Pediatric Hemodialysis

Pediatric Hemodialysis

Dialysis is used when the kidneys stop working. Kidney failure may be temporary or last forever. Kidney failure is also known as end-stage renal disease, or ESRD for short. ESRD is diagnosed when there is permanent loss of 90% of total kidney function.

What is Pediatric Hemodialysis?

Pediatric hemodialysis is a machine that is used to clean the blood outside of the body.

How does Pediatric Hemodialysis work?

  1. A dialysis machine uses a pump to remove blood from your child’s vascular access (central line, graft or fistula).
  2. As the blood goes through the tubing outside the body, it is cleaned by a fluid called dialysate (di-al-y-sate). The dialysate fluid removes the waste and fluid from the blood. Your child’s doctor orders the dialysate based on your child’s needs.
  3. Once the blood is cleaned, the clean blood returns back to your child through their vascular access.

Each hemodialysis treatment lasts about four hours. They are done three or more times a week. The doctor will give you a prescription that tells you how much treatment your child needs to keep them healthy.

How does Pediatric Hemodialysis machine help keep my child safe?

The dialysis machine has special monitors that tell the nurse:

  • Your child’s blood pressure during dialysis
  • How fast the blood moves through the machine
    • Your child’s doctor orders the flow rate that is best for your child
  • If there are air bubbles
    • It is important to keep air out of your child’s blood

What blood test are checked before/after Pediatric Hemodialysis?

Your child’s dialysis care team may measure:

  • Urea reduction ratio (URR) - URR should be at least 65%
  • Kt/V (kay-tee-over-vee) - Kt/V should be at least 1.2

Other lab tests that we check often are:

  • Blood urea nitrogen (BUN) and creatinine – To measure the amount of waste
  • Sodium (Na) and potassium (K) – To measure chemical amounts in the body
  • Hemoglobin and hematocrit (H&H) – To measure red blood cell counts

Other important things we watch closely:

  • Weight and blood pressure before and after dialysis

How much blood is outside my child’s body during Pediatric Hemodialysis?

The machine type is based on your child’s size. For older children, no more than 2 cups (1 pint or 16 ounces) of blood are outside your child’s body. For smaller children, the amount of blood outside the body is even less.

How do we know that Pediatric Hemodialysis is working?

The dialysis care team tests your child’s blood levels often. The blood test results show how dialysis is removing the waste and fluids. This tells us if your child is getting the right amount of dialysis. Blood tests may be drawn each week, each month and each year depending on your child’s needs.

Pediatric Hemodialysis Doctors and Providers

Frequently Asked Questions

  • When should I call the hemodialysis team?

    Call your child’s hemodialysis team if you find any of the problems below with your child’s catheter:

    • The skin around the catheter looks red or swollen
    • Your child complains of pain around the catheter site
    • There is blood or drainage coming from the catheter site
    • The dressing has peeled up along the edges and is letting air get into the dressing
    • The catheter is pulled out or broken
    • The cap has come off
    • If your child has a fever of 100.5°F (38°C) or greater, or chills
  • What should I do in a catheter emergency?

    Accidents can happen. We want you to be ready. When you are traveling or at home with your child, you should always have an emergency bag of equipment with you. Your bag should always be ready to use. Below has a list of possible problems and what to do in case they happen.

    Fever, chills, tenderness, redness or pus at hemodialysis catheter site

    • Possible cause: Infection
    • What to do: Check your child temperature and call the hemodialysis team right away

    Fluid leaking form the hemodialysis catheter

    • Possible cause: Injection cap not screwed on securely or a hold in the hemodialysis catheter
    • What to do: Tighten the injection cap. If you see a leak in the line, clamp it (or fold it over and pinch it) between the damaged area and the skin. Call your hemodialysis team or go to the emergency room right away

    Skin redness where the dressing was

    • Possible cause: Sensitivity to the dressing
    • What to do: The nurse may need to change the type of dressing or tape used

    Part of the hemodialysis catheter comes out

    • Possible cause: The hemodialysis catheter was not secured under the dressing or it was tugged or pulled on
    • What to do:
      • Do no push the catheter back in or pull on the catheter.
      • Secure with tape and go to the emergency room right away

    Hemodialysis catheter comes completely out

    • Possible cause: The hemodialysis catheter was not secured under the dressing, or it was tugged or pulled on
    • What to do:
      • Place a sterile gauze pad on the site and press firmly until the bleeding has stopped (2-5 minutes).
      • After the bleeding has stopped, apply a bandage snugly.
      • Save the hemodialysis catheter can call your hemodialysis doctor, or go to the emergency room.
  • How can I help in my child's care?

    As a dialysis patient, your child is at risk for infections. In the hospital and at home, cleanliness is a key factor in lowering chances of infection.

