Ateneo de Zamboanga University

College of Nursing Nursing Skills Output (NSO) Report No. 1 HEMODIALYSIS

Description: Hemodialysis is a treatment for severe kidney failure and fluid and electrolyte imbalances. Dialysis takes over a portion of the function of the failing kidneys to remove the fluid and waste. It is usually the treatment of choice when toxic agents, such as barbiturate overdose, need to be removed from the body quickly. Materials Needed: - Gloves - Dialysis Machine - Dialysis Solution - Dialyzer Blood tubes - Anticoagulant - Needle - Syringes - Bleach and disinfectants - Water test kits - Water treatment tanks - Dialysate Procedure: Preparatory Phase 1. 2. 3. 4. Explain the procedure to the patient. Assess indications for procedure and obtain informed consent as appropriate. Gather all the necessary equipments/materials needed during the procedure. Placed patient in a comfortable position.

Performance Phase Priming the Hemodialysis machine: 1. Ensure that the hemodialysis machine has been appropriately disinfected according to the guidelines for the prevention of blood borne virus transmission in the hemodialysis service 2. Wash hands following recommended guidelines 3. Remove packaging and place dialyser into its holder 4. Using a non-touch technique, attach the arterial line onto the machine, then feed through blood pump and attach to dialyser; attach pressure detector isolator, tightly, to the pressure detector ports, using a double isolators according to guidelines for the prevention of blood borne virus transmission in the hemodialysis service 5. Clamp the arterial line and insert the spike into a 1L bag of 0.9% saline 6. Using a non-touch technique attach the venous line onto the machine and attach to the dialyser (if appropriate leave the venous pump insert out for priming); attach pressure detector isolator, as above 7. Hang up the priming bag 8. Using a no-touch technique, insert he administration set into the second bag of 0.9% saline and prime through to end. This must be connected to the arterial T junction of the circuit following connection of the patient to dialysis.

Connect dialysis solution Machinery must be operated according to the manufacturers instructions

Priming of blood lines 1. 2. 3. 4. 5. 6. This procedure is carried out to ensure all air is eliminated from the dialysis circuit, and to rinse out any residual sterilant, which may be present. Invert the dialyser (venous end up) Ensure both the arterial and venous lines are unclamped Turn on the blood pump and set rate to 150 200 mLs per minute Fill the arterial and venous bubble traps to the appropriate levels as the circuit fills with saline. Agitate the dialyser if necessary to expel air. Once filling volume is reached, as prompted byt eh machine, clamp the venous line and priming bag then, using a no-touch technique, detach the venous line from the priming bag and attach it to the T junction on the arterial blood line. Unclamp the venous line and the clamp on the T junction and restart the blood pump. Recirculate the saline until the machine alarms have completed and the patient is ready to connect to dialysis.

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Connection to a dialysis catheter at the start of hemodialysis 1. 2. 3. 4. 5. 6. 7. Wash hands following recommended guidelines Open renal pack and arrange contents with forcepts Wearing non-sterile disposable gloves, remove tape, old dressing, and discard all. Clean hands using alcohol hand rub Don sterile gloves Place waterproof sheet from pack under the catheter. Observe exit site for signs of infection Document state of exit site in HD record book If infection is suspected, take a swab and report it to medical staff before commencing treatment antibiotic cover may be required If exit site care is to be carried out, do so at this stage. Clean around the exit site with chlorhexidine solution, then remove any excess with dry, sterile gauze If exit site is clean, dress with IV 3000 dressing or alternative if patient allergic. Change sterile gloves. Actively clean catheter limbs with chlorhexidine solution, dry each limb with sterile gauze. Ensure clamps on each limb of catheter are closed, remove bungs and discard. Place catheter end(s) on fresh sterile towel. If using a single lumen catheter, attach a Y connector, ensuring clamps are closed. Attach a 5mL syringe to each limb of catheter or Y connector; release each clamp in turn and withdraw 3mLs of blood from each lumen and then re-clamp Empty blood from syringes onto gauze to detect any clots that may be present. Blood samples may be taken at this stage. Attach a syringe containing 10mLs 0.9% saline to each limb of the catheter or Y connector, release each clamp in turn and briskly flush through each limb before clamping each off. Remove syringes. Attach blood line(s) to catheter limbs and start blood pump at 100mLs/ min until circuit is filled with blood. Increase blood flow to prescribed level and commence HD.

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NURSING RESPONSIBILITIES Before Procedure 1. Correct identification of patient, using hospital number and date of birth. 2. Instruct patient to have a diet that is low in sodium, potassium, and phosphorus and the amount of fluids (in drinks and foods) may be limited. 3. Take weight, blood pressure, and temperature. 4. Blood glucose if diabetic 5. Observe / assess patient for any other problems or needs 6. Observe access site neckline / fistula / graft 7. Topical anesthetic (a pain-numbing medicine) is usually applied to the area of needle insertion, if needle insertion is needed. 8. Heparin is given to prevent blood clotting. During Procedure 1. Tell patient that he will not feel the blood exchange. There may be some temporary discomfort with the insertion of the needle or tube. After Procedure 1. Discard used materials 2. Document the procedure 3. Blood pressure will be monitored. Once the procedure is complete and blood pressure is stable, you are fee to continue daily activities. 4. Avoid traumatizing the arm where the access is located; do not wear tight clothes, jewelry, carry heavy items, or sleep on the arm. Do not allow anyone to take blood or measure blood pressure on this arm. 5. Check the access area daily for signs of infection, including warmth and redness.

RECOMMENDED TEXT: Medical-Surgical Nursing 5th Edition, Vol. 2, pp 1231 -1233

July 19, 2012 Date

NUR, REEM. A BSN IV - D

RN, MN Clinical Instructor