U.S.. MARIA ISABEL HERRERA. U.S.. Ibacache YOLANDA C. U.S.. O. Marcelo Vega CONTENTS Page 1. January 3 Introduction to What is Dialysis System Co?

January 4 b What is the Kidney? July 1 c What is Hemodialysis? Entry Requirements 1 d Jul y 2. Vascular access September 2 to What is Vascular Access? 10 2 b c Catheter F ebruary 10 Goretex graft or implant 13 3. Food and Fluid Intake in Food March 14 March 15 b What is the dry weight? March 15 c What should I eat? 17 3c1 The pot assium in our diet 18 3C2 the salt in our diet 3v3 23 Phosphorus in our diet 3c4 24 Proteins in our diet 24 2 3 d Emergency Food April 25. Drug 4 Drug Medication basic b April 29 5. Renal Tr ansplantation 31 6. Quality of life 34 7. Emergency 36 7 What do we do in an eme rgency? Evacuation Method 7b 37 38 8. Rules and Instructions for patients 40 9. Informed Consent 3 1.I N T R O D U C C M 1st Dialysis SYSTEM WHAT IS CO.? Dialysis System is a group of dialysis services that have come together to give their patients quality care through continuous improvement of processes and the development of standards aimed at satisfying th eir needs and expectations. The group is made up of four services, serving over three hundred patients with chronic renal insufficiency on dialysis. There are f our medical specialists 4 in nephrology, dialysis nurses 16 and 60 employees trained. THE MISSION SYSTEM P roviding Dialysis patients with chronic renal failure the best quality in the tr eatment of their disease, according to modern standards by a highly qualified te am in an atmosphere of empathy and warmth. Achieve levels of excellence in meeti ng the needs and expectations of our patients through continued development of q uality standards based on them. Position ourselves as leaders in quality care at the national level, be identified by this and serve as a model to develop other dialysis services. Encourage employee engagement and the mission now encouragin g the professional development of workers through continuous training, participa tion in process design quality and team work. that of the in 5 Kidney failure is a chronic disease, we have designed this manual dialysis patie nt in order to lead, to educate and train our self-care patient. Hemodialysis tr eatment you receive, will be held three times a week (Monday, Wednesday and Frid ay or Tuesday, Thursday and Saturday) in a system of shifts (morning, afternoon and evening) and times will be assigned according to their turn. These days also include holidays. Dialysis System Co. has specialized in Medical Director Nephr ology at each of its dialysis centers, those with the responsibility of evaluati ng, diagnosing, treating our patients and / or referring them to other specialis ts as appropriate. Dialysis System Co has professional and highly qualified tech nical. In all this shift is a doctor who will evaluate and treat you for your di alysis session. University Nurse and a nurse's aide for six patients. In terms o f infrastructure, all sites have been conditioned and designed to give comfort, welfare and safety. It should be noted that all dialysis machines are the latest generation and what sets us apart is that we have a proper and permanent techni cal service for each dialysis center, ensuring continuity of treatment. 6 System Co. Dialysis given to patients in need, help with transport and basic med

icines. 1b WHAT IS THE KIDNEY? The kidney is a vital body functions are: Cleanse the bod y of toxic substances, such as urea, creatinine, potassium and fluids removed th rough the urine. 7 When the kidneys fail and the presentation of CKD, these features disappear and it's time to use the replacement therapy of renal function. These include: hemod ialysis, peritoneal dialysis and renal transplantation. 1c WHAT IS HEMODIALYSIS? Hemodialysis is a procedure to fill the role purification (cleaning) of the kidn ey, which is accomplished by passing his blood, which contains toxic materials t hrough a membrane (filter) that is bathed in a 8 solution of similar composition to the blood but not toxic to cause a series of changes in their lifestyle as regards food and care. Feel free to ask and answer any questions that may arise, by telephone or by dir ectly asking the day of dialysis. It is also important€his family is aware and i nvolved in their treatment of hemodialysis. 9 1 d. ENTRY REQUIREMENTS To enter dialysis dialysis patient must: 1. Submit a med ical report or epicrisis of hospitalization. 