Should Dialysis Centers Allow Food and/or drink?

[wrandym]

Sorry-had to.  Inquiring minds want to know...

[okarol]

I would expand the poll to include:

o You should be allowed to eat anything you want, anytime.
o The center has the right to tell me what to do and I will obey.

[wrandym]

I would expand the poll to include:

o You should be allowed to eat anything you want, anytime.
o The center has the right to tell me what to do and I will obey.

So it shall be!

[G-Ma]

I think each of us or our nurse/Dr. should be able to make this decision and how much or what.

[wrandym]

This is coming from the viewpoint of whether the center should allow food or drink at all

[Rerun]

As long as the CEO makes 26 MILLION dollars a year???  I'll eat what and when I want to. 

                                                             

[Short Stuff]

I believe that as long as the patient is coherent, then the patient should have the option of bring in some water, light snack or have ice chips if they wish.

[Chris]

From my experience yes we should be allowed to bring food (not a lot) and a drink. At my center we had a couple patients keep asking for ice chips or water, but the staff wouldn't bring them any because they were on fluid overload. If they had their own water, then staff could not stop them from having it, but would have to try to adjust for it on the machine.

I figured you would make a post wrandym after reading your reply on the other topic.

Have to agree with rerun 100%. If they make that much money, you better allow me some sort of pleasure I still can have while stuck to a chair many hours a day.

[monrein]

Making our own decisions about food and drink is an important part of taking responsibility for and control over our illness.  It is our duty to learn about as many aspects of kidney disease as we possibly can and management of CKD goes on 24 hours a day not just the hours we spend on the machine.  No one has told me what to eat or when to eat it since I was about 6.  Suggestions yes, orders no. 

[boxman55]

I think rules are rules. if the center does not allow food or drink during treatment then they have their reasons. I would suggest finding another clinic that does allow drinking and dining if that are your desires...Boxman

[twirl]

As long as the CEO makes 26 MILLION dollars a year???  I'll eat what and when I want to. 

                                                             

I agree

[peleroja]

I'm against bringing any food or drink into the center.  I have had to kill 9 ants at my seat in the past 3 weeks, one of which was crawling all over my permacath!  Also, what I see being brought in, such as Cheetos, Jack in the Box, Burger King, dark sodas, etc., are simply not good for us due to high sodium and/or phosphorus content.  If I can arrange my eating schedule around my dialysis, I don't see why everyone else can't.

[karen547]

I think that we should be allowed to bring in food and a drink. I do however think that if we choose to bring in food or a drink, we should be respectful enough to clean up after ourselves, and not to bring in foods that have strong odors, which can really bug people. I sometimes will bring in a slice of pizza, but most times its just a sandwich and a drink. I admit it I am a pepsi drinker lol. There is this one lady at the center who is always eating sunflower seeds, and she spits them out into a cup which grosses me out. I mean she practically hawks them out and makes a nasty spitting noise. Not to mention they are loaded with salt, and I swear she puts on so much fluid in between her treatments and she skips treatments for a week at a time too, which causes her to be sick and throw up during treatment and I cannot stand the sound of people throwing up, and I don't feel sorry for her because shes doing it to herself. Sorry I kind of got off topic, but I guess I'm saying be sensible if you bring in food.

[MIbarra]

I think a sensible snack and drink should be allowed. I had to do dialysis after work. I wasn't hungry before I went into the center so I took a snack or sandwich with me. After a full day of work, 4 1/2 to 5 hours in a dialysis center, and a 30 minute drive home, the last thing you want to do is make dinner for yourself. All you want to do is climb into bed.

We are all adults and should be allowed to make our own decisions. If we want that high phosphorous soda or that bag of chips, it is our choice. I can make all the suggestions to the parents of the children I teach. I can not MAKE them make the choice that is better for the child.

[rose1999]

If I can arrange my eating schedule around my dialysis, I don't see why everyone else can't.

