Children and families |
HaemodialysisThis leaflet explains haemodialysis and what to expect when your child comes to Great Ormond Street Hospital. Contents
Why does my child need dialysis?Dialysis is needed when a child's kidneys stop working properly. This can be for several reasons. Your child's doctor will have discussed with you what has happened in your child' case. If you would like more information on this, please see our separate leaflet on kidney failure. What does dialysis do?Dialysis does the job that is normally performed by the kidneys - that is, it removes waste products from the blood and excess water from the body. How does dialysis work?There are two methods of dialysis: haemodialysis, which involves filtering out waste by passing blood through an artificial kidney machine, and peritoneal dialysis, where a catheter is inserted into the abdomen. This leaflet explains haemodialysis. When your child starts dialysis you will have a lot of new skills to learn. Your child will also need to be prepared for dialysis, both physically and mentally.
How do haemodialysis and peritoneal dialysis
compare?
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Haemodialysis: |
Peritoneal dialysis: |
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Haemodialysis works by passing blood from the body to an artificial kidney machine. Waste products in the blood are filtered through the machine, which contains many layers of special membrane, then returned to your child. Each dialysis session lasts around four hours. The kidney machine is programmed for each child to ensure that the rate of blood flow and filtering is correct.
For haemodialysis to be carried out there must be access to your child' bloodstream. There are two methods: a Perm-cath or an arterio-venous fistula connecting an artery to a vein (please see our accom-panying leaflet ‘Haemodialysis access').
Almost all children with kidney failure can benefit from haemodialysis. The main requirements are:
it must be possible to access the blood system easily;
patients must be able to cope with changes in fluid levels and amounts of chemicals in the blood. This is not usually a problem, but haemodialysis may not be advisable for some children.
There are some side effects associated with haemodialysis. Due to rapid changes in the body's fluid level and chemical balance during dialysis, your child may feel unwell during dialysis sessions. The most common effect is that your child' blood pressure may drop which can cause nausea, dizziness and occasionally muscle cramps. This can however be minimised by limiting fluid intake - this will be discussed fully with you by your child' dietitian and healthcare team.
It can be quite difficult to balance the amount of fluid your child drinks and how much fluid is removed during dialysis. When the balance is not right, your child could develop fluid overload (too much fluid in the body) or dehydration (not enough). You will need to watch out for any signs of either fluid overload or dehydration.
Another potential problem is hyperkalaemia or too much potassium in the blood, which causes problems with heart rhythm. These could be life threatening. Further details of signs to watch for appear later in this booklet.
Before your child starts haemodialysis, you will meet your nephrologist (a doctor who specialises in kidney disease) and clinical nurse specialist. They will explain haemodialysis and what to expect. This will be a good opportunity for you to ask practical questions, discuss how the system will work and get used to the idea of dialysis.
The play specialist on the ward will help you to prepare your
child for dialysis. He or she will show your child a photo book
of children who are already on dialysis and maybe a special doll
who is also ready to start haemodialysis.
You will also meet the ward dietitican who will explain the details
of the special diet your child will need to follow.
Your child will come to hospital for each dialysis session. As you know your child best, you are considered to be very much part of the team involved in caring for your him or her during dialysis. And, of course, you will be your child's main carer at home between sessions. There will be a great deal to learn but the ward staff will make sure you feel confident and comfortable with dialysis before you go home. Remember there is always someone on the end of the telephone at Great Ormond Street Hospital to advise and reassure you.
Before leaving hospital, you should feel confident about all the things on the following checklist:
Where will my child have haemodialysis? Your child will have to come to Great Ormond Street Hospital three times a week for dialysis. Each session will last around four hours. Unfortunately, it is not possible for children to have haemodialysis at home or in community units as their needs are different from those of adult kidney patients.
Will haemodialysis hurt? Haemodialysis is not painful but it can be tiring. The levels of various substances in the body rise between dialysis sessions and drop rapidly when dialysis starts. This could make your child feel faint or washed out or give him or her a headache. These effects should pass quickly and not every child will feel this way. If your child feels unwell during dialysis, tell the nurse who can make adjustments to the kidney machine.
If your child has a fistula, he or she may take time to become used to the needles being inserted. The nurses will always apply some local anaesthetic cream to your child' arm to minimise the pain of needle insertion.
Will my child' condition improve when dialysis starts?
Each child is different. Some feel better as soon as dialysis
starts, for others it takes longer. It depends on the severity
of your child' disease before dialysis started.