2. Have negative serology for poten tially communicable diseases in hemodialysis (hemodialysis only) Hepatitis B Hbs Ag Hepatites C HCV HIV AIDS 3. Have submitted to the secretary their pension records and documents as reques ted for the processing of programs (or Isapre FONASA credential, last payment of wages, etc..) 4. Signing the informed consent document and the rights and dutie s of patients. 1 e. WHAT IS THE peritoneal dialysis? A procedure similar to hemo dialysis in that instead of a filter using the peritoneal membrane (which covers the abdomen from the inside). The treatment is performed on the patient's home and must receive this training. 1 f. WHAT IS THE TRANSPLANT? It is the graft of a healthy kidney from a living donor or dead. 10 2. VASCULAR ACCESS 11 The 2nd WHAT IS VASCULAR ACCESS? In order to perform hemodialysis need an entran ce through which to take his blood dialysis machine, where it will cleanse itsel f of substances that the kidneys can not eliminate excess fluid and you may have . This entry may be temporary, through a temporary catheter and / or in part, th rough an arteriovenous fistula, graft, or indwelling catheter. 2b catheter is a plastic tube, flexible and sterile, which is inserted through a blood vessel of large caliber which allows us to draw blood to perform the hemodialysis procedur e and then return to the body. This tube protruding outside through an outlet co vered by a dressing, shows two branches which are always covered with sterile ga uze. Catheter Care: • The shower should be carefully (ideally phone type), keeping the catheter prot

ected and dry should not 12 include washing head, which should be apart, to prevent the catheter from gettin g wet. • Communicate to the nurse the onset of pain or heat in the area of the c atheter and / or fever. • The catheter can not be handled by personnel outside t he dialysis center, unless hospitalized. • The catheter is unique to hemodialysi s and should not be used for other treatments. In case of bleeding, you must: • Click on the patch by placing a handkerchief or clean gauze compress for 10 minutes. If the bleeding does not stop, call the di alysis center or go to the nearest emergency center to your home. • If you press the exit of the catheter insertion hole with gauze or clean cloth and go immedi ately to the dialysis center or emergency center nearest your home. 2b Arteriovenous Fistula Using an outpatient procedure and is performed under lo cal anesthesia the fistula, which is the union of an artery and a vein that is i ntended to obtain a high flow in the vein for blood and will return after spendi ng by the filter. 13 Care for the development and maintenance of the fistula • Every day should feel his fistula, warning any change: no thrill or decreased, or occurrence of pain, etc.. • When the fistula is freshly made, avoid the increased volume of the arm, holding it aloft. • At the beginning, after a medical indication to do exercise s to your fistula has a better development. To do this, squeeze a rubber ball th e size of your hand for 10 minutes at least six times per day. • Be alert to low pressure during dialysis if you feel dizzy notify your treating doctor. The fis tula may be covered by low pressure. • In your home can also lower blood pressur e, either by vomiting or persistent diarrhea. Whereupon you must advise the dial ysis center. • Avoid wearing jewelry or clothes that squeeze your arm. • Avoid s leeping on the arm of the fistula. • Do not carry heavy objects with that arm. • After dialysis, remove the patch covering the puncture sites after 5 to 6 hours or overnight before the morning shower. 14 • Keep the arm of the fistulas, wash with soap and water before going on dialysi s. Do not allow the drawing of blood, administering medication or have blood pressu re measurements on the arm of the fistula. 2c OR IMPLANT OF GRAFT Goretex This vascular access use at the impossibility of Arterio Venous Fistula, either by poor quality vein or by exhaustion of them.€Is the union of an artery and vein through a Goretex implant or tube which is plac ed in a surgical operation under local anesthesia. 15 2d WHAT TO DO IN CASE of bleeding and bruising? • If there is bleeding in the puncture sites, you must compress the arm raised dir ectly with the fingers without lifting for at least 10 minutes, if after this ti me, the bleeding does not stop, repeat the above. If it still persists, contact the dialysis center or go to the nearest emergency center. • In case of in hematoma during dialysis, the nurse will assess whether to apply ice, compression only or both. The next day you should apply local heat or a wa rm cloth wrapped in a towel guatero at least three times a day.