    1. Make sure everyone has clean hands - Clean hands are the best way to keep your child from getting an infection.
      • Everyone must wash hands with soap and water or use hand sanitizer.
      • Doctors and nurses must clean hands and put on gloves before touching your child’s hemodialysis catheter.
      • Remind family, guests and your child’s doctors and nurses if you notice they didn’t clean their hands.
    2. Help us with daily care - Daily care is important to keep infection away from your child’s hemodialysis catheter.
      • Tell/call your child’s nurse right away if your child’s:
        • Line is leaking or comes out (do not reconnect)
        • Hemodialysis catheter cover or dressing is loose, wet or looks dirty
        • Hemodialysis catheter tubing or dressing gets body fluids like stool, vomit or mucus on it- Hemodialysis catheter looks red or hurts
      • Help give your child a bath each day and change their clothing
        • Make sure the dressing and the catheter do not get wet.
      • Remind our staff to always “Scrub the Hub” – Cleaning the hemodialysis catheter caps before use with alcohol for 15 seconds and letting it dry for 15 seconds helps kill the germs.
      • Make sure everyone, even your child, wears a mask when the hemodialysis catheter caps or dressing is changed.
    3. Please speak up
      • We want you to be our partner and help keep your child safe.

    You can also help by learning:

    • When your child should get the hemodialysis catheter caps or dressing changed next
    • About extra cap covers that protect and keep the central line caps clean
  • How does my child bathe?

    Your child may take baths or showers, but you must cover all of the catheter dressing and connections.

    Ask your child’s nurse to go over any special instructions with you about bathing. It is important to NOT get the catheter dressing or connections wet.

    • During a shower, keep your child’s back to the water to keep the central line and tubing from getting wet.
    • Take short showers to keep steam from getting into the dressing.
    • During a bath, do NOT let the central line or tubing go under the water.
    • Do NOT swim with the central line.

    To cover the catheter dressing and connections:

    1. Place the connections in a plastic bag and seal the bag around the connections or cover them with a protective plastic covering and tape.
    2. Then cover the connections and catheter dressing with a plastic covering like AquaGuard® or Press ‘N Seal®.

    If the catheter dressing gets wet or loose, the dressing should be changed right away. Call the hemodialysis nurse for a plan to get the dressing changed.

  • What are other helpful catheter tips?

    Look at the catheter and dressing many times a day: morning, afternoon, night and when concerned.

    • Check that the catheter is still in place. Check that there is no redness, swelling, bleeding or drainage under the dressing
    • Check that the dressing is sealed completely and not peeling up. If the dressing is peeling up a small amount, you may use tape on the edges to keep the dressing on
    • Check that the clamp on the line is closed
    • Check that the caps are on tight

    Hemodialysis catheter care will be done in the hemodialysis clinic. Care includes:

    • Catheter dressing changes once every seven days and as needed
    • Cap changes before and after hemodialysis
    • Use of medicines called heparin and tissue plasminogen activator (TPA) to keep the catheter from clotting

    You should have emergency supplies everywhere your child goes. Supplies you should have:

    • Clear dressing or tape in case reinforcement is needed
    • Alcohol wipes
    • Sterile gauze and tape
    • Plastic clamps in case of accidental line break

    Ways to keep your child’s catheter safe:

    • Do not let your child do activities that could bend or pull the catheter out (contact sports, rough play).
    • Do not use pins or scissors near the hemodialysis catheter.
    • Do not scratch or pull at hemodialysis catheter dressing.
    • Do not put anything in the hemodialysis catheter.
  • What should I know about fluids and dialysis?

    One of the jobs of normal kidneys is to remove extra fluid from the body. When the kidneys fail, dialysis can help remove some of the fluid. Kidney failure patients need to eat a low-salt diet and drink less fluid because their kidneys have trouble removing salt and fluid.

    What counts as a fluid?

    Anything you drink is a fluid. This includes water, juice, soda, milk, etc. Some foods count as fluids too, including foods that melt like popsicles or ice cream, and watery foods like watermelon, soups and thin stews.

    If your child comes to dialysis with too much fluid, the child may feel bad during the dialysis treatment. They may:

    • Feel dizzy or faint
    • Have muscle cramps
    • Have headaches
    • Experience nausea
    • Pass out during treatment

    Over time, too much fluid can harm your child’s body. Too much fluid can cause:

    • A type of heart failure
    • Your child’s feet or legs to swell up with fluid- This is called edema (e-DEE-ma)
    • Your child to feel short of breath if extra fluid goes to the lungs

    Signs and symptoms of having too much fluid in your child’s body:

    • Trouble breathing
    • High or low blood pressure
    • Swelling from fluid in the tissue and/or puffiness, commonly in hands, feet, face and ankles
    • Lower percent of red blood cells, or hematocrit (HCT), than usual
    • Low energy
    • Heart problems

    How much fluid can your child have?

    The amount of fluid depends on how much pee your child makes. Talk to your hemodialysis care team about how much salt and fluid your child can have. Measuring fluids for a while will help your child get used to the limit.

    How can I help my child with thirst?

