times per week depending on the patient's condition.

Setting

Dialysis can be performed in various settings, such as:

• Dialysis centers
• Hospitals
• Outpatient clinics
• Home dialysis (with appropriate training and equipment)

Personnel

• Nephrologist (Kidney specialist)
• Dialysis nurse
• Dialysis technician
• Support staff

Risks and Complications

• Common: low blood pressure, muscle cramps, fatigue
• Rare: infection at the access site, allergic reaction to the dialyzer, bleeding
• Complications are typically managed with medication or adjustments to the procedure

Benefits

• Relief of symptoms associated with kidney failure
• Improved quality of life
• Prolonged life expectancy by effectively managing ESRD

Recovery

• Immediate post-dialysis fatigue is common; rest is recommended
• Monitoring of weight, blood pressure, and diet
• Regular follow-up appointments to assess ESRD management
• Continuous education on care for the dialysis access site

Alternatives

• Kidney transplantation: A surgical alternative offering potential for normal kidney function, but requires a suitable donor and comes with surgical risks.
• Conservative management: Focuses on managing symptoms without dialysis, generally chosen in non-surgical candidates or those preferring not to undergo dialysis.

Patient Experience

• During dialysis, you might feel a bit uncomfortable initially when the needles are inserted and may feel fatigued afterward.
• Most patients can read, watch TV, or sleep during the session.
• Pain management options and comfort measures are available; always communicate any discomfort to the healthcare team.

By understanding each aspect of the dialysis process, patients and caregivers can better prepare for and manage the treatment of ESRD.