This information, taken from a patient booklet has been written to help you understand how our haemodialysis service operates at St. George’s Hospital and answer some frequently asked questions.
It covers a lot of basic information – please ask a member of staff if you have any further questions.

Where will you dialyse ?

St George's currently (June 2016) has five units and around three hundred and fifty patients on dialysis :

• Two units are on the St George’s site :
  • Acute/short stay unit including inpatient care, on Champneys ward
  • The dialysis trailer sited on the car park of the Courtyard Clinic, just off the western part of the perimeter road.
• Three units are off site (sometimes called satellite units) :
  • Colliers Wood
  • North Wandsworth
  • Kingston (shared with Epsom & St Helier's Trust patients)

Currently, due to a lack of suitable space on the hospital site, new patients are being transfered to Epsom & St Helier Hospital Trust.

You may also want to consider dialysis at home, if this has not already been discussed with you. Most people who dialyse at home do peritoneal dialysis but you can also do haemodialysis at home. Please ask the nurse in charge for further information.

When will you dialyse ?

You will need to have three sessions a week, for four hours either on a :

• Monday, Wednesday and Friday or on a
• Tuesday, Thursday and Saturday .

You will be offered a morning, afternoon or evening session depending on availability of spaces and which unit you go to.

At present the six units are open :

Unit	Monday, Wednesday, Friday	Tuesday, Thursday, Saturday
Acute/short stay unit on Champneys	8am-8pm Irregular dialysis start times due to nature of patients	8am-8pm Irregular dialysis start times due to nature of patients
Trailer	7am-12am    3 Sessions a day Morning, Afternoon, Evening	7am-12am    3 Sessions a day Morning, Afternoon, Evening
Colliers Wood	7am-11:30pm   3 Sessions a day Morning, Afternoon, Evening	7am-6pm    2 Sessions a day Morning, Afternoon,
North Wandsworth	7am-6pm    2 Sessions a day Morning, Afternoon	7am-1pm    1 Session a day Morning,
Kingston	7am-11pm    3 Sessions a day Morning, Afternoon, evening	7am-6pm    2 Sessions a day Morning, Afternoon,

Changing days/times

Once you have been allocated a dialysis day and time this is your allocated ‘slot’.

If you need to change your day or time please give the nurse in charge notice so this can be planned.

Preparing for dialysis

Pain relief

If you have a fistula or graft and use EMLA (or similar) cream, this should be applied. Optimum time before needling varies between patients but this seems to vary between 45 minutes and 75 minutes. If you have not been prescibed this by the doctor please discuss this with your nurse as soon as you arrive for you first session.

Weigh yourself

You should be weighed. Please remove any outdoor clothing. You can weigh with your shoes on but make sure you weigh with them on after dialysis. You may also find it helpful to wear similar clothes each time to see how your weight compares between each session.

Medication & health

You may be advised not to take certain medications before dialysis.

If you are/have been feeling unwell please let a nurse know.

Attending on time

Please attend on time. If you are delayed please let your unit know. Arriving late will have a knock on effect and in some cases may mean that your dialysis will be cut short.

If you attend before your allocated time you should not expect to start your dialysis early. Speak to the nurse in charge of your unit if you have any queries regarding your appointment time.

Unfortunately we can not guarantee your treatment will start at a specific time. We do our best to keep to schedule but delays can happen.

If you are unwell

If you feel unwell on the day of your dialysis please ring your unit before attending and the nursing team will advise you what to do.

It may be better for you to go to Accident and Emergency to be fully assessed first. If you are experiencing diarrhoea and vomiting you will need to have your dialysis in a side room.

You should not miss your dialysis session even if you do not feel like coming.

If you do not attend and do not inform us we will contact you. If we are unable to contact you we will contact your next of kin. If still unsuccessful, we will inform the police as we need to ensure that you are not in any harm.

If you are having difficulties coping with dialysis we can offer you psychological support.

If you feel unwell on a non dialysis day you should still ring your unit for advice as it may be a dialysis related problem. If your unit is closed please ring Buckland ward.

How will you dialyse ?

Patients will dialyse using a haemodialysis machine, connected to them at an access site,

There are 2 main types of access site;

• a line (sometimes called PermCath or Tesio) or
• a fistula or graft (a graft using artificial tubing to help where the veins are weakened)

Ideally you should start dialysis with a fistula or graft. If this is not the case you may have to start dialysis with a line. This is not a good long term option for most people. Looking after your fistula/graft or line is very important. For more information please click here.

During dialysis

A nurse will be allocated to look after you – it may not be the nurse who starts your dialysis.

You will be regularly checked during your treatment. You will be given a call bell if you need attention.

Many patients complain of feeling cold during dialysis. Please wear layered clothing with easy access to your fistula or line. Blankets are supplied (not in Kingston unit) but you may also want to bring your own soft blanket.

Facilities in each unit

Apart from the Norman Tanner unit you will be able to watch TV in the St George's and satellite units. We would encourage you to bring your own earphones so you can hear the programmes and not disturb your neighbours.

You can use electronic devices such as tablets, mobile phones and laptops. Internet connections (wifi) vary by location and at St George's are chargable. For more information see here.

Eating and drinking during dialysis

A sandwich is offered during dialysis with a hot drink (Kingston unit only offers biscuits and a hot drink). You can bring food with you if you wish but we are unable to heat this food.

The dietitian may prescribe supplements and a hot meal but this will only be offered if you have a nutritional need.