16 3. FOOD AND LIQUID INTAKE The 3rd FOOD. As already mentioned, a diseased kidney is unable to eliminate exc ess toxic substances and some 17 containing foods, therefore, it is very important to know which should be consum ed and in some cases restricted. Here are some guidelines and recommendations de livered in this regard. Another major problem to which dialysis patients are fac ed with, is that it also alters the elimination of fluids through the reduction or absence of urine, which means having to restrict their consumption. 3b WHAT I S DRY WEIGHT? Dry weight, less weight is tolerated by the patient at the end of dialysis and appears generally normal blood pressure and no edema. It is very im portant from a dialysis session and another does not have an overweight than 1.5 - 2 kilos, ie do not eat a quantity of liquid than a quart and a half to two li ters. That will ensure a greater sense of wellbeing during dialysis and also pro tect your heart from fluid overload. 18 Fluid intake. Now that you have started dialysis, it is very important to contro l the amount of fluid you drink. In this concept of "liquid" should know that it includes not only water, but all that is liquid and moist, therefore, liquid is also soups, creams, milks, juices, beverages, fruit, coffee, tea, yogurt, jelli es, puddings, ice cream. What happens if you have consumed or accumulated high amounts of liquid? If, aft er the fluid accumulation occurs: swelling of face, arms and legs, fatigue, tire dness, difficulty breathing, especially if you try to lie as well, these signs a re increasing, should call or visit the dialysis center. 19 How much liquid can take a day? The amount of fluid you take will depend on the amount of urine you delete it. As a rule of thumb should always keep in mind tha t "can take 24 hours both fluid and urine in this period of time, más1000 cc of fluid intake, including food content." Tips to control fluid intake • Limit intake of salty foods that increase thirst, for example, bread, ham, chees e, sausages and canned products. • Measure the total liquid to be taken daily (24 hour urine over 1000cc) • The w ater is removed sautéing vegetables after boiling. • The toast has less water th an the bread, about 35% less. 20 • It is advisable to eat sugarless gum even in the case of non-diabetic. • Drink iced tea instead of soft drinks which are thirsty. • Never take fruit juice or nectar. 3c WHAT SHOULD I EAT? This is a very important question on dialysis for three reasons: • A balanced diet will improve your quality of life. • Allow the outcome of hemodialysis is better. • Will you be better prepared in case of tran splantation. Foods contain substances that the body needs to live, some of them are, potassium, protein, sodium, phosphorus, calcium and water that are of most interest to you. 3c1 THE POTASSIUM IN OUR DIET IS IMPORTANT WHY RESTRICT THE USE OF POTASSIUM? It is a substance needed for the proper functioning of the nervou

s system and muscle. Enters the body with food and as the kidney can not elimina te it accumulates in the blood and can cause alterations in the activity of your muscles, especially around the heart. The control of foods that contain potassi um is essential to avoid the increase of this between 21 dialysis sessions because their consequences are so serious that may lead to hea rt failure and death. ALARM SIGNS MUST GO IMMEDIATELY AFTER SERVICE IS AN EMERGENCY excessive intake o f foods that contain potassium SEE: • Tiredness.€• Tingling and heaviness in the arms and legs. • Difficulty speaking. • Muscle weakness. Although potassium is found in virtual ly all food, must know that the potassium-rich foods include fruits and vegetabl es. The recommended daily consumption of fruit is: • Two units of low-potassium a day or 22 • A unit of moderate potassium daily. The recommended daily intake of vegetables is: • Two servings of low-potassium a day or • A moderate portion of potassium daily. In relation to foods high in potassium, it is advisable not to consume th em. Importantly, natural fruit juices and nectars are strictly outside the dialy sis diet for its high content of potassium. LIST OF FRUITS AND VEGETABLES WITH: LOW POTASSIUM 23 FRUITS Apple Fruit (1 unit Pera (1 small) small unit) Pear ((a regular unit) Cuc umber 1 small unit) Cucumber (1 regular unit) Watermelon (1 slice regular) Water melon (1 (regular cut) Cherries 10 units) Cherries (10 units) 2 units Plum) Plum ((21unidades) Pineapple Cup) Vegetables VEGETABLES Artichokes (1 unit) Chicory Chicory Cress Cress Beet Beet Onion Cucumber Lettuce Cucumber Lettuce Onion Paprika Pepper Cabbage Cabbage MODERATE POTASSIUM CONTENT OF FRUIT Strawberry (1 cup) raspberries (1 cup) cooke d Quince Peach (1 medium) Khaki (1 unit median) Figs (3 small units) Mango (1 cu p) Loquat (6 units) Tunas (2 units) Kiwi (2 units) beets VEGETABLES Cauliflower Celery Peas Carrots Tomatoes Green Beans Zucchini Yellow Squash Italian Choclo 24 HIGH POTASSIUM FRUIT Banana (unit) Orange (1 large) calameño Melon Tangerine Gra pefruit (1 regular slice) Melon tuna (1 piece regular) Grapes (15 medium units) Apricot (2 units medium) Lucuma (a small unit) VEGETABLES Brussels Asparagus (8 units) Spinach bean sprouts, avocado, pomegranate Beans Potatoes Eggplant It is very important that you know that nuts are extremely high concentration of potassium so you should avoid drinking alcohol. These fruits are: DRIED FRUIT F igs Prunes Raisins Dried peach Huesillos Fruit juices and nectars can not take patients on dialysis for the content extre mely high in potassium. 25 TIPS TO REDUCE THE POTASSIUM OF FRUITS AND VEGETABLES • Vegetables and fruits lose potassium in contact with water. Should be cut into

small pieces leaving them to soak at least three hours changing the water sever al times and without using the soaking water. • Vegetables should be soaked in w ater and it switches between 3-4 times before cooking, preparing what will be co nsumed with fresh water. Its use is recommended during weekdays, Tuesday through Thursday. • The frozen vegetables potassium lost by leaving it thaw at room tem perature. • The fruit is about half cooked potassium fresh fruit as the other ha lf is dissolved in the cooking liquid. The fluid MUST NOT DRINK. 26 3C2 IN OUR DIET SALT Sodium chloride is table salt. He is responsible for the in creases in blood pressure, weight gain and swelling of legs, face and eyes, and cause him to be what it will consume more fluids. Severe hypertensive patients s hould only consume 2 grams of salt per day, equivalent to a bic pen cap, as an e xample a pan containing 2 grams of salt. Is worth noting that dietary salt DO NOT EAT, AND THAT CONTAINS A LARGE AMOUNT O F POTASSIUM. Forbidden foods in the diet with salt restriction: • • • • Cooking salt and table. Salted and smoked meats. Meats. Smoked fish. 27 • • • • Charquis and cheeses. Olives. On soups, instant mashed, soup cubes. Generally pr eserved, salty and sweet (we recommend that you read the content information on labels of canned) • Fruits salty. 3v3 THE MATCH IN OUR DIET excess phosphorus alters bone metabolism and calcium t hat extracts of these coming to cause pain, deformity and fractures. Additionall y, calcium tends to stick to the walls of blood vessels especially the arteries of the heart. Generally, phosphorus enrichment is manifested through an uncomfor table itching in the body called pruritus. Do not forget to take calcium intake during the hours between meals, because this drug binds to phosphorus in the int estine and prevents the blood passes, therefore, both are eliminated through the stool. Foods rich in phosphorus • Milk and dairy products: cheese, yoghurt, custard. • Flour (bread, noodles, pastries, etc..€) • cola drinks. • Legumes. 3c4 PROTEIN IN OUR DIET 28 They are one of the main components of the human body and are essential for the proper functioning of the body. It recommends eating daily servings of foods con taining protein. Foods that contain more protein you use can be found at: • Meat (beef, turkey, chicken) • Fish. • Milk • Egg whites. 3d FOOD IN CASE OF EMERGEN CY OR DISASTER The scheme aims to delay the onset of complications due to the im possibility of dialyzed patients, either because of prolonged blackout in the pr ovision of water and / or electricity or severe structural failure, resulting fr om earthquakes, fire , floods, etc. The most important restrictions are: 1. Decr ease consumption of foods that provide protein, such as: meat and dairy. 2. Incr ease consumption of foods which provide energy, such as mass and sugars. 3. Avoi d eating foods that provide salt (cold cuts, salted and smoked meats, cheese, et c.)..