Because some people aren't lucky enough to have their own transport - one person at my Dad's unit has to leave home at 11 a.m. (she's told to be ready from 9.30 onwards!) and doesn't get back until between 6.30 and 7 p.m. because she has to rely on hospital transport that picks her up then goes an hour's round trip collecting others and the same on the return journey.  When she gets in (she lives alone) she is so tired that she just goes to bed so she has to eat at dialysis or she would only get breakfast.  I do agree however that strong smelling, very messy foods should be avoided and that due consideration for other patients is important.  

[swramsay]

Ugh. I personally get nauseous at the thought of eating at the center... other peoples blood, dirty people, dirty bathrooms. I am always amazed when people can eat in that environment. To each his own I guess. I do have ice chips or something to sip on but even that is not appetizing. I can see how a hot beverage can pose a problem since the side trays that we have are not very steady and drinks are easy to spill. Since this is a medical procedure, I can understand common sense needs to be used here. Snacks...ok. Full blown meals?...maybe not.

I read somewhere that if people eat a lot during dialysis, the blood goes to the gut for digestion which can affect dialysis or vice versa.

[mikey07840]

Where I live, the state of New Jersey has banned all food from the treatment area of all dialysis centers. I was told it is a sanitation issue.

Note that this applies to both outpatient and inpatient dialysis centers. When I was an inpatient, this required interesting scheduling of my dialysis and surgeries.

The two centers I dialyzed at provided drinks and ice on demand and allowed outside drinks. They followed the law and no food for patients or staff was allowed in the treatment area.

[cookie2008]

I live in NJ and it is posted as soon as u walk in the door that no food is allowed in the treatment area, there is alot of sneaking snacks.

[RightSide]

For us dialysis patients, the lap of luxury is epitomized by this dialysis center in London England:

"A selection of sandwiches, tea, coffee and biscuits is also available for patients on request."

http://www.thelondonclinic.co.uk/specialties/dialysis__renal_medicine.aspx

Dialysis or no dialysis, no British dialysis patient wants to miss afternoon tea.

[RichardMEL]

Lol RightSide.. how very brittish - Afternoon tea. I guess that's why we have a similar thing in the land of oz.

I think as I posted in the other hot thread on this issue the key here is being SENSIBLE and using common sense. Staff should inform those morons bringing in burger king, big gulps of coke and other inappropriate stuff that not only is it not right to eat this stuff in the dialysis clinic but for God's sake it's not exactly smart for your renal diet full stop! LOL OK if folks want to do that at home fine but really. I see nothing wrong with some small sandwiches, a fruit cup and a cup of tea or water with treatment.

Sure if some states or units want to ban food (probably because of that jack that brought in a pizza and didn't share or was rude about it or spilled coke all over their seat) well that's their right and I guess it would be up to the patient to find a place that will accept them having reasonable food... I find the notion of feeling the need to SNEAK snacks in to be... well.. somehow wrong and/or sad.

Why are we sometimes treated like naughty school children rather than, in the main, rational adults?

[kimcanada]

I think that I am all grown up, and if I want to pig out because I am starving, then I will "pig out"  If I want to nibble on something then I will "nibble" on something, and pitty help the person that tells me different

[wrandym]

I see nothing wrong with some small sandwiches, a fruit cup and a cup of tea or water with treatment.

Sure if some states or units want to ban food (probably because of that jack that brought in a pizza and didn't share or was rude about it or spilled coke all over their seat) well that's their right and I guess it would be up to the patient to find a place that will accept them having reasonable food... I find the notion of feeling the need to SNEAK snacks in to be... well.. somehow wrong and/or sad.

Pretty much my thoughts from the beginning.  Since, in the US, the outpatient clinics are a business venture (not sure about other countries),  the ones with this policy should fail.  If it is a law or statute, then the powers that be should have their cages rattled.

