Being on dialysis can be tricky in many ways. The dialysis treatment itself has a host of complexities. But apart from that, there are a number of things you need to watch out for. The trouble is the staff in a hospital are not always aware of what dialysis patients need to be careful about. So it is important for us, as patients to be on the watch about some basic things. Don’t assume that doctors, nurses and technicians know everything. They may not know or they may forget. It is our life at stake and therefore, it is completely upon us to take care of these things.
1. No BP cuff or injections on the Fistula arm
An access for dialysis is a lifeline for a dialysis patient. So, we must all take good care of it. Two most important things to be watchful about in relation to the access are BP cuffs and injections.
Never allow anyone to tie a BP cuff to the arm or hand on which you have your access. It could damage the access and cause it to fail. Also never allow blood to be drawn from a vein on the arm or hand on which you have your access. Even injections like iron or Erythropoietin should be not be administered on this side. Let them use the other side. So if you have your fistula in the right arm, make sure BP is checked or injections adminstered on the left side.
The only exception to this is the dialysis procedure itself. When your dialysis needles are inserted, they are always done on the access side. Injections are often administered through the dialysis needles. This is OK. BP cuffs should always be tied on the other hand though.
2. No drinking of too much water before an ultrasound scan
Many people on dialysis need to get ultrasound scans for a variety of reasons. Technicians or nurses managing patient flow almost always ask patients to drink a lot of water (1 to 1.5 liters) before the ultrasound as they require the bladder to be full during the scan. However, we should not do this. How much ever water we drink our bladder is not going to get full because our kidneys are not working. So please explain to the technician or nurse that you are on dialysis and are not allowed to drink so much water. If they insist, ask to speak to the doctor in-charge. Hopefully, this should solve the problem. If they still insist, walk out of there and have your doctor speak to them. Whatever happens, do not drink that much water at once (however tempting that may seem!)
3. Injection of contrast dyes for various kinds of scans
Some kinds of scans require a dye to be injected into the vein of our body before doing a scan. We need to be very careful about this. We must talk to our nephrologist about this and remind them that we are on dialysis and ask them if a dye is safe. There could be some dye that is safe. Another option is to get a dialysis session immediately after the scan is completed to remove the dye completely.
Whatever be the case, we must speak to our nephrologist and discuss this aspect and make sure we mention repeatedly to the technician or doctor in-charge of the scan that we are on dialysis and that they are aware of what dye they are using.
The bottomline is that in Indian healthcare (and many other countries in the world), healthcare workers don’t always know everything. Even if they know, they might forget. It is very important for us to be aware of these things that can harm us immensely over a period of time and to take adequate precautions to ensure that we are safe. Dialysis, by itself can be difficult to deal with. We don’t need additional problems to make life challenging.