29 4. Avoid eating foods that provide potassium (fruits and vegetables). 5. Limit f luid intake to slow the symptoms of fluid overload, high blood pressure, swollen legs, shortness of breath, tiredness. 30 Emergency Menu No. 1 • Breakfast 1 cup sugar 4 tea pure salt-free crackers with unsalted margarine and jam • Lunc h ¾ cup white noodles with oil and half a beef or chicken croquettes an unsalted cracker unit 1 tablespoon oil • 1 cup of tea Eleven pure sugar 4 unsalted crack ers with unsalted margarine and jam • Food ¾ ½ cup rice croquette with beef or c hicken 1 piece of biscuit without salt 1 tablespoon oil 31 Emergency Menu No. 2 • Breakfast 1 cup sugar 4 tea pure salt-free crackers with margarine and jelly, unsalted tortilla noodles • Lunch with ¾ cup noodles and 1 egg white with a clear jelly • Once a pure tea cup sugar 4 unsalted crackers with unsalted margarine and jam • Eating rice ¾ cup egg white (2 units) a jelly biscuit without salt 1 tablespoo n oil 32 Emergency Menu No. 3 • Breakfast 1 cup sugar ½ tea pure salt-free bread toasted unsalted margarine and jam • Lunch ¾ cup white rice with fried egg and a tablespoon oil 1 tablespoon oil • Once a cup of tea with sugar ½ pure salt-free bread with unsalted margarine and jam • Food ¾ cup egg noodles with water curren ts 1 tablespoon oil 33 34 4. MEDICATIONS 35 MEDICATION 4 People who take medications that require dialysis treatment or supp lement to help reduce the symptoms of the disease. Remember to take medications as prescribed by your nephrologist and he recommended doses. The drugs most comm only used are: IRON: used to reduce anemia. Depending on the severity of this, t he iron to be prescribed can be directly into the vein, a drug known as Venofer or oral ferrous sulfate, Fierrovitamínico, Iberol, Maltofer. These latter must b e consumed away from meals. Phosphate binders: used to reduce phosphorus in the blood. Be taken, usually with meals or as medical advice. Eg calcium carbonate, Elcal, PhosLo, Calcefor, Levucal. Hypertension: are used to correct hypertension (high blood pressure. You must take them from the way your doctor tells you and never stop taking or change the dose on their own, since the risks of inadequat e doses can be serious. eg Nifedipine, Atenolol, Lozartan, Tareg, Cardura, Carve dilol. VITAMINS: used both to replenish the vitamins that are removed by dialysi s, such as those that are altered by renal insufficiency. multivitamins eg, Tono pron, Folic Acid. ACID Acetylsalicylic: used to prevent clot formation in patien

ts prone to them. eg baby aspirin, Ecotrin. 36 Gastric protectors: they are used to protect the stomach irritation that can pro duce the large number of medications that is necessary to consume. Eg, famotidin e, ranitidine, omeprazole, Losec. 4 b.Medicamentos Basic Dialysis System Co. has a program to help with basic medications for hemodialysi s patients in need. Included in the group of these products: Antihypertensive Ni fedipine Atenolol Vitamins and supplements retard Polyvitaminic Ferrovitaminico phosphate binders Ferrous Sulfate Calcium Carbonate Anaprolina erythropoiesis st imulating Antacids Antidepressant Fluoxetine Famotidine 37 Not included in the basket of vitamin D (Rocaltrol Etalpha or Calciyec), erythro poietin,€And non-drug Venofer to dialysis as antibiotics, antiarrhythmics, etc. To obtain this benefit is no requirement to fund the treatment, no other way to obtain medications and clinic controls. At your request, you should contact your nurse to be included in the program starting next month. During the visit your doctor's monthly exams, it will make prescribing and medicines will be delivered during the week. The center can not be responsible for maintaining the supply o f drugs if at any time there is no existence of them among travel providers. 