[glitter]

My husband takes in a lemon/lime soda and a few tootsie pops. It is against policy to eat during session, but it is not strickly enforced. Sometimes I bring him a doughnut or a Quarter pounder hamburger, he is very careful with his diet so these occasional treats are okay- (his labs are always spot-on) he generally compensates elsewhere in his food....the idea that someone else is going to decide what is 'sensible' for him to eat makes me angry. Just like you have the right to quit dialysis- you also have the right to be uncompliant. Yes, I know it could hurt the chances for a transplant- but if drinking Coke and eating pizza is how you want to go out- you should have the freedom to do it.

[pelagia]

This is an interesting article on the subject.  They mention at least some of the pros and cons being discussed on the two current threads.

from: Nephrology Nursing Journal,  March-April, 2008  by Helene Christner, Monica Riley

http://findarticles.com/p/articles/mi_m0ICF/is_2_35/ai_n25376791

Should patients eat during hemodialysis treatments?

Should patients on hemodialysis be allowed or encouraged to eat during a dialysis treatment? As with any debate, there are always at least two opposing views and this argument is one that continues to have clinicians on the "pro" and also on the "con" sides.

One point made by the pro-side is that many of our patients have diabetes. Consistency with diet, exercise, and insulin regime is important to maintaining control of blood glucose levels. Regularly missing or skipping meals is not encouraged for anyone trying to maintain a healthy lifestyle and, in particular, it is not a good practice for the population with diabetes. Skipping meals can disrupt the balance of insulin control and can lead to life-threatening hypoglycemic complications.

In general, those supporting eating during hemodialysis advocate for allowing patients to consume small meals or snacks during their treatments in order to improve their overall nutritional status. Improving or at least maintaining the nutritional status of patients on hemodialysis is just one of the many challenges faced by health care teams; and, by improving the nutritional status of our patients, we will undoubtedly increase the odds for positive outcomes.

Because treatments last 3 to 4 hours, patients on hemodialysis are often receiving a treatment through a meal period on treatment days. Treatments are routinely scheduled for 3 days per week, potentially resulting in 156 lost meals per year. This would mean that patients on hemodialysis are missing or are prevented from eating one meal on more than 40% of the days in a given year on dialysis. If patients are not allowed to eat during dialysis, they are at jeopardy for missing meals; this equates to a lost opportunity to improve their nutritional outcomes. Even the Centers for Disease Control (CDC) suggests it is appropriate for patients to eat food brought from home to be consumed while the patients are undergoing dialysis treatment (CDC, 2001).

Those advocating for meals during dialysis see this meal and treatment time as a good opportunity to supplement and improve the patients' dietary intake by allowing patients to eat during their treatments. Both sides seem to agree that treatment time is a fortuitous time to discuss and review dietary intake, lab results, and general teaching. Because of the potential distractions, however, those arguing against eating during treatment do not see this time as appropriate for consuming any foods. There is evidence that food intake should be limited an hour or more before all hemodialysis treatments to avoid medical problems during dialysis.

If a patient's blood glucose drops during hemodialysis, those against eating during dialysis can argue that glucose testing is easily attainable while the patient is on dialysis. The dialysate electrolyte concentration is a dextrose based solution of 200 mg/dl, but despite this, some patients will experience hypoglycemia. If blood sugars do decline, juice is available in most units and may be effective in reversing the low blood sugar levels. Since treatments are routinely scheduled, patients can be encouraged to adjust meal times around dialysis treatments. In units that do not allow eating during treatment, patients usually bring in juice, a high protein/caloric nutrition drink (or other supplements), and snack meals for after treatment.

Nurses who do not support eating during dialysis have some very persuasive arguments for their position. One point often made concerns the issue of postprandial hypotension. When food is consumed, blood is shunted to the gastrointestinal track to aid digestion. Blood flow in the splanchnic and hepatic circulation is elevated. This shunting of blood reduces systemic circulating blood volume that may result in a decrease in systemic blood pressure (Kinnel, 2005). Patients who eat during dialysis have often reported experiencing nausea and vomiting, or some may have episodes of diarrhea. These types of complaints may lead patients to request to discontinue their treatments prematurely. When treatment duration is shortened, adequate solute clearances, dialysis adequacy, and outcomes are affected.

