PREFACE __________________________ Procedures Manual Procedures Manual This pape r aims to guide Procedures Manual nurses about system

assembly and description o f materials in various procedures in intensive therapy Procedures Manual. The nu rse deGilberto Procedures Manual in its training in the Intensive Care Unit of H ospital de Clinicas de Porto Alegre realized the need for a Manual of Procedures Manual for guidance assembly systems such Procedures Manual slow hemodialysis a nd continuous ultrafiltrate, breathing circuits , Swan-Ganz and others. Talking to this Manual aProcedimentos leadership was challenged to use their artistic ta lents (drawing) in these schemes Manualdesenvolvimento Procedures systems. This manual is the result of their work and Procedures Manual deo collaboration of co lleagues Simone and Ivan. Congratulations Manualbem as its employees by having t he Enf. Gilberto, Procedures accepted this challenge and have produced a work of this Manual that this manual can quality. We believe Procedures to assist nursi ng students Manualárea Intensive Care. and future nurses in the Procedures Manu al of Procedures Enf ª Prof. Deborah Vieira, Chief of Staff SETI. Procedures Ma nual Procedures Manual -1 GLOSSARY ________________________ VP VD PCWP PCP DC PVC CO HR MAP DAP PASP PMAP SF ETO ATC BH Un Cm IPR L MI HEP-P CR IV BIA CPAP 2Via Via Proximal Distal Pulmonary Artery Occlusion Pressure, Pul monary Capillary Pressure Central Venous Pressure Cardiac Output, Cardiac Index Right Atrial Pressure Heart Rate Mean Arterial Pressure, Pulmonary Artery Systol ic Pressure Pulmonary Artery Mean Pressure Saline Ethylene Oxide Anti-coagulatio n Continuous Water Balance Units Intermittent Peritoneal Dialysis Liters Centime ters Millimeters Heparin Parada Cardio Respiratory Intra-venous Intra-aortic Bal loon Continuous Positive Airway Pressure Procedures Manual SUMMARY __________________________ HDLC - equipment ............................................... ............... . 04 HEMODIà LIS SLOW AND CONTINUOUS - system ................... 05 ADO-ultrafilt er system ..... ........................................... 05 HDLC - system set up. ...................................... 06 HDLC - water balance sheet ..... . .............................. 08 DPI - equipment and system ............. ..... ................................ 09 DPI - spreadsheet control ....... .......... .............................. 10 Assembly and exchange of IPR system .......... ..................... 11 SWAN-GANZ-material ...... ............................. ................. 13 SWAN-GANZ - implanted catheter system and hemodynamic measu res ................ 14 ...................... ........................ 15 LINE MAP - equipment and system ................... ................. 17 BIA - equipm ent and systems - with a specific transducer ... 18 BIA - equipment and systems - without specific transducer ... 20 MARK BIRD MARK 7 and 8 - system ........... ....................... 22 BEAR and Venturi Mask - system ...... ............... ....... 23 SERVO 300 and CPAP mask - valve ................... .. 24 CPAP Mask FIO2 control and the IBRD ................ 25 Clean respirators and masks ..... ........... ............ 26 Procedures Manual -3 SLOW CONTINUOUS HEMODIALYSIS ______ MATERIAL Mesa Machine to Machine hemolenta sensor bubble Extension electrical (voltage co mpatible) Support specific clamp with protector (6cm.) Gauge Syringe 20 ml Tape artery line (red) venous line (blue) filter dialyzer Hansen Hansen red blue bag collector Silicone sterile closed urinary system (5 cm) Pointer (2 pcs.) Equipo drops (2un.) SF 0.9% 1000 ml (2un.) Solution for dialysis in 1000 ml (2un.) Glov