    Follow these tips for helping your child when they are thirsty:

    • Limit sodium (salt). See tips on next page.
    • Ask the dialysis team how much fluid your child can drink each day.
      • To feel their best, you need to limit their fluids so that they gain no more than 2-4 pounds (1-2 kilograms) between treatments.
    • Choose the right fluids for them to drink:
      • Sugar-free, caffeine-free drinks like diet 7UP, ginger ale, lemonade or caffeine-free tea.
    • Have your child chew sugarless gum, sugar-free hard candy and especially sour candy, if they are old enough and able to.
    • In hot weather:
      • Use a mist bottle with a fan to cool your child down.
      • Giving a spoonful of chilled applesauce may help.
      • Give a frozen piece of your child’s favorite fruit (ask dietitian for a list of low-potassium fruits).
      • Stay out of the sun, and stick to shady areas if you can.
      • In hot weather, wear lightweight clothing.
      • Give crushed ice if your child is old enough and able to eat it.
      • Quench their thirst with lemon wedges.

    Measure and record the amount of salt and fluid your child eats and drinks each day.

  • How can I help my child limit sodium (salt)?

    Children on hemodialysis should get between 2,000 to 3,000 milligrams (mg) of sodium per day.

    Our body needs minerals to be healthy. When the kidneys fail, some minerals build up in the blood. Your child should eat less:

    • Sodium (salt)
    • Phosphorus
    • Potassium

    Six tips for lowering sodium:

    1. Do not add salt to foods.
      • Take the salt shaker off the table. The most common form of sodium is sodium chloride (table salt).
      • One teaspoon of table salt contains 2,300 mg of sodium.
    2. Do not eat foods where you can see salt on top. Avoid these foods or look for lower sodium versions:
      • Pretzels, potato chips, nuts, crackers
    3. Use other seasonings instead of salt when cooking foods. There are many herbs and spices that can make food taste great. Try adding these seasonings instead of salt. (Do not use salt substitute.)
      • Herbs (basil, thyme, oregano, parsley, etc.)
      • Spices (black pepper, anise, cumin, sage, etc.)
      • Garlic, onions or peppers
      • Lemon or lime juice
    4. Prepare foods at home so you can control the amount of sodium.
      • Eat fresh and frozen foods instead of canned, processed or pickled foods.
      • If using canned foods, rinse under water to remove some of the sodium.
      • Select no-sodium or low-sodium foods when available.
      • Do not cook with mixes or instant products that already have sodium.
    5. Choose carefully when eating away from home.
      • Check on sodium content before ordering.
      • Order foods that are baked, broiled or grilled.
      • Remove any skin from meats.
      • Choose fresh vegetables.
      • Watch out for salad dressing. This can be very high in sodium.
    6. Learn to read the food label.
      • Some foods may have a lot of sodium, even if they do not taste salty.
  • How do I read food labels?

    The food label will help you know how much sodium food contains. The food label is also called Nutrition Facts.

    Look at the serving size

    • Are you eating the same amount that is on the label? If you eat double the serving listed, you have to double the sodium value.

    Look at the milligrams (mg) of sodium

    • Try to eat foods with less than 140 mg of sodium per serving.

    Label lingo

    You may see words on the label that can help you choose lower-sodium foods. Always read the Nutrition Facts to see exactly how much sodium is in the food.

    • Sodium-free or salt-free - Less than 5 mg sodium per serving
    • Very low sodium - 35 mg or less of sodium per serving
    • Low sodium - 140 mg or less of sodium per serving
    • Reduced or less sodium - At least 25% less sodium than the regular version
    • Light in sodium - 50% less sodium than the regular version
    • Unsalted or no salt added - No salt added to the product during processing (it does not mean it is a sodium-free food)

    Fresh foods

    Some fresh foods do not have a food label. They are usually low in sodium.

    • Vegetables (fresh or frozen, ½ cup): 1 - 70 mg
    • Fruit (fresh or frozen, ½ cup): 0 – 5 mg
    • Meats (fresh meat, fish or poultry, 3 oz): 30 – 90 mg
    • Beans (dried beans, ½ cup prepared): 0 – 5 mg
  • How can I help my child limit phosphorus?

    Phosphorus is found in your bones. Having high phosphorus in your blood will pull calcium out of your bones, making them weak and break easily. The calcium then deposits in the heart, blood vessels and lungs, causing them to harden. Children on hemodialysis should eat less phosphorus.

    Try to eat less of these foods:

    • Dairy
    • Dried beans and peas
    • Whole grains
    • Nuts, seeds, and peanut butter
    • Chocolate
    • Molasses
    • Dark-colored sodas (Dr. Pepper®, Coke®, Pepsi®) - root beer is ok
  • How can I help my child limit potassium?

    Potassium is found naturally in most foods. Foods with the most potassium are fruits, vegetables, meats and milk. We measure the potassium we eat in milligrams (mg). Try to eat foods with less than 200 mg of potassium per serving.

Resources

Your Child’s Hemodialysis Journey: Printable version