WEBVTT FILE

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If you have chronic
kidney disease and are getting

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hemodialysis, you may have a
fistula, probably in your arm,

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where you are connected to the
dialysis machine that cleans

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your blood. It's important to
understand how your healthcare

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team will access your fistula
each time you go to the clinic

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for dialysis. Before the
dialysis begins, you'll weigh

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yourself to determine how much
fluid needs to be removed during

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dialysis. Then you'll wash your
fistula, a very important part

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of the process. “We are required
to wash our fistula areas with

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soap and water before we get
put on, obviously to help with

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preventing any type of
infection.” Then your nurse or

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technician will check your
vitals... “They will have their

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blood pressure taken standing if
they're able to stand. Then when

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they sit in the chair they'll
have their blood pressure taken

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while they're sitting. They'll
have the temperature taken and

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they'll report their weight to
you.” Because your fistula is a

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direct access to your blood,
guarding against infection is

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critical. That's why your
dialysis tech will wear

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protective clothing as well
as gloves at all times. “Your

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technician is in a white
gown sometimes they're white,

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sometimes they're yellow. That
is to protect them from your

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body fluids and to protect you
from anything that our personnel

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might have. They will wear
either a shield or goggles.” You

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should expect your tech to
pay special attention to your

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fistula...how it sounds and how
it feels... “We listen to the
the

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access with the stethoscope to
make sure that, you know, it has

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a normal sound. It's not a very
faint sound; that there's no

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blockage or anything like that”"
“By assessing the thrill and

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bruie, or noise, and by looking
at the behavior of the fistula

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or graft while the patient's on
dialysis, you can get a handle

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on how it's flowing.” “Sometimes
you have arm accesses that are

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considered clotted. So we have
to send them to the E.R. to get

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them de-clotted.” Other things
the dialysis center staff will

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watch for is any sign of
infection around the fistula,

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such as redness, warmth,
pus, any skin irritation or

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temperature. After your general
health and fistula are checked,

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it's time to be connected to
the machine. This is done with

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cannulation, 2 needles that are
placed into your fistula...
“They

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understand that it's their
lifeline. And with the right

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technique and the skill level
that we see in most dialysis

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units patients can be
cannulated, or needled,

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repeatedly without too much
stress or suffering.” After 3 to

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4 hours, when dialysis is
complete, your blood pressure

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will be taken again. “You still
want to make sure that they're

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in a safe range when they come
in and when they leave.” “And

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that's just so that we know
post treatment-wise once they

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finished with their sitting,
if they stand up we can monitor

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them so they're not going to
fall over or pass out.” Before

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you are taken off the dialysis
machine, a pressure dressing is

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applied to your fistula to
prevent bleeding. Then you're

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free to go about your life
until your next session. “It's a

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lifestyle change definitely. But
once you become accustomed to it

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it's like everyday business you
don't even think twice about.”

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If you have any questions about
your fistula or how it will be

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accessed during dialysis, talk
to your healthcare provider.