e procedure if medically indicated: Solution heparin (ATC) Equipo serum Infusion pump Heparin (to flush the system) Syringe Needle -4 Procedures Manual SLOW CONTINUOUS HEMODIALYSIS Line Line venous blood drainage system closed Peritofundin Bottle w / Filter dialyzer tubing (capillary) Ultrafiltered Procedures Manual -5 SLOW CONTINUOUS HEMODIALYSIS ______ MOUNTING SYSTEM Connect a filter in the arterial and venous lines obeying the colors. 2 Adapting the filter in the holder. 3 Secure with tape catabolha the venous line in the s upport and the arterial line at the table 4 Secure the machine with bubbles in the sensor holder 5 Position in the venous part of the line machine with sensor bubbles 6 Connect the pressure gauge with a pointer towards specific venous line (longer end up catabolha) and place it in the holder. 7 Connect the 20 ml syringe in the specific pathway of the venous line (the shorte r catabolha above) receives input from turning around the route of replacement) 8 Adapting the silicone part of the arterial line to hemolenta (9 Adapt the gear on the road with SF replacement every 10 Hansen Adapt the filter (corresponding colors). 11 Fit the bottle of solution to dialysis tubing with the Hansen blue using a pointer to the connection for connecting the silicon 12 Adapting the urine collection bag in red using Hansen -6Manual Procedures 13 Connect the wires, giving equal voltage of appliances - machine to machine with the sensor hemolenta bubble - bubble machin e with sensor on the wall - if necessary, to the machine with sensor bubbles rea ch the wall, use the extension cord with voltage compatibility 14 Carry out cleaning of the system: - If medically indicated, adding heparin to SF - with the aid of forceps, rinse in sections following the path that blood flow will make it from the patient and always leaving an escape route open for air and SF - all seek to withdraw air f rom the system - using two liters SF washing system 15 Fill the filter with a solution for dialysis - Use two liters of solution during the washing system 16 If medically indicated, install the appropriate route in the solution ATC

infusion pump and / or add heparin in SF to do the washing system insensible los ses (body weight x 0.5 x number of hours) 17 The water balance should be calculated every 6 hours, including the Procedures Manual -7 8SAÃ H RA BAN H O No. The TRAD EN VO LU M E 00 h 01 h 02 h 03 h 04 h 05 h 06 h 06h 07 h 08h 09 h 10 h 11 h 12 h 12 h 13 h 14 h 15 h 16 h 17 h 18 h 18 h AD-VO LU ME TO BH BH Parc La BSERVAÃ Ã The TAL ES

19 h 20 h 21 h 22 h 23 h Procedures Manual 24 h HDLC - WATER BALANCE Intermittent peritoneal dialysis ___ MATERIAL Dialysis bag 5000 ml with 1.5% glucose or 4.25% (as a medical indication (4un.)) 5000 ml dialysis bag empty bag for dialysis in 2000 ml empty Equipo octopus Bur eau for dialysis (with heater) Scale Labels tapes to record weights of sterile g loves handbags Mask Intermittent peritoneal dialysis SCHOLARSHIP FOR BATH 200ml Hot plate Collecting bag 5000ml TEMPERATURE CONTROL BOARD EQUIPO OCTOPUS Procedures Manual -9 10Tà RM EN-ION TO TRAD ES BSERVAà à I II N CO SAI SAI AD AD TERM WEIGHT ION BO LSA CO LETO RA VO LU MEDE SAI AD BALAN SERVICE TO SUCH Parc La BH = No. The H BAN I II N CO A EN TRAD VO LU M EN AND TRADE Procedures Manual PERITONEAL DIALYSIS FITTING AND CHANGING THE SYSTEM DPI __ 1) Weigh each bag and put 5000ml sticker with the weight found. Add the weight o f all and note the balance sheet as initial weight (IW) - the column of comments . Wear a mask and sterile gloves. Connecting pathways equipo octopus grants dial ysis. In the case of adding to drugs and / or electrolytes to purses, antisepsis , the route of medication should be taken with alcohol or iodine 70% alcohol. Dr ugs and / or electrolytes should be added to the bags so far as they are being u sed. Fill the bag smaller (2000ml) with the volume specified in the prescription for the baths and put it on the hot plate to warm the liquid (37 ° C). Start t