Dialysis is only part of the treatment, along with diet and medication.
Your child will need to stick to a special diet which limits the
amount of salt, potassium and phosphate he or she consumes. Your
dietitian will explain more about the diet. Your child will also
need to continue taking medication as before, although the amounts
and timings may be altered. Your child' nurse and pharmacist will
explain this in more detail.
Will my child be able to have a shower or bath? Your child can have a bath or shower once the fistula site has healed. Showers tend to be better if your child has a Perm-cath but if he or she has a bath, make sure that the level of water is below the tube. It is also safer to put the ends of the tube in a waterproof bag and tape them out of the way.
Will my child still be able to go to school? Your child will still be able to go to their regular school between dialysis sessions. While he or she is in Great Ormond Street Hospital, a teacher from the hospital school will visit the dialysis unit. The teacher will liaise with your child' home school to ensure your child' education continues during dialysis sessions.
If a school trip or exam clashes with your child' planned dialysis session, talk to the ward staff. It may be possible to move the session.
Your child will still be able to swim if he or she has a fistula, but sticking to a short session is best. It is very important that your child does not get cold, as this might cause a fall in blood pressure which could lead to clotting. Unfortunately your child will not be able to go swimming with a Perm-cath due to the risk of infection. Your child should still be able to do PE, but be careful not to damage the fistula or Perm-cath. Contact sports like rugby are not a good idea.
Your child will still be able to eat school meals as long as they fit in with the special diet he or she will need to have. You may need to discuss this with your child' school.
Your child is unlikely to need a 'statement of special educational needs' although some children have one.
Are we entitled to extra benefits? While you are in hospital, you will be able to meet the renal social worker. He or she is experienced in helping families who have a child with kidney disease and will be able to tell you which benefits you can claim and explain other sources of support. Generally, children who are on dialysis receive Disability Living Allowance.
What about taking medicines? It is important for your child to take all the medication prescribed by the hospital. Taking extra medicines could lead to your child having side effects not normally associated with that medication - check with the ward on the contact number below if you are in any doubt.
Will we be able to go on holiday? Some of the kidney support organisations have special holiday centres where the whole family can go on holiday. These have dialysis units, so your child can continue to have dialysis on holiday. However, not all of these centres are suitable for children, so please discuss this with your nurse.
It is unlikely you will be able to go abroad while your child is on haemodialysis.
Feelings and emotions while on haemodialysis
Your child (and you and the rest of your family) may feel fed up with haemodialysis from time to time. The following are problems that may occur, but do not expect them as not every family is affected in the same way. If you are worried about any of these, call the clinical nurse specialist who will be able to arrange a meeting with one of our psychologists who will be able to give you ideas on how to cope.
Body image
Children may feel self conscious about their fistula or Perm-cath.
Talking to other people on dialysis can help so contact the
support organisations for advice.
Feeling tied down by haemodialysis
Your child, you and the rest of your family may feel that
everything has to revolve around dialysis. Keeping to your
normal routine outside dialysis sessions as far as possible
may help.
Sibling rivalry
If you have other children, they may feel upset at the attention
their brother or sister is receiving. Having 'special time'with
your other children may help. If relatives and friends seem
to focus on your child on dialysis and pay less attention
to your other children, you could ask them to treat all your
children equally. Having as much attention paid to your other
children will make them feel a bit happier.
National Kidney Federation
6 Stanley Street
Worksop S81 7HX
Helpline: 0845 601 0209
Website:
www.kidney.org.uk
Kidney Research UK
King's Chambers
Priestgate
Peterborough PE1 1FG
Helpline: 0845 070 7601
Website:
www.nkrf.org.uk
British Kidney Patient Association
Bordon GU35 9JZ
Tel: 01420 472021/2
Website:
www.britishkidney-pa.co.uk
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Looking out for fluid overload |
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Fluid overload = too much fluid in the body |
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Signs: |
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Due to: |
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Looking out for dehydration |
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Dehydration = not enough fluid in the body |
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Signs: |
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Due to: |
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Looking out for hyperkalaemia |
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Hyperkalaemia = too much potassium in the blood |
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Sign: |
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Due to: |
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Ref: F040280 © GOSH Trust 2001
This information does not constitute health or medical
advice and will not necessarily reflect treatment at other hospitals.
If you have any questions, please ask your doctor. No liability can be
taken as a result of using this information.
This page was last updated on 6 August, 2008
UCL Institute of Child Health
Great Ormond Street Hospital for Children NHS Trust
