Kidney Dialysis Clinical (Write Up)

I recently had a long day of clinicals at a kidney dialysis center.  This was my first time being thoroughly exposed to the world of kidney dialysis. I worked with a variety of nurses as well as dialysis technicians and a nephrologist or two. The first nurse I worked with showed me around the clinic, introduced me to staff and briefly informed me about the details of kidney dialysis treatments that were provided there.  It was a slightly overwhelming realization as I watched an entire room full of people—of both genders and all ages (but mostly older) sitting on reclining chairs whose bodies were hooked up to elaborate machines.

The kidney dialysis machine happened to be a bulky contraption positioned right next to the patient. Some patient’s had venous and arterial catheters inserted into different sections of their subclavian artery used for hemodialysis access. Other patients had either a graft or fistula in their arm where a vein (such as the basilic vein) and artery had been anastomosed. A catheter would be inserted into this graft or fistula to facilitate blood exchange. The catheters inserted into the patient’s body lead out into a confusing, serpentine display of flexible plastic tubing. The nurses were kind and taught me how to set up the hemodialysis machine. They observed patiently as I threaded the tubing through all the necessary facets and compartments of the machine.  This act reminded me of threading my sewing machine. There was a cylindrical container (AKA “Artificial Kidney”) that had a densely packed mesh-like fabric inside of it. The patient’s blood would flow from the bottom of this cylinder to the top.  The patient’s blood would pass through the mesh-like reticular structure inside the artificial kidney and sludge and waste products from the blood were funneled out and escorted through a tube and eventually into a draining system. I became mesmerized by this entire process.

 Never before had I considered the exquisite workings of the kidney and its incredible yet indispensable function. I became saddened and dismal, realizing that so many human beings were on kidney dialysis 3 times each week for a period of 4 hrs each appointment. This was something that rarely made it out into the media—something that fully functional human beings outside of the medical field were unaware of. It made me realize how much quality of life would be impacted, but still, they had a few days of the week that were available to do other things. However, since dialysis treatments took a good chunk of the day (3days a week) and this did not include the trip to and from the dialysis center, dialysis patients would have a difficult time managing a full time job. This also made me reflect on the importance of organ donation.  

The nurse pulled me aside and informed me about the differences between hemodialysis and peritoneal dialysis. I learned that peritoneal dialysis could be done via a home machine and could be used while the patient was sleeping (at night).  Patients using PD had a permanent tube inserted into their abdomen from which dialysis would take place. Because the peritoneum (the serous membrane that lines the abdominal cavity) is rich with capillaries and therefore blood flow, the waste products in the blood could be filtered out into this peritoneal space.  A type of solution known as “Dialysate” was used with this form or filtration. The Dialysate solution would be pumped into the peritoneal space. Next, the peritoneum and the solution would act as a filtering mechanism for the body’s blood. Waste products from the blood would be filtered out of the body along with the Dialysate solution.

At the kidney clinic I was informed that many (if not most) of the individuals who were on kidney dialysis had underlying health conditions such as diabetes and hypertension.  These chronic conditions were well known to cause damage to the vessels—in this case, the kidneys in particular. Diabetes increases the speed of blood flow into the kidney. This increase in blood flow causes the kidney glomeruli to work harder; scarring and hardening can be a result.  I learned that diabetic nephropathy is a leading cause of kidney failure in the United-States.

Other experienced professionals at this facility included dieticians and social workers. I was shocked to learn all about the dietary restrictions of those on kidney dialysis treatments. Nutrients that were monitored included the patient’s intake of: phosphorus, sodium and potassium. Also, fluid restriction was a necessity for dialysis patients. (I learned that those on dialysis usually do not urinate as their fluids and wastes are removed during each 4 hr treatment.)

Thankfully I was able to get a tiny amount of hands-on experience. I was able to flush the venous and arterial subclavian catheters of one patient and also able to administer heparin. The day was a long one with some bouts of monotony, but I definitely learned a lot about kidneys and kidney dialysis.