/clinical/,/clinical/pted/,/clinical/pted/hffy/,/clinical/pted/hffy/renal/,

/clinical/pted/hffy/renal/4822.hffy

20170103

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100

UWHC,UWMF,

Clinical Hub,Patient Education,Health and Nutrition Facts For You,Renal

Hemodialysis Accesses (4822)

Hemodialysis Accesses (4822) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Renal

4822









Hemodialysis Accesses




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Table of Contents

Introduction to Hemodialysis Accesses...................................................................... 2
What Is a Hemodialysis Access? ............................................................................ 2
What Are the Different Types of Hemodialysis Accesses? ................................... 2
Which Type of Access Will I Have? ...................................................................... 2
What Is an External Access? ...................................................................................... 3
The Straight Catheter ............................................................................................. 3
How Do I Care for an External Catheter? .............................................................. 4
Cuffed and Tunneled Hemodialysis Catheter......................................................... 6
Catheter Care ...................................................................................................... 6
Changing the Dressing at Home ............................................................................. 7
How is a Catheter Used during Dialysis? ............................................................... 8
What Is an Internal Hemodialysis Access? ................................................................ 9
How Do I Prepare for an Internal Access Placement? ........................................... 9
The Arterial-Venous Fistula ................................................................................. 11
The Graft .............................................................................................................. 12
How Do I Care for My Fistula or Graft? .............................................................. 13
After Surgery .................................................................................................... 13
Signs of Infection ............................................................................................. 14
Maintenance Care ............................................................................................. 14
How Are Fistulas and Grafts Used with Dialysis? ............................................... 16
Caring for Yourself on Dialysis Treatment Days ..................................................... 17
Special Instructions .................................................................................................. 19
Recommended Vaccination for Hemodialysis Patients ............................................ 19
Hepatitis B Vaccine .............................................................................................. 19
Pneumococcal Vaccine ......................................................................................... 19
Seasonal Influenza (Flu) ...................................................................................... 19
What Phone Numbers Do I Call If I Need Help? ..................................................... 20


Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 1/2017. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4822.



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Introduction to Hemodialysis Accesses

Your doctor has scheduled you for hemodialysis access placement. Knowing what
an access is and how to care for it will help your access work well and last a long
time.

What Is a Hemodialysis Access?

It is an entry into your blood stream. It is needed to provide a safe place to connect
you to the hemodialysis machine. Your blood moves through the entry tubing to a
filter that removes waste products and extra fluids. This process is called
hemodialysis. Hemodialysis is needed when your kidneys do not remove enough of
the wastes and extra fluid from your body.

What Are the Different Types of Hemodialysis Accesses?

There are two types of hemodialysis accesses, external and internal. The external
access is for temporary use only or for patients who cannot have internal access due
to various reasons. It can also be used as a bridge for internal access. The external
access is called a dialysis catheter. The internal access is for long term dialysis use.
It is the recommended access for hemodialysis. It can be either a fistula or a graft.

Which Type of Access Will I Have?

You will meet with a doctor and discuss the best type of access for you.

Many things are thought about when looking at which access to use: how long you
will need hemodialysis, which type is most likely to work well with your blood
vessels.

This booklet describes the most common kinds of accesses placed at the University
of Wisconsin Hospital and Clinics. It explains how to arrange for access
placement, how an access works, and how to care for your access after placement.



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What Is an External Access?

There are two types of external access. There is the straight hemodialysis catheter or
the cuffed and tunneled hemodialysis catheter. Both types can be used right after
placement.

The Straight Catheter

The straight hemodialysis catheter is inserted into a big vein. It is used for a short
period of time while you are in the hospital. You will not be sent home with this
type of catheter because of the risks such as infection, bleeding or displacement. If
you need hemodialysis after you leave the hospital, a cuffed and tunneled catheter
will be placed.

The most common veins used for this type of catheter are the internal jugular vein
(IJ) or the femoral vein. The catheter will be at your neck if the IJ vein is used. It
will be at your groin if the femoral vein is used. The catheter is named by its
location, such as the IJ catheter or the femoral catheter.

You will go to a dialysis room or
the cardiac cath lab at the hospital
to have the external catheter placed.
A doctor will explain what will
happen. Please ask questions or
voice any concerns you might have.