38 5. KIDNEY TRANSPLANT 39 5 Renal Transplant Program When the diagnosis of chronic renal failure, can be u sed to hemodialysis or peritoneal dialysis. However, there is no alternative to replace the damaged kidney is renal transplantation, which certainly offers grea ter advantages, such as improving the quality of life and allow for better emplo yment and social integration .. What is a kidney transplant? Kidney transplantat ion is a surgical procedure through which is placed a kidney from a living donor or cadaver to a receiver, whose purpose is to replace the damaged kidney functi on. Are all transplanted insufficient? stones can No. There are certain diseases for which transplantation is contraindicated, suc h as AIDS and active cancer. There are also behaviors that prevent transplant as active drug consumption (marijuana, cocaine base, cocaine, etc..) And alcohol. Currently, advanced age is not a contraindication, provided that the patient is in optimal cardiovascular conditions. What are the steps to get a transplant? 40 First tell your nephrologist or dialysis nurse intention to be transplanted, whi ch will evaluate your case and then be referred to the hospital's transplant cli nic has been applied. If it is accepted into the transplant program will begin i nterviews and studies (blood tests, x-rays, ultrasounds, endoscopies, etc.), whi ch will be necessary to repeat them so often to get updated information. Once th is stage will be sent to the Institute of Public Health to establish (get the ge netic information of their blood for comparison with potential donors). Once est ablished, it will be included in the national waiting list of the Institute of P ublic Health, being a necessary condition monthly take a blood sample, called Se rotec. The Institute of Public Health will be responsible for comparing the gene tic information of donors with potential recipients. After selecting the patient more compatible with the donor, you are notified that you attend to your hospit al, be essential that you keep a phone number where you can be notified 24 hours

a day, 365 days a year. How is it funded a transplant? 41 In the event that the patient is FONASA (groups A, B, C or D) that is, a benefic iary of the public system, the state pays 100% of renal transplant and include: surgery, the transplant itself, hospitalization, examinations and procedures, an d immunosuppressive drugs exclusively in public hospitals that are accredited to perform kidney transplants. It should be noted, that sometimes you may request tests are not conducted in public hospitals, so these have to be financed by the patient. If the patient is affiliated with ISAPRE, ie incorporated into the pri vate system, the entity will carry out the subsidy for the health plan you are. 42 6. QUALITY OF LIFE 6 TIPS FOR BETTER QUALITY OF LIFE dialysis represents an abrupt change in their lifestyle. There are changes at the personal, social and labor. There is an inst itution called ASODI (dialysis and Transplant Association) where you can find he lp and numerous benefits, including prescription drugs at a lower value than tra de, sports, cultural activities, workshops. It is located in Rancagua Street N ° 0250, Providencia, Santiago. For any questions or concerns you can call the fol lowing telephone numbers 2042851, 2044724, 2742700. 43 • It is recommended to take between exercise habits. In principle, the walks, as far as possible is a desirable activity and from there can be any physical exer cise that is not violent. The end of the vascular access must be adequately prot ected. • Abolish or reduce as far as possible the consumption of snuff, and that increases the risk of cardiovascular complications.€• Do not suppress their rel ationships with friends, not isolate, list as it always did. The people around y ou will understand and be willing to help. • If possible do not stop holiday, as it can move to other cities in advance by contacting your nurse for the respect ive reservation and seat in a dialysis center in the city to visit. This is poss ible unless the funding of dialysis either through an agreement with the health area or through the AUGE. 44 7. EMERGENCY 45 7 WHAT TO DO IN AN EMERGENCY? The center is prepared to deal with various types of emergencies, such as power outages, water shortages, fires. We have also take n steps to evacuate for earthquakes and disasters of great magnitude. Note that because it is a health service center has the support of firefighters, police, C hilectra, etc. As general measures are recommended: 1 Stay calm, do not scream a nd run. 2nd obey the instructions from your nurse on duty. 3 ° Maintain a curren t address and phone number, if possible have a number of errands, for easy locat ion. 4 ° is suggested to always have shoes on, to facilitate evacuation and prev ent injuries (cuts and falls) 46 7 b Method of evacuation proceed to evacuate when some of the above situations e ndanger the lives of patients and staff. The evacuation is as follows: 1) The au xiliary nurse come to your room off. 2) It will stop the machine, disconnect the circuit without blood being returned to the needle clamp. 3) immediately prompt

