Starting hemodialysis is often a frightening experience. Hemodialysis machines are complicated and dialysis sessions often are punctuated by alarms. At the beginning of dialysis and at the end of dialysis a lot of things happen. Not knowing what it is can be anxiety provoking. The following step-by-step description of hemodialysis will hopefully clarify some things for people starting dialysis and allow others to gain a better understanding of what dialysis entails.
Pre-dialysis
#Before or around the time the patient arrives for his/her scheduled session, a dialysis machine will be prepared. There are many models of dialysis machines, but typically in modern machines there will be a computer, CRT, a pump, and facility for disposable tubing and filters. The filters (the actual artificial kidneys) are cylindrical, clear plastic outside with the filter material visible inside (looks like thick paper). They are perhaps 15-18 inches long, and 2-3 inches thick. They have tubing connectors at both ends. The technician or nurse will set up plumbing on the machine in a moderately complex pattern that has been worked out to move blood through the filter, allow for saline drip (or not), allow for various other medications/chemicals to be administered. How the plumbing is set up may vary between models of machine and the types of filters. For some filters, it is necessary to clear sterilizing fluid from the filter before connecting the patient. This is done by altering the plumbing to push saline through the filter, and carefully checked with a type of litmus test.
# The pump does not directly contact the blood or fluid in the plumbing — it works by applying pressure to the tubing, then moving that pressure point around. Think of a disk with a protrusion in it. Put this into a close fitting 270 degree enclosure. Put plastic tubing between the enclosure and the disk, entering and exiting in the 90 open degrees. Now imagine the disk turning. It will put pressure on the tubing, and the pressure point will roll around through the 270 degrees, forcing the fluid to move (see also Peristaltic pump). It is characteristic of dialysis machines that most of the blood out of the patients body at any given time is visible. This facilitates troubleshooting, particularly detection of clotting.
#The patient arrives and is carefully weighed. Standing and sitting blood pressures are taken. Temperature is taken.
#Access is set up. For patients with a fistula (a surgical modification to an arm or leg vein to make it more robust, and therefore usable for high capacity blood movement required by dialysis) this means inserting two large gauge needles into the fistula. This is painful for the patient but there are various methods of numbing the entry sites before the needles are inserted — the two most common are lignocaine (lidocaine), a local anaesthetic injected under the skin, and there is also a cream called EMLA which is applied to the skin 45 minutes before the needles are inserted. Fistulas are widely considered the desirable way to get access for hemodialysis, but they take time to set up and mature (anywhere between 5 weeks to 15 weeks). For other patients, access may be via a catheter installed to connect to large veins in the chest. Other arrangements can be made as well.
#When access has been set up, the patient is then connected to the preconfigured plumbing, creating a complete loop through the pump and filter.
Dialysis
#The pump and a timer are started. Hemodialysis is underway.
#Periodically (every half-hour, nominally) blood pressure is taken. As a practical matter, fluid is also removed during dialysis. Most dialysis patients are on moderate to severe fluid restrictive diets (in addition to other dietary restrictions), since kidney failure usually includes an inability to properly regulate fluid levels in the body. A session of hemodialysis may typically remove 2-5 kilograms (5-10 pounds) of fluid from the patient. The amount of fluid to be removed is set by the dialysis nurse according to the patient's "estimated dry weight." This is a weight that the care staff believes represents what the patient should weigh without fluid built up because of kidney failure. Removing this much fluid can cause or exacerbate low blood pressure. Monitoring is intended to detect this before it becomes too severe. Low blood pressure can cause cramping or loss of consciousness. Often this is temporary and passes after the head is placed down (Trendelenburg position) for a short time.
Post-dialysis
#At the end of the prescribed time, the patient is disconnected from the plumbing - blood lines (which is removed and discarded, except perhaps for the filter, which may be sterilized and reused for the same patient at a later date). Needle wounds (in case of fistula) are bandaged with gauze, held for 10 to 15 minutes with direct pressure to stop bleeding, and then taped in place. The process is similar to getting blood drawn, only it is lengthier, and more fluid or blood is lost.
#Temperature, standing and sitting blood pressure, and weight are all measured again. Temperature changes may indicate infection. BP discussed above. Weighing is to confirm the removal of the desired amount of fluid.
#Care staff verifies that the patient is in condition suitable for leaving. The patient must be able to stand (if previously able), maintain a reasonable blood pressure, and be coherent (if normally coherent). Different rules apply for in-patient treatment.