For your comfort, your doctor will
inject numbing medicine (lidocaine)
under your skin and may order
something to help you relax. The
external catheter will be placed into
a large vein in your neck, or groin
(Figure 1). A chest X-ray will
check correct placement when it is
placed in your neck.

Some people feel mild pain at the site after it is in. If this should occur, you may
take anything for pain that is ordered by the doctor, or Tylenol . Do not take other
kinds of pain pills as they may cause bleeding.
Figure 1. Detail of a right internal jugular straight
hemodialysis catheter.
internal
jugular



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How Do I Care for an External Catheter?

An external catheter is at greater risk of infection than an internal hemodialysis
access. Careful cleaning and handling is required to protect it. Infection poses a
great risk to your health and even to your life. Go to an emergency room or report to
your doctor if you ever notice any sign such as redness, warmth, or chills.

After the catheter is inserted, a nurse will clean your skin and place a dressing at the
point where the catheter enters your skin. The dressing will help prevent infection.
The staff will change your dressing during your dialysis treatment once a week or
more often if needed.

The hemodialysis catheter is your life line. Only trained dialysis staff may use it. It
should never be used for routine blood draws or giving medicines.

 Both you and your caretaker need to wear masks when the catheter caps are
open or the dressing is being changed.

 Your caretaker must wash his or her hands with soap and water or use alcohol
hand sanitizer before putting on gloves.

 The catheter should never be handled by ungloved hands.

 The catheter dressing needs to be changed when it is wet with body secretions
or blood or the edges of the dressing are peeling off.

Questions and Answers about Catheter Care

Can I shower or take a bath?
 A bath should be avoided since it can get the catheter hub or catheter dressing
wet which can cause infection.
 Take a shower only with the catheter dressing and hub completely covered
with plastic wrap and with the edges of the plastic wrap secured with tape.
 Keep the site dry.
 If the dressing gets wet, it will need to be changed; or else you may get an
infection.




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What should I do if blood comes from the catheter dressing?
 Apply steady pressure over the bleeding site for 20 minutes without lifting up
your fingers to check.
 If bleeding continues, repeat the steady pressure for 20 minutes.
 Call the dialysis unit or the emergency department if bleeding continues after
holding pressure on the site for 40 minutes.

Can I swim with a catheter?
ξ No.

What should I do if the catheter seems to be coming out?
ξ If it comes part way out, do not push it back in.
ξ Do not pull on it.
ξ Tape it to your skin.
ξ Call the hemodialysis clinic if you have questions.

What should I do if blood comes from the catheter?
ξ If the clamp is open, close it. Call the dialysis unit.
ξ If there is a crack or cut on the catheter, pinch off the catheter at the site of the
crack or cut. Call the dialysis unit.

What should I do if a cap falls off?
ξ Wash your hands.
ξ Put on gloves.
ξ Clean the open end of the catheter with povidone-iodine or alcohol and let dry.
Do not touch the end of the catheter with your fingers.
ξ If the clamp is open, close it.
ξ Put a new sterile cap on the end of the catheter or cover it with sterile gauze.
ξ Call the dialysis unit.

What clothing should I wear during my dialysis treatment?
ξ A button-down shirt or blouse is best.
ξ A shirt or blouse with a wide or loose neck may also work.
ξ Wear loose shorts, skirt, or pants with a large leg opening if you have a
catheter in your groin (a femoral catheter).
ξ Wear clothing that is easy to clean near the access site.



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Cuffed and Tunneled Hemodialysis Catheter

This type of catheter is designed to last longer than a straight catheter.

The catheter is placed underneath your
collar bone, through your skin, and
then tunneled or threaded under your
skin for a short distance before going
into a large vein in your neck.

The catheter has a small “cuff” on the
catheter under the skin. Your skin
tissue grows into the cuff to help
prevent infection and anchor the
catheter so that it will not fall out after
healing has occurred. (Figure 2).

Catheter Care

Care of the cuffed and tunneled
catheter is like the care of the straight
catheter. The main difference is that
the cuffed and tunneled catheter will not require stitches at your neck after healing
has occurred. The staff will tell you when the site has healed. You will always need
to have a dressing under your collar bone where the catheter comes out of your skin.
It is called the exit site. Care of the exit site for your cuffed and tunneled catheter is
the same as care for the straight catheter. Please refer to that section for details.
Some people find it helpful to tape the ends to their chest to avoid pulling it out by
accident and for comfort. Avoid pulling or putting tension on the catheter.