he infusion bath obeying the time of entry and note the time prescribed in the b alance sheet. During the time spent preparing the next bath (warm). After the pr escribed time shall start the drainage time (output), always noting the times on the balance sheet. The collection bag should be placed on the scale. At the end of exit time, check the weight of the collection bag and write it on the balanc e sheet. 2) 3) 4) 5) 6) 7) 8) 9) 10) Repeat steps 4-9 until the successive entry of all purses. Carry the exchang e system. Procedures Manual -11 11) In the exchange system, clamp the bags filled with clamps IPR. 12) Repeat st eps 1 and 2. 13) Remove the old tip of the bag and introduce the new purse and t he most careful not to contaminate. 14) Restart the system again by repeating st eps 40-10. 15) carry bags weighing of old. The sum of the values found is equal to weight (BW) - note on the sheet below the IP. 16) Make the water balance (PFPI). 17) After the disregard of the scholarships in the purge old clamps IPR mus t be cleaned and reused CLAMPS CLEANING OF IPR 1) 2) When in use, during the IPR, do álccol disinfection with iodine (no need to soak). After use, when the system shuts down, wash with soap and water, dryin g and disinfecting do in CIDEX for 30min. 3) Condition in plastic boxes with lids. -12 Procedures Manual Swan-GANZ _____________ MATERIAL Swan-Ganz catheter 8.5F 7F Introducer Tray subclavian puncture sterile gloves (p air) Gauze (3 packets) Chlorhexidine Field sterilized (2 pcs. Large) 2 or 1% Xyl ocaine without epinephrine Syringe Needle 25x06 10 ml (2un) SF 0, 9% 250ml (bott le) 20 ml Syringe (3ml) taps (7un) Extension for serum (4 pcs) membrane pressure transducer Transducer Support Support for serum cardiac Monitor Module PRESS Procedures Manual Catheter for infusion pump (2un) 250ml 0.9% SF +0.3 ml heparin (2un) Infusion pu mp (2un) Equipo drops serum (flush) SF SF 250 ml 0.9% 0.9% 100ml (for thermomete r cable cardiac output CO Module. Equipo for serum (drops or micro, depending on the choice of infusion introducer Soro as medical indication for infusion into the introducer) wire suture material for dressing (obs. .. routine) PCR Micropor e Car -13 - SWAN - GANZ - SYSTEM CO Cape Cape module module press membrane pressure transducer taps

Via proximal distal SWG SWG Via Via Via cardiac output cuff - SWAN - GANZ - cath eter Thermistor PULMONARY ARTERY Balonet VIA PROXIMAL VIA DISTAL RIGHT ATRIUM -14 Procedures Manual Hemodynamic __________ 1. Position the patient obeying the level "zero" the bed x membrane pressure. 2. "Zero" the pressure of the membrane permeability and confirm VP and VD (flush). 3. PCWP - Open RV to the membrane pressure. - Monitoring Procedures + Wedge - I nflate cuff (check specific change in the pressure curve). - Stop Trace: deflate the cuff. - Edit + Wedge. - Position the cursor over the line pressure curve: a t the end of expiration, or if pulmonary hypertension, the wave deflection (PCP) . - Note the value. - Record values of systolic, diastolic and mean. - Open to V P membrane pressure. - Monitoring Procedures + Wedge - Note value. 4. PAP 5. PVC 6. DC - Display Standard Monitoring Procedures + + CO - repeat three times: SF a spirate 10 ml syringe connected to the VP Start CO (read inject Now) quickly inj ect the syringe, maximum 4 sec. Procedures Manual -15 - Edit CO. obs tolerance 10% of the difference of values of the DC if you want t o delete some cur va: Select Curve + On / Off For 7th Avg. Confirm Hemo + Calc. 8. