A haemodialysis session is three to four hours in the chair, three times a week. The part families get wrong is rarely the session itself, which the unit runs. It is the two hours before leaving the house and the four hours after coming home, when the patient is most likely to be turned away for a missed reading, to cramp on the way home, or to bleed on the sofa at nine at night. This checklist is written for the person who does the escorting, whether that is a son taking leave, a spouse, or an attendant.
Before leaving the house
Weigh the patient first thing, after the toilet and before breakfast, on the same scale as always, and write it down. The unit sets the amount of fluid to remove from the gap between this number and the dry weight, so a weight taken after a glass of water and a plate of idli is a wrong instruction to the machine. Take blood pressure sitting and then standing and write both down next to the weight.
Check the medicine list against what the unit has said. Some blood pressure tablets are held on dialysis mornings because they add to the pressure drop during the session; others are taken as usual. If nobody has told you which is which, ask the unit at this session and write the answer on the medicine chart, because it does not change from week to week.
Give a light breakfast unless the unit has said otherwise. A heavy meal before the session makes nausea and the pressure drop worse; an empty stomach in a diabetic patient invites a low sugar in the chair. Keep the day's fluid allowance in mind even on dialysis mornings.
Wash the fistula arm with soap and water before leaving and keep it uncovered by tight sleeves or a watch. This is the cheapest protection there is against a needle-site infection. If the patient has a catheter, check the dressing is dry and intact; a wet or lifting dressing is reported to the unit on arrival, not patched at home.
Pack the bag: the medicine list, the last blood report, the fluid and weight log the unit reads, a light blanket because dialysis rooms are cold, a snack for after if the unit allows one, and a charged phone. Add reading glasses and hearing aids for an older patient, because a session is long and the technician needs to be understood.
Leave early. Bangalore traffic and a fixed slot do not negotiate, and a unit running three shifts a day will not hold a chair for a patient stuck on the Outer Ring Road. Plan the trip so the patient arrives with time to sit and settle rather than walking in flustered with a raised pressure.
During the session
Hand over the log and the readings to the technician and tell them, unprompted, how the last session went and how the days since have been: cramps during or after, any bleeding at home, doses missed, fever, breathlessness lying flat, a fall. The technician adjusts the session on this information and cannot act on what nobody mentioned.
Remind anyone new to the patient that the fistula arm is not used for a blood pressure cuff, a blood draw or a drip. Most units know this well; a locum, a visiting phlebotomist or a nervous trainee may not, and a cuff inflated on that arm can clot the fistula. The fistula and catheter care page covers the arm rules in full.
In the waiting area, stay reachable. Units call escorts when a patient's pressure drops or the session is cut short, and a phone left in a bag on silent means the patient sits alone. Use the hours for the pharmacy run and the next session's booking rather than leaving the premises for a meeting across town.
After the needles come out
The unit presses each needle site for about ten to fifteen minutes before dressing it. If the patient is asked to hold the gauze themselves, make sure they press without lifting to look; peeking is why sites bleed again in the car.
Standing up is done in stages. Sit up in the chair for a minute, then stand with support, then wait before walking. Blood pressure is at its lowest right now, and the first steps to the door are where patients faint. Ask for a wheelchair to the vehicle if the patient is dizzy or older, and do not treat it as a defeat.
The patient does not drive, and does not go home alone in an auto. Sit beside them, keep the fistula arm away from the door and the seat belt, and have a small snack ready for a diabetic patient if the unit allows it. A forty-minute trip in traffic with a low pressure and two fresh sites is the most vulnerable hour of the week, which is why families lose three afternoons a week to it.
At home, straight to bed or a reclining chair. A light meal after a rest, no heavy housework, no lifting with the fistula arm, no bath over the dressing. The bathroom is the place people fall, so the escort stays at the door for that first visit and the patient uses a stool if showering. Cramps in the calves are eased with gentle stretching and warmth, and noted for the next session if they follow every dialysis.
The evening and bedtime
Take weight and blood pressure again in the evening and write them next to the morning numbers. This pair, along with the next morning's readings, is what the nephrologist uses to judge whether the dry weight is right. When nobody records them, the unit is adjusting blind.
Before bed, look at the dressings. Dry and intact means leave them on for the hours the unit has set. Blood soaking through means sit the patient down, press with clean gauze for the full time, and call the unit if it does not stop. Never pick a scab, tonight or tomorrow.
Feel the thrill. Two or three fingertips over the fistula should find a continuous buzz. A fistula that clots often does so on the night of a low-pressure session, and a lost thrill is a call to the unit that night, not a note for Monday.
The red flags for the evening
Call the unit, or 108 for an ambulance, for any of these: bleeding from a needle site that continues past the time the unit has set despite firm pressure; fainting, or dizziness that does not settle after lying flat; chest pain or a fast, slow or irregular pulse; fever or shaking chills, especially in a patient with a catheter; confusion, restlessness or unusual drowsiness, which in someone new to dialysis can be disequilibrium; and no thrill over the fistula. The unit would rather hear about an oozing site at nine at night than meet the patient in the emergency department at midnight.
The next morning
Weigh and take blood pressure before breakfast, then restart the fluid discipline. The morning after dialysis is when patients feel freed from the limit and drink the most, and the gain from that morning is what the next session has to remove. Remove the dressings as instructed, look at the sites for redness or oozing, and feel the thrill once more. The kidney and dialysis care page covers the between-days routine of fluid, diet and readings.
When an attendant or a nurse is worth it
A patient who comes off the machine steady mainly needs a reliable escort and someone in the house for the first hours. That is attendant work, and a trained attendant on a twelve-hour shift is listed at ₹800 to ₹1,200 in the EzyHelpers home nursing cost guide for September 2026, with placements taking three to seven days to arrange.
A patient who drops their pressure every session, who has fainted or fallen at home, who bleeds from the sites, who has a catheter, or who is in the first weeks of dialysis needs a nurse on session days. A nurse twelve-hour shift is ₹1,200 to ₹1,800 in the same guide and is booked with 48 hours' notice around the dialysis schedule. The post-dialysis care page describes the settle-in work in detail, and the nurse for a dialysis patient page covers what a nurse does that an escort cannot.
Ask the unit how the patient usually comes off the machine. Their answer, more than the patient's age, tells you which of the two you need. EzyHelpers assesses free and places either, around the session days that actually need cover; the dialysis care cost guide sets out how the two levels compare.