Figure 2 Detail of a right internal jugular
hemodialysis catheter
internal jugular



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Changing the Dressing at Home

You should replace the dressing only if it becomes wet, loose, or comes off. Or
else, reinforce it and let the dialysis staff change it at the next treatment. You need
these supplies to change your dressing. You should keep them on hand.

1. Clean gloves
2. Face mask
3. 2” X 2” sterile gauze or 4” X 4” sterile gauze or transparent adhesive
dressing (Tegaderm®)
4. ChloraPrep stick
5. Tape

To change the dressing, follow these steps.

1. Remove the soiled, wet dressing. Do not touch the catheter where it enters the
skin.

2. Wash your hands with soap and water.

3. Put on gloves and face mask.

4. Inspect the catheter site for redness, skin irritation, breakdown, or drainage.
Call the doctor if new tenderness, redness, swelling, or pus appears at the site.

5. Clean the site with chlora prep stick; starting
where the catheter comes out of the skin, this is
called the exit site. Pinch the wings on the
ChloraPrep stick to release the liquid into the
sponge pad. Do not touch the pad. Gently
press the sponge against the skin at the exit site
until you can see the liquid on your skin. Use a
circular friction rub, starting at the catheter site
to about 2 inches from the site.

6. Let air dry. Do not blot, wave at, or blow-dry the area.



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7. Place a 2” x 2” or 4” x 4” sterile gauze pad or Tegaderm over the insertion
site.

8. If a gauze dressing is used, apply strips of tape to cover all edges of the gauze
and hold it to the skin.

9. Avoid pulling or bending the catheter. Tape the free ends down to the skin so
they won't get caught on clothing.

How is a Catheter Used during Dialysis?

Dialysis staff will clean each port of the catheter then connect it to the hemodialysis
tubing. Staff members will wear gloves and masks. You will be asked to wear a
mask as well to keep germs from the open ends of the catheter when they are being
connected.

After the catheter is connected to the dialysis tubing, the hemodialysis machine is
turned on. Blood will be pulled from one of the catheter ports, through the tubing
and filter, and returned to the other catheter port after waste products and extra
fluids are removed. This process takes 3-4 hours for each treatment, with three
treatments per week. When the treatment is done, staff will return the blood in the
tubing to you.

Hemodialysis treatments should not be uncomfortable. Recliner chairs and
televisions are present for your comfort. Many people either watch TV or sleep
during their treatments. Sometimes side effects of fluid and waste removal may
occur, such as light-headedness or leg cramps. If you feel symptoms during your
treatment, report them to staff so they can help.






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What Is an Internal Hemodialysis Access?

Internal hemodialysis accesses are used when hemodialysis will be needed for
longer than three months. The two types of internal accesses are the arterial-venous
fistula and the graft.

Like an external access, internal accesses require that you know how to care for
them so they last a long time and provide you with good treatment.

How Do I Prepare for an Internal Access Placement?

Getting a fistula or graft placed is part of getting ready for hemodialysis. A fistula
or graft is the preferred access for dialysis. This list outlines things you need to do
to get the dialysis access.

Begin to protect your arm - If you are right handed, your surgeon’s first choice is
to place the access in your left arm. If you are left handed, the right arm will be the
surgeon’s first choice. There are times when this will not be the case. Your
surgeon will tell you which arm to protect. Tell people not to use that arm for IV’s,
needle sticks for lab work, or checking a blood pressure.

Ultrasound mapping - Some patients may need studies to check the size of the
blood vessels before the access placement. Ultrasound mapping of the arm is one
useful tool to assist the surgeon in planning for access. There are no needles
involved when mapping is done.

Venogram - Some patients may need a study called a venogram. In this study, a
needle is used to inject dye into your blood vessels. The Access Team will decide
which study is best for you.

Access Clinic - At this visit, your access options will be discussed with you. The
Access Team will decide the best type of access for you based on your exam and
any tests you may have had. After that, you will go to the Outpatient Surgery
Center to discuss anesthesia. You will NOT have surgery on this day. Your
surgery will be scheduled within 30 days of this visit. You do not need to hold your
medicines or insulin, or skip breakfast for this visit.






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Surgery - A fistula or graft is placed in the operating room. This will take 1 to 2
hours. You will be watched after surgery until you are ready to go home (most
often in 1-3 hours). You must have a ride to and from the hospital. You cannot
drive after getting medicine for pain. You must also have someone who can stay
with you during the first night.