Post-dialysis washout
Following hemodialysis, patients may experience a syndrome called "washout". The patient feels weak, tremulous, and may suffer extreme fatigue. Patients report they "are too tired, too weak to converse, hold a book or even a newspaper." It may also vary in intensity ranging from whole body aching, stiffness in joints and other flu-like symptoms including headaches, nausea and loss of appetite. The syndrome may begin toward the end of treatment or minutes following the treatment. It may last 30 minutes or 12-14 hours in a dissipating form. Patients though exhausted have difficulty falling asleep. Eating a light meal, rest and quiet help the patient cope with washout until it has 'worn away.'
Pre-dialysis
#Before or around the time the patient arrives for his/her scheduled session, a dialysis machine will be prepared. There are many models of dialysis machines, but typically in modern machines there will be a computer, CRT, a pump, and facility for disposable tubing and filters. The filters (the actual artificial kidneys) are cylindrical, clear plastic outside with the filter material visible inside (looks like thick paper). They are perhaps 15-18 inches long, and 2-3 inches thick. They have tubing connectors at both ends. The technician or nurse will set up plumbing on the machine in a moderately complex pattern that has been worked out to move blood through the filter, allow for saline drip (or not), allow for various other medications/chemicals to be administered. How the plumbing is set up may vary between models of machine and the types of filters. For some filters, it is necessary to clear sterilizing fluid from the filter before connecting the patient. This is done by altering the plumbing to push saline through the filter, and carefully checked with a type of litmus test.
# The pump does not directly contact the blood or fluid in the plumbing — it works by applying pressure to the tubing, then moving that pressure point around. Think of a disk with a protrusion in it. Put this into a close fitting 270 degree enclosure. Put plastic tubing between the enclosure and the disk, entering and exiting in the 90 open degrees. Now imagine the disk turning. It will put pressure on the tubing, and the pressure point will roll around through the 270 degrees, forcing the fluid to move (see also Peristaltic pump). It is characteristic of dialysis machines that most of the blood out of the patients body at any given time is visible. This facilitates troubleshooting, particularly detection of clotting.
#The patient arrives and is carefully weighed. Standing and sitting blood pressures are taken. Temperature is taken.
#Access is set up. For patients with a fistula (a surgical modification to an arm or leg vein to make it more robust, and therefore usable for high capacity blood movement required by dialysis) this means inserting two large gauge needles into the fistula. This is painful for the patient but there are various methods of numbing the entry sites before the needles are inserted — the two most common are lignocaine (lidocaine), a local anaesthetic injected under the skin, and there is also a cream called EMLA which is applied to the skin 45 minutes before the needles are inserted. Fistulas are widely considered the desirable way to get access for hemodialysis, but they take time to set up and mature (anywhere between 5 weeks to 15 weeks). For other patients, access may be via a catheter installed to connect to large veins in the chest. Other arrangements can be made as well.
#When access has been set up, the patient is then connected to the preconfigured plumbing, creating a complete loop through the pump and filter.
Dialysis
#The pump and a timer are started. Hemodialysis is underway.
#Periodically (every half-hour, nominally) blood pressure is taken. As a practical matter, fluid is also removed during dialysis. Most dialysis patients are on moderate to severe fluid restrictive diets (in addition to other dietary restrictions), since kidney failure usually includes an inability to properly regulate fluid levels in the body. A session of hemodialysis may typically remove 2-5 kilograms (5-10 pounds) of fluid from the patient. The amount of fluid to be removed is set by the dialysis nurse according to the patient's "estimated dry weight." This is a weight that the care staff believes represents what the patient should weigh without fluid built up because of kidney failure. Removing this much fluid can cause or exacerbate low blood pressure. Monitoring is intended to detect this before it becomes too severe. Low blood pressure can cause cramping or loss of consciousness. Often this is temporary and passes after the head is placed down (Trendelenburg position) for a short time.
Post-dialysis
#At the end of the prescribed time, the patient is disconnected from the plumbing - blood lines (which is removed and discarded, except perhaps for the filter, which may be sterilized and reused for the same patient at a later date). Needle wounds (in case of fistula) are bandaged with gauze, held for 10 to 15 minutes with direct pressure to stop bleeding, and then taped in place. The process is similar to getting blood drawn, only it is lengthier, and more fluid or blood is lost.
#Temperature, standing and sitting blood pressure, and weight are all measured again. Temperature changes may indicate infection. BP discussed above. Weighing is to confirm the removal of the desired amount of fluid.
#Care staff verifies that the patient is in condition suitable for leaving. The patient must be able to stand (if previously able), maintain a reasonable blood pressure, and be coherent (if normally coherent). Different rules apply for in-patient treatment.