Some patients may be advised not to eat during dialysis as occasionally eating may make you feel unwell.

If you are diabetic please ask your diabetic team/doctor to review your medication. A dietitian should review you also.

There is a dietetic service and each unit has a named dietitian. The team will refer you to a dietitian if you score above … with monthly assessment. You can ask to be referred. You can also contact the dietitian directly (see contact numbers)

Remember to bring "phosphate chasers" with you if you have been prescribed these by your doctor.

After dialysis

You will be able to leave the unit once the nurse looking after you has discharged you.

Please ensure you have a drink with you in case you feel lightheaded travelling home. This may happen if a lot of fluid has been removed during dialysis.

If you are diabetic always make sure you have some type of sugar with you.

If you have a fistula or graft please make sure you have some spare gauze and tape with you.

Occasionally you may experience bleeding after you have left the unit. If you are concerned please ring or if necessary return to unit/A&E.

Travel to and from dialysis

Driving 

You are allowed to drive after dialysis but should not plan to drive yourself after your first session.

Free parking is provided for dialysis patients at St. George’s . You will have to complete an application form which staff will provide on request or follow the link. You will need to go to security with your ticket each time.

The three units off site (satellite units) have free parking although Kingston can be busy during the transition between afternoon and evening sessions.

Expenses

If you require financial assistance with your travel costs reimbursement can be offered for petrol or public transport fares.

You will need to complete a form each month stating how many times you have attended. Fare receipt will be required. The money will be paid directly into your bank account. If you are on benefits you can claim for your fares in advance if required.

Taxis

The trust does not reimburse taxi fares. However there is a healthcare travel cost scheme whereby you may be able to use a hospital taxi. In order to be eligible you have to meet the criteria dependent on any benefits/allowances you receive. Please ask the nurse in charge for more information.

Hospital transport

This is provided on medical grounds only and is based on a clinical assessment of your needs. There are different vehicles allocated according to your mobility. Unfortunately the hospital is unable to provide a service solely for renal patients. You may have to travel to and from the hospital with patients attending different parts of the hospital. If transport is booked for you please ensure you are ready two hours before your appointment time. If you do not require transport please ensure you ring to cancel the booking. More information can be found here.

Holidays

Patients on haemodialysis can go on holiday provided there is a dialysis unit near your chosen destination.

There is a separate information sheet regarding how to organise a holiday – please ask. Depending on where you go you may have to pay for your dialysis. You can apply for a grant through the British kidney patient association (KPA) to help with the cost of your holiday – please ask our social worker.

It is important to ensure you have travel insurance also. Please let us know where you intend to travel – some countries are high risk to go to for dialysis and we will advise you. You should be fully vaccinated against hepatitis B.

When you return from holiday abroad you will have your dialysis in a side room for up to twelve weeks. This is as a precaution in case you may have been exposed to any infectious disease. Depending on where you travel to you may be suspended from the transplant list for up to 12 weeks. You will be suspended from the list whilst you away if you can not return within 4 hours.

For more information please see the section dedicated to holidays.

How will I be looked after by the medical staff?

Each unit has a consultant who will be in charge of your care. The nursing teams will co-ordinate all your care. You will be allocated a named nurse you can contact about your care.

You will be assessed each time you come for dialysis by the nursing team on duty that session.

Generally you should have a review with your named consultant every three months. Ideally this should take place in a clinic room and not on dialysis.

Other members of the team will review you as appropriate.

If you would like to be seen by any member of the team please ask.

Your blood will be taken routinely once a month on dialysis so you will not need to attend for separate blood tests.

If you were previously being looked after by one of our kidney teams your care will be handed over to the haemodialysis team. This means your kidney consultant will probably change.

You only need to attend clinics now with your haemodialysis team and consultant. If you receive/have any appointments with your previous consultant/team please cancel or ask if unsure.

Consultant Doctors supporting each unit

Unit	Consultant
Acute/short stay unit on Buckland ward	Dr Jones
Knightsbridge	Prof Oliveira
Norman Tanner	Dr Nelson
Colliers Wood	Dr Jones
North Wandsworth	Dr Shrivastava/ Dr Asgari
Kingston	Dr Nelson

Environment

It is important to be able to provide an environment whereby staff and patients feel safe and secure.

The trust operates a violence and aggression policy which is strictly adhered to. Inappropriate patient behaviour will be dealt with as per policy.

 

Useful contact numbers

For hospital or unit numbers check here.

For Transport 0208 725 2120/2121

If you want to bleep please call main switchboard 0208 672 1255

For key staff details see here

You can also email certain staff – please ask for address.

 

Useful websites

 

Kidney Patient Association websites

http://www.sgkpa.org.uk – St George’s Kidney Patient Association own website

http://britishkidney.pa.co.uk – British Kidney Patient association

 

St George's Hospital Renal Services
http://www.stgeorges.nhs.uk/services_renalindex.asp - St George's own website

UK National Kidney Federation
http://www.kidney.org.uk/ - leading UK renal charity

UK Transplant
http://www.organdonation.nhs.uk/ - the national transplant organisation's website

Kidney Research UK
http://www.kidneyresearchuk.org/   the leading UK charity funding research that focuses on the prevention, treatment and management of kidney disease

Holiday Haemodialysis information

http://dialysisfreedom.co.uk

http://globaldialysis.com

Patient Decision Aid

http://sdm.rightcare.nhs.uk – specially designed information to help you choose the treatment option best for you