After surgery teaching. Before you leave, your nurse will give you a handout
about how to take care of your new fistula or graft. It is helpful if your driver can
be with you when the nurse reviews these instructions. You may take your arm out
of the sling after you get home. Prop it on a couple of pillows to decrease swelling
when you are sitting in a chair or in bed.

You will be scheduled back to the Access Clinic after your surgery to have
your new access checked.

Call the doctor if you have any of these symptoms.
ξ Severe pain
ξ Swelling with numbness or tingling
ξ Redness and heat or drainage at the incision site
ξ Fever above 100° F
ξ Bleeding from the wound that doesn’t stop
ξ Pale or purple cold fingers

You may contact your kidney doctor by calling (608) 270-5656 between the hours
of 8-4:30 Monday - Friday. After hours, on weekends or holidays, please call the
same number and follow the answering machine instructions. If you cannot contact
the doctor for any reason, go to the nearest Emergency Department.




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The Arterial-Venous Fistula

The arterial venous fistula (A-V fistula) is a link between an artery and a vein. It is
most often in your upper or lower arm. When this link is created, the high-pressure
arterial blood rushes into the low pressure vein. Over time the vein becomes larger
and the vein wall thicker. The blood from these vessels can be used for dialysis.

In about 4-6 weeks, if the fistula matures, it will be possible to insert two needles
for treatment. One needle will be used to pull blood from your body through the
dialysis tubing and filter then return it to the other needle which returns the cleaned
blood to your body. The A-V fistula is the recommended access for hemodialysis.
It is less likely to become infected or clotted, because it is flexible and made of your
own tissues. When it is developed well, it provides you with better dialysis. As a
result, you will feel better. There is a risk that a fistula may not develop
successfully.


Figure 3. Detail of the link between a vein and nearby
artery forming the fistula.



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The Graft

A graft is like a fistula because it is internal and connects an artery to a vein. It is
used for dialysis in the same way as a fistula. The graft is made of a thin, hollow,
semi-rigid tube of a man-made material (one type is called Gortex ). This is the
best access for people with veins which cannot (or did not) develop a fistula. The
graft is placed in the upper or lower arm or the upper leg. It may be straight or
looped (Figure 4). Because it is larger and more rigid than a vein, needles may go
in with less trouble than with a fistula. On the other hand, because the graft is made
of a material that is not part of your normal body tissue, it can become infected or
clotted more easily than a fistula.




If you have a loop graft, ask the surgeon which side, thumb or pinky (circle one),
is the “arterial” side. You will need to relay this to dialysis staff so you receive the
best dialysis treatment. You can begin using a graft about two weeks after it is
placed.

Figure 4 Detail of a loop graft in the lower arm.



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How Do I Care for My Fistula or Graft?

After Surgery

You will have one or more incisions, each about two to four inches long. The
edges will be held together with stitches or sterile strips and covered with a dry
dressing. The dressing must stay on for three days or until all drainage stops.
Change the dressing to keep it clean and dry to help prevent infection.

ξ If your access is in your arm; rest
your arm, above the level of your
heart, on pillows, for 24 hours or
until the swelling is gone.

ξ If your access is in your leg; rest
your foot on a stool, or sit in bed
with your leg level with your body
for 24 hours or until the swelling
is gone.

ξ Avoid extra movement.

ξ Begin normal use of your arm or
leg after 24 hours unless swelling
is still present.

ξ Change the dressing if it becomes wet or soiled. Replace with dry sterile gauze
and tape

ξ Wrap and tape the area with plastic wrap during the first three days when
bathing. Remove plastic wrap after your bath or shower.


Figure 5 Elevate your arm above the
level of your heart for a few days after
fistula or graft placement.



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Signs of Infection

ξ Redness, itching, tenderness, pain, warmth, or swelling at the incision site.
ξ Temperature by mouth above 100 θF.
ξ Bleeding or drainage at the new access site that does not stop.
ξ Swelling, numbness, and tingling in access arm, hand, foot, or leg.
ξ Fluid that drains from the incision causing a constant wet dressing.

If you have any of the above symptoms, contact the Access Clinic, your dialysis
unit, or your local emergency department (phone numbers on back page). If you
are scheduled for a treatment and will not be able to keep your schedule, call to let
someone know.