ed the evacuation site safer. Once the claim will be assessed to reconnect or su spension of dialysis, proceeding to remove the needles. Where possible the phone will be provided for each patient to contact his family in the form of rotation and time. In case of a major catastrophe will assess the situation being advise d in a timely manner the site and dialysis day and given instructions for self-c are until the situation returns to normal. (See contacts on page 25) Situations. Power outages: • In this case proceed to use the power plant with the heart tha t counts. • Then your dialysis continue as usual and the term of this will be ev aluated by the doctor and the nurse on duty. We may have to shorten a bit the se ssion. 47 Water cuts: • The center has pool of reserve and if the cut is long the situatio n will be evaluated to inform you in time any change in the schedule, date and p lace of dialysis. Fire: • The center has strategically placed fire extinguishers. • If the situati on so require the evacuation shall be carried out as described above. • If there is heavy smoke moving at floor level to prevent aspiration. Earthquakes: • In this case the situation will be evaluated and depending on the magnitude of the quake will proceed to the evacuation. • You must stay away fro m glass and windows. • Stand to shelter in doorways or in areas designated for e vacuation. 48 49 8. REGULATION OF SYSTEM CO dialysis. 50 8 Rules for Dialysis Center patients. We are aware that you are confronted with a difficult life situation, that many things about your illness, its causes and its treatment are still not clear to you, want you to know that this place is a group of people concerned about him appropriate treatment and minimize discomfor t. Here's are a few recommendations for you to take into account: • The schedule of dialysis will let you know when to grant a quota, it can be permanent or tra nsitory, a condition established after starting treatment. • It is important to respect the assigned times and that dialysis works in relation to a shift system , with fixed hours, so proper preparation is made of machines and filters, thus achieving compliance with the times and schedules for all patients. • You need t o wait his turn in "Waiting," this would speed up the shift. 51 • Once inside the dialysis room shall be controlling weight and blood pressure. Then be connected to start the dialysis session. • Once installed and during the first hour of dialysis, the center will serve you a cup of tea, you may attach a couple of crackers or half sandwich. • We recommend that you attend and loose comfortable clothes,€with wide sleeves to facilitate wide neck punctures or if I had a catheter. You will be assigned a place to store their belongings. It shou ld not keep valuables as these locations are shared with others. • Any questions or information is channeled through the nurse on duty, and if necessary will re fer you to the head nurse or doctor on duty. • consultations in relation to thei r drug regime and the answer while you dialyze. • Monthly tests that will be mon itored to ascertain the progress and response to treatment that we are applying. • The consultation on administrative matters, licensing, programs should be mad e directly to the secretariat. 52