A serious blood pressure drop can occur when the shunting of blood to aid digestion is coupled with the treatment's fluid removal goal. In response to hypovolemia, the body may respond with an increased heart rate and vasoconstriction to improve venous return. Cramping may occur, and, if vomiting occurs, it may increase the risk of aspiration. Drops in systemic blood pressure may jeopardize the efficacy and/or duration of the dialysis treatment as well as adequate organ and tissue perfusion.

A point that may be made by individuals on the con-side is that eating during dialysis may lead to less-than-desired Kt/V results. They hypothesize that, when blood is shunted to the digestive organs and away from the systemic large vessels, clearances are affected. This implies that the circulating blood in the digestive organs reduces the amount of available blood to be circulated through the dialyzer, and therefore diminishes clearances.

Yet another point for not allowing food consumption during hemodiaysis focuses on the question of liability. Nonsupporters contend that when patients are allowed to consume food during their dialysis treatments, there is the possibility for litigation to occur. This now becomes a question of safety. Hypotension is the number one complication that occurs with hemodialysis, and allowing situations that may induce or exacerbate a known risk factor creates a potential for liability. This particular issue has been raised in website chat rooms, such as AllNurses.com (2003) and AllExperts.com (2005). The suggestion is that physicians and nurses may be liable if they permit patients to actively engage in a behavior that we know has the potential of causing harm.

Bringing food into the unit may require preparation, for example, heated by microwave or arranged for the patient's convenience. This assistance takes time away from the dialysis staff during an already busy schedule to stop and "play waiter or waitress." Nurses employed in units that do not permit food to be eaten during the dialysis treatment time have pointed out the burden of potential trash that staff has to clean up related to drink spills, food wrappers, and emesis.

Conclusion

The question of whether patients should eat during or just before a hemodialysis treatment is one with many facets and warrants more research. Patients who miss meals regularly may jeopardize their nutritional health status. Allowing eating during hemodialysis may pose immediate safety and infection control concerns as well as long-term treatment outcomes. The legal implications indicate that facilities need to establish policies for their patients concerning food intake during hemodialysis. Research studies have not directly answered the questions related to patients eating during hemodialysis except the risk of hypotension and related physiological responses. Until that occurs, facilities will need to develop policies, inform patients of the risks and rationales, and ensure that those policies are being followed.

References

AllExperts.com. (2005). Eating on dialysis. Retrieved February 1, 2008, from http://en.allexperts.com/q/Nephrology-975/Eating-dialysis.htm

AllNurses.com. (2003). Eating on dialysis. Retrieved February 1, 2008, from http://allnurses.com/forums/f48/eating-dialysis-33787.html#post411278

Centers for Disease Control and Prevention (CDC). (2001). Recommendations for preventing transmission of infections amongst chronic hemodialysis patients. Morbidity and Mortality Weekly Report, 50(RR-5), 1-43. Retrieved February 1, 2008, from http://www.cdc.gov/MMWR/ PDF/rr/rr5005.pdf

Kinnel, K. (2005). Should patients eat during hemodialysis treatments? Nephrology Nursing Journal, 32(5), 513-515, 568.

Helene Christner, BSN, RN, is Director of Patient Care Services for Dialysis, James B. Harrigan Center for Kidney Dialysis, Sterling, CO. She is a member of ANNA's High Country Chapter and of the Hemodialysis Special Interest Group.

Monica Riley, BSN, RN, CDN, is employed in acute care dialysis services, The Ohio State University Medical Center in Columbus, OH. She is President-Elect of ANNA's Buckeye Chapter and a member of the Hemodialysis Special Interest Group.

COPYRIGHT 2008 Jannetti Publications, Inc.
COPYRIGHT 2008 Gale, Cengage Learning

[karen547]

So the past couple of treatments, when I have ate anything my blood pressure has dropped. I haven't had this problem before and am wondering what snacks people bring to dialysis or eat during treatments at home? I always thought that eating raised blood pressure. Maybe I am eating to much, although usually its a sandwich and an apple.