A scab or crust on the incision is part of the healing process. Do not remove the
scab! Your stitches will be removed in two to three weeks during your dialysis
treatment. Your doctor or nurse will arrange for this to be done. The sterile strips
do not need to be removed. They will fall off when the incision is healed.


Maintenance Care

As long as you have a fistula or graft, you should check your access every day.
Two ways this is done are:

1. Listen with a stethoscope or place your ear to the access. When you
listen to your access, you should hear a whooshing sound called a bruit
(Broo-ee).

2. Check your access for pulsation and thrill. As your access develops,
you will be able to feel it pulsating. By placing your fingers over the
access, you will feel blood rushing through it. This is called a thrill.

If the bruit decreases, the thrill will also decrease. This means blood is flowing
more slowly through your access which may lead to clotting. If your access has a
clot, blood will not flow through it. It cannot be used for hemodialysis. If you
cannot hear the bruit or feel the thrill, call the Access Clinic and/or your local
dialysis unit.



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Starting one week after fistula surgery, you should start to exercise your access arm
to develop your new fistula. Exercise will help the fistula to mature well and to
avoid cannulation problems. If the fistula is in your lower arm, squeeze a small
rubber ball at least 3 times a day for 5 minutes at a time. If the fistula is in your
upper arm, do light-weight (1 – 3 pounds) lifting by bending your arm up slowly at
the elbow then stretching it out. If you have a graft, you do not need to do this.

Any chores that involve movement of the arm
muscles, such as washing dishes, may also help fistula
development.

You may use your arm or leg with the access as you
did before. To prevent infection or damage to your
access:

ξ Make sure your access arm or leg is clean before
coming to your chair. Wash the skin over your
access with soap and water before sitting down.
This helps to reduce Staphylococcus (staph). on
your skin. Staph is a germ that is on everyone’s
skin. It can make you very sick if it gets into your
bloodstream.

ξ Do not allow anyone to collect a blood sample or start an IV in the access arm or
leg.

ξ Do not take a blood pressure on the access arm or leg.

ξ Guard against direct injury to your access arm or leg.

ξ Check with your doctor before you go back to work.

ξ Avoid slowing the blood flow through the access.
- Do not sleep or lie with the arm or leg bent.
- Do not wear tight clothing or jewelry around your access arm or leg.
- Do not carry a purse or bag, or wear a watch on your access arm.
- Do not rest heavy objects on the access arm or leg.
Protect your access! Guard against infections and clots. Your access is your
lifeline!




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How Are Fistulas and Grafts Used with Dialysis?

Most often, a fistula is ready to use in 4-6 weeks. A graft is ready to be used 2–3
weeks or sooner depending on the type of graft material being used.

After your fistula or graft is ready to be used, the nurse or technician will place two
needles into the access before each treatment. You may discuss with the nurse
about options for numbing the skin before the needle is placed if you are uneasy
with needle placement. The needles sites will need to be rotated to stop damage to
the area being used regularly.

During dialysis you will sit in a recliner
chair and rest your arm on a pillow or towel.
You will be asked to limit movement of
your access arm or leg. Common activities
enjoyed include watching TV, talking with
others, sleeping, listening to tapes, and
reading.

When your treatment is over the staff will
remove the needles, apply a bandage, gauze,
and ask you to hold the gauze in place with
your fingers until bleeding stops. If you
cannot hold the gauze in place then the
plastic clamps can be applied to the
access site.

Apply just enough pressure to stop the bleeding after the needles are removed. This
can take from five to twenty minutes.

A dialysis nurse or technician will check to make sure the bleeding has stopped
before you leave. You will go home with clean gauze taped over the needle site.
Check your access area often within the first hour after treatment to be sure that the
bleeding has not started again. Remove the gauze 4-6 hours after your dialysis
treatment if there is no more blood oozing.

Watch for bleeding after you leave. If your access arm or leg feels warm or wet all
of a sudden, check for bleeding at the puncture sites. If your access is bleeding:

Figure 7. After dialysis, apply pressure to
the needle sites until bleeding has stopped.



