Post-dialysis care at home for the hours when patients fall, faint and bleed.

The session removes the fluid gained since the last one, and as that fluid leaves, blood pressure falls. Add the shift in blood chemistry over a few hours, the cramps, and any underlying anaemia or heart disease, and the result is the “washout” fatigue that can last into the next day. It is common, and it is still worth recording. If the weakness follows every session or gets worse, the nephrologist can look at the dry weight, the speed of fluid removal, the haemoglobin and the session length. A written note of how he was that evening and the next morning is what makes that possible.

Sit him back down at once and lie him flat if the dizziness continues. Standing after a session is done in stages: sit up for a moment, then sit on the edge of the bed for a minute, then stand with someone’s support, and go back down at the first sign of dizziness. Keep the bathroom door open and someone at it. If he faints, or the dizziness does not settle after lying down for a few minutes, call the unit or 108. Do not give extra salt or fluid to bring the pressure up unless the unit has told you to.

Sit him down, press firmly on the site with clean gauze and do not lift it to look. Keep pressing for the time the unit has told you, usually ten to fifteen minutes, then check. If it has stopped, apply a fresh dressing and leave the scab alone. If it has not stopped within the time the unit set, or the bleeding is heavy or he feels faint, call the unit and, for heavy bleeding, 108. Our fistula and catheter care page goes into the site care in more detail.

Yes, and this is the most common reason families come to us for post-dialysis care. The attendant is at the centre before the session ends, asks for a wheelchair if she is unsteady, checks that her blood pressure was acceptable before leaving, and travels beside her in the car or cab, keeping the fistula arm clear of the door and seat belt. At home they settle her, do the checks and record the readings. We plan the escort around the session slot and Bangalore traffic so she is not sitting in a jam at eight at night.

It needs a call to the unit that day. In the first few sessions, urea leaves the blood faster than the brain can adjust, and the imbalance, called dialysis disequilibrium, can cause headache, nausea, restlessness or confusion. Mild headache is common; confusion, severe headache with vomiting, or a seizure are treated as an emergency. The unit often shortens or slows the early sessions to prevent it. For the first weeks of dialysis we suggest a nurse on session days rather than an attendant, precisely because of this.

An attendant is right for a patient who comes off the machine steady and needs escorting, settling and the evening readings. A nurse is right when the patient drops their blood pressure during or after sessions, has fainted or fallen at home, bleeds from the needle sites, has a catheter, or is in the first weeks of dialysis. Ask the unit how his sessions usually go; their answer decides the level, and we will say plainly on the call which one fits.

It depends on whether you need an escort-and-settle attendant on session days, a twelve-hour dialysis-day nurse, or a live-in attendant who also holds the between-days routine, and on how many sessions a week the patient has. We quote after a free assessment that covers the dialysis schedule, how the patient comes off the machine and who is at home. Our dialysis care cost guide sets out how the levels compare.