• Considering that share many hours together, it must be remembered that the bas is of good relationships based on trust, communication and respect. We hope to m eet their expectations and are open to listen and take into account their demand s and suggestions. • First irregularities, complaints and suggestions please cha nnel them through the Book of Suggestions and Complaints at the reception or in the suggestion box located in the Waiting Room, which will be answered in writin g within one week. In situations of extreme urgency, please raise them orally to the Head Nurse. • The anonymous suggestions or complaints can not be answered 8 b Instructions for the use of patient transport. Dear Patient: We turn now to de tail the rights and duties that you will have to be a beneficiary of the shuttle door to door dialysis center. RIGHTS: The recipient patient will be transported to and from his home in vans provided 53 • free by the Dialysis Center in the days and times that are appropriate for your attention. • If for some reason, the assigned vehicle is unavailable, another ve hicle will be provided by the carrier, which also will be no cost to you. • The dialysis center will ensure the security, cleanliness and maintenance of the veh icle. • The vehicle is subject to Law No. 142 of the rules of the Traffic Act, w hich stipulates the prohibition of smoking within it. DUTIES: • Once the existence of quota transfers and home carrier will contact yo u to inform the departure time from home. • Transportation available room ten mi nutes after arrival in the home, so 54 it is essential to be ready ten minutes early. All this for the benefit of and c ompliance with schedules and time of arrival at the turn of all patients who use the service. • The vehicle will announce its arrival honking. We ask that you o r a family take eye contact with the driver as soon as possible to avoid disturb ing their neighbors. • The vehicle will be waiting with the engine running and d oors open. The driver will help you climb. • In the dialysis center you will be helped up and / or lower the vehicle by the driver of the van. • The vehicle sha ll be removed from Dialysis Center once all the group of patients has been accom modated in the van. • Upon returning home, it is important that you wait for a r elative and it should assist the driver to drop the phone. • After a hospitaliza tion, you or a family member must notify the carrier that is high with at least 12 hours prior to restarting the shuttle. If you fail to comply with this reques t must go to dialysis on their own. 55 • The driver always available to you via cell phone ............................ .... N ° 09 • We welcome help in maintaining the cleanliness of the vehicle, eli minating waste in plastic bags inside the vehicle available. 56 57 INFORMED CONSENT Hereby undersigned declares the patient has voluntarily gone to the Santos Dumont dialysis service to receive dialysis treatment is indicated. For that authorizing the dialysis service Santos Dumont to perform the procedure itself and those related to this, including making regular examinations among w hich is the AIDS test (serology for Human Immunodeficiency Virus). Also reported having received the Manual for the Hemodialysis Patient that includes the dutie s and rights of the patient, who accepts and agrees to comply and enforce as app

ropriate. In an emergency situation and the fact that the patient is not able to do so explicitly and specifically,€authorizing the dialysis service team to per form the maneuvers it deems appropriate and necessary to preserve the patient's health. Emergency situations, and after considering the doctor, the dialysis tre atment may be shortened or postponed, provided this does not jeopardize patient welfare. The center undertakes to compensate the time lost in the following dial ysis session, so the total time of dialysis is preserved. The center will handle the necessary programs for the payment of the benefit, the patient agrees to de liver promptly the necessary documents for this. The patient can express their s uggestions, complaints or comments by the book claims or mailbox installed for t his purpose in the waiting room. The center promises to reply in writing within 58 a week. answered. Patient Name: Signature: Santiago, The messages anonymous no will 59 BIBLIOGRAPHY • Charter of Patient Rights, FONASA. • Internet address of Hospital Universitario Reina Sofía de Andalucía: www.hrs.sas.juntaandalucía.es-nursing-p ublicacionestratamiento_diálisis.pdf • Extract Societies instructive Chilean Con gress of Nephrology, Hypertension and Transplantation Viña 2001 • Manual periton eal dialysis, Baxter . • www.CONSUL / manuales.htm 60 61