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 Use gauze or a clean cloth (such as a wash cloth) to stop the bleeding
 Apply direct pressure with your fingers right to the bleeding site(s).
 Keep steady, firm pressure on the bleeding site for 20 – 30 minutes. Do not
check the site during this time. If it is still bleeding after 20 – 30 minutes,
keep steady pressure on the bleeding site for another 20 – 30 minutes. If
bleeding has not stopped, continue applying pressure and call the emergency
department.
 If you feel that you have lost too much (more than a cup) of blood, have
someone take you to the nearest clinic or emergency department.

Caring for Yourself on Dialysis Treatment Days

Wear loose clothing on your access arm or leg
 A button down shirt, short sleeves, or sleeveless top works well with an arm
access.
 Wear loose shorts, skirt, or sweat pants with a leg opening if you have a leg
graft.
 Wear pants or sweater or other warm clothing over your dialysis clothes in
cold weather.
 Clothing should be easy to wash.

Prevent and be alert to the signs of low blood pressure
 Take blood pressure medicines as ordered, but do not take blood pressure
medicine right before or after your hemodialysis treatment unless
advised to by your nurse or doctor.
 If you have weakness, dizziness or light-headedness, after a hemodialysis
treatment, sit down or lie down. Drink 1 – 2 cups of water. If symptoms do
not improve, have someone take you to the nearest emergency department.

It is normal to feel tired and washed out after dialysis. Take it easy and allow time
to rest after a treatment.





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Figure 8. Hemodialysis using a left forearm fistula or graft.



19
Special Instructions





If you have questions or concerns, contact dialysis staff by calling your local
dialysis unit or calling the paging number at your local hospital listed on the last
page of this booklet.

If there is anything that was discussed in this booklet that remains unclear to you,
please ask someone to explain it to you.

Recommended Vaccination for Hemodialysis Patients

Hepatitis B Vaccine

Since patients who receive dialysis at a center are at risk for hepatitis B, a vaccine is
recommended for all patients. It is also recommended for pre-end-stage renal
patients before they become dialysis dependent or for peritoneal and home dialysis
patients because they might require in-center hemodialysis. The vaccine is given
into a muscle in the upper arm (deltoid). Each series of hepatitis B vaccination
includes a total of 3 doses. The first dose can be given anytime. The second dose is
given one month later. The third dose is given 6 months after the first dose. Some
time after you receive the shots, you will be tested to be sure you have made
antibodies to protect you from hepatitis B. If your antibody level is low, a second
series of the vaccine will be needed for your body to respond. In this way, we will
know that you are protected from the virus.

Pneumococcal Vaccine

People with chronic kidney failure are considered immunocompromised. This
means they are at increased risk for pneumococcal disease or its complications. It is
recommended that dialysis patients receive pneumococcal vaccination. There is
special pneumococcal vaccine advice for dialysis patients. Your dialysis nurse will
discuss this with you.

Seasonal Influenza (Flu)

Annual seasonal influenza (Flu) vaccination is recommended for all people with
chronic kidney failure. They are at increased risk for the Flu.



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What Phone Numbers Do I Call If I Need Help?

To Make an Appointment with a Doctor

UW Hospital Renal Clinic - (608) 263-6808, Monday through Friday,
8:00 a.m. - 5:00 p.m.

UW Hospital Access Clinic - (608) 262-5420, Monday-Friday,
8:00 a.m. - 5:00 p.m.

To Schedule an Internal Hemodialysis Access Placement
UW Hospital Access Clinic - (608) 262-5420, Monday-Friday,
8:00 a.m. - 5:00 p.m.

External Access Placement Questions
UW Hemodialysis Inpatient/Hospital Unit - (608) 263-8748, Monday through
Saturday, 7:30 a.m. - 9:00 p.m.

Treatment Questions
UW Hemodialysis Outpatient Clinic - (608) 270-5600, Monday through
Saturday, Mon. Wed. Fri. 7:00am. - 11 pm; Tues. Thurs. Sat.7:00am-5:30pm

When I Need to Talk to a Hemodialysis Doctor or Nurse and the Clinics are Closed
UW Hospital Paging (after hours) - (608) 262-0486. Ask for the Hemodialysis
doctor or nurse on call. Give the operator your name and phone number with the
area code. The doctor or nurse will call you back.

When I need to See or Talk with a Doctor or Nurse right away.
UW Hospital Emergency Room - (263) 262-2398 (Open 24 hours daily).

Other

Your local dialysis unit: ______________________________________________

Their phone number: __________________________

Your local hospital emergency room:____________________________________