Post-dialysis washout
Following hemodialysis, patients may experience a syndrome called "washout". The patient feels weak, tremulous, and may suffer extreme fatigue. Patients report they "are too tired, too weak to converse, hold a book or even a newspaper." It may also vary in intensity ranging from whole body aching, stiffness in joints and other flu-like symptoms including headaches, nausea and loss of appetite. The syndrome may begin toward the end of treatment or minutes following the treatment. It may last 30 minutes or 12-14 hours in a dissipating form. Patients though exhausted have difficulty falling asleep. Eating a light meal, rest and quiet help the patient cope with washout until it has 'worn away.'
Mark Smith (born 1971) is a London-based writer, consultant and contributing editor at European Spa Magazine. He is considered one of the few male health spa writers in the world.
Early years
Smith was born in 1971 in Tasmania, Australia. He studied law and graduated from the University of Tasmania.
Professional life
Smith is an expert on spas and male grooming and writes about those subjects for several national publications, including The Guardian, the Daily Telegraph, Tatler, European Spa Magazine, Spa Secrets and Men’s Fitness. He is a judge in the AsiaSpa Awards. He also works as a media consultant for beauty brands, offering marketing, public relations and social media support. His spa reviews typically describe the setting, amenities services and architecture of a facility. His review of the Chedi Andermatt spa in the Swiss Alps described the spa location as a "idyllic mountain setting for a luxurious and memorable wellbeing escape. The five-star property is a member of The Leading Hotels of the World and features a truly distinct look designed by architect Jean-Michel Gathy."
Changing Trends
Smith has said more men are visiting spas because there is less of a stigma associated with men receiving grooming and beauty treatments. Smith added that the metrosexual trend that began in the 1990s has fueled male interest in spas. “There’s an increasing emphasis on appearance in today’s fast-paced world. Career aspirations and peer pressure force men to seek out treatments to help them look good. And then there is peer pressure from the media … that have men aiming to emulate the images they see on screen.” Smith says one of the biggest spa trends is the growth of male barbering services and anti-aging facials for men during the 2010s. “Once men have been to a spa with their wife or girlfriend, they become hooked. They realize it’s not a pink pampering beauty parlor and that spas offer high-quality, problem-solving therapies that are good for health and wellness.”
Smith is considered one of the top spa experts in the United Kingdom, receiving praise from national and international publications. During an interview with The Guardian about current trends in male grooming, Smith said there is a competitive aspect among males nowadays that make spa treatments and male grooming more socially acceptable.
Other Accolades
Smith is a member of the Chartered Institute of Public Relations and Cosmetic Executive Women.
Early years
Smith was born in 1971 in Tasmania, Australia. He studied law and graduated from the University of Tasmania.
Professional life
Smith is an expert on spas and male grooming and writes about those subjects for several national publications, including The Guardian, the Daily Telegraph, Tatler, European Spa Magazine, Spa Secrets and Men’s Fitness. He is a judge in the AsiaSpa Awards. He also works as a media consultant for beauty brands, offering marketing, public relations and social media support. His spa reviews typically describe the setting, amenities services and architecture of a facility. His review of the Chedi Andermatt spa in the Swiss Alps described the spa location as a "idyllic mountain setting for a luxurious and memorable wellbeing escape. The five-star property is a member of The Leading Hotels of the World and features a truly distinct look designed by architect Jean-Michel Gathy."
Changing Trends
Smith has said more men are visiting spas because there is less of a stigma associated with men receiving grooming and beauty treatments. Smith added that the metrosexual trend that began in the 1990s has fueled male interest in spas. “There’s an increasing emphasis on appearance in today’s fast-paced world. Career aspirations and peer pressure force men to seek out treatments to help them look good. And then there is peer pressure from the media … that have men aiming to emulate the images they see on screen.” Smith says one of the biggest spa trends is the growth of male barbering services and anti-aging facials for men during the 2010s. “Once men have been to a spa with their wife or girlfriend, they become hooked. They realize it’s not a pink pampering beauty parlor and that spas offer high-quality, problem-solving therapies that are good for health and wellness.”
Smith is considered one of the top spa experts in the United Kingdom, receiving praise from national and international publications. During an interview with The Guardian about current trends in male grooming, Smith said there is a competitive aspect among males nowadays that make spa treatments and male grooming more socially acceptable.
Other Accolades
Smith is a member of the Chartered Institute of Public Relations and Cosmetic Executive Women.
William Hawthorn Lynch, Sr., known as Bill Lynch (April 16, 1929 - February 15, 2004), was an American journalist who served as the first Inspector General of the U.S. state of Louisiana, a position which involves investigations into corruption, misuse of state property, and governmental inefficiency.
Background
Lynch was born in Pittsburgh, Pennsylvania, and reared, first, in New York City and then in rural Elizabeth in Allen Parish in South Louisiana. In 1951, he graduated from Louisiana State University in Baton Rouge and then spent two years in the United States Marine Corps, in which he attained the rank of staff sergeant. In 1948, Lynch was a temporary sportswriter for Shreveport Times in Shreveport in northwestern Louisiana.
Journalist and inspector general
After his military service ended in 1953, Lynch returned to The Shreveport Times, where he became an assistant city editor and political reporter until 1965. At The Times, Lynch covered the 1959 saga of then Governor Earl Kemp Long, the relationship with stripper Blaze Starr, and Long's commitment to the state mental hospital in Mandeville in St. Tammany Parish. He established the Shreveport Times bureau in Baton Rouge, from which he did most of his newspaper investigative work. In 1965, he launched a 14-year association with the since defunct New Orleans States-Item. He covered the destructive Hurricane Betsy, which struck the Gulf Coast and New Orleans area in 1965.
Death and legacy
Lynch died in Baton Rouge at the age of seventy-four after hospitalization from complications related to heart disease. Upon his death, then Governor Kathleen Babineaux Blanco termed Lynch "one of our state's legendary journalists and a talented man of great character who helped make a stronger Louisiana. ... He relentlessly aimed his journalistic light into the dark places of Louisiana politics. ... As inspector general, he continued his crusade to clean up our political system by exposing wasteful spending and corruption. He leaves behind a legacy of integrity, devotion, and courage." Subsequent governors set their own priorities for the inspector general's office.
Lynch was twice honored by the Alliance for Good Government in New Orleans and by the New Orleans Press Club. Lynch's colleague Jack Wardlaw was inducted into the hall of fame a year earlier in 2004.
Lynch had two sons, Bill Lynch, Jr. (born 1962), of Baton Rouge and Jonathan D. Lynch (born 1968) of Flowery Branch, Georgia.
Background
Lynch was born in Pittsburgh, Pennsylvania, and reared, first, in New York City and then in rural Elizabeth in Allen Parish in South Louisiana. In 1951, he graduated from Louisiana State University in Baton Rouge and then spent two years in the United States Marine Corps, in which he attained the rank of staff sergeant. In 1948, Lynch was a temporary sportswriter for Shreveport Times in Shreveport in northwestern Louisiana.
Journalist and inspector general
After his military service ended in 1953, Lynch returned to The Shreveport Times, where he became an assistant city editor and political reporter until 1965. At The Times, Lynch covered the 1959 saga of then Governor Earl Kemp Long, the relationship with stripper Blaze Starr, and Long's commitment to the state mental hospital in Mandeville in St. Tammany Parish. He established the Shreveport Times bureau in Baton Rouge, from which he did most of his newspaper investigative work. In 1965, he launched a 14-year association with the since defunct New Orleans States-Item. He covered the destructive Hurricane Betsy, which struck the Gulf Coast and New Orleans area in 1965.
Death and legacy
Lynch died in Baton Rouge at the age of seventy-four after hospitalization from complications related to heart disease. Upon his death, then Governor Kathleen Babineaux Blanco termed Lynch "one of our state's legendary journalists and a talented man of great character who helped make a stronger Louisiana. ... He relentlessly aimed his journalistic light into the dark places of Louisiana politics. ... As inspector general, he continued his crusade to clean up our political system by exposing wasteful spending and corruption. He leaves behind a legacy of integrity, devotion, and courage." Subsequent governors set their own priorities for the inspector general's office.
Lynch was twice honored by the Alliance for Good Government in New Orleans and by the New Orleans Press Club. Lynch's colleague Jack Wardlaw was inducted into the hall of fame a year earlier in 2004.
Lynch had two sons, Bill Lynch, Jr. (born 1962), of Baton Rouge and Jonathan D. Lynch (born 1968) of Flowery Branch, Georgia.
Cork on Sunday was a Cork Sunday newspaper serving Cork City and County which was published in 1996 and 1997. It was started in August 1996 by Joseph O'Connor, formerly the boss of Cork super pirate ERI and operated from the former radio studios of both ERI and .
The newspaper was moderately successful with audited circulation of 4,500 copies per week during this period. This initial success prompted a fundraising effort to relaunch the newspaper in 1998, but the new Cork On Sunday was cancelled in late 1998 due to technical difficulties and the withdrawal of a key investor.
The company which was established to launch the new Cork On Sunday later started the East Cork Express, which operated as a newspaper for the East Cork area from 2002 until 2005.
The newspaper was moderately successful with audited circulation of 4,500 copies per week during this period. This initial success prompted a fundraising effort to relaunch the newspaper in 1998, but the new Cork On Sunday was cancelled in late 1998 due to technical difficulties and the withdrawal of a key investor.
The company which was established to launch the new Cork On Sunday later started the East Cork Express, which operated as a newspaper for the East Cork area from 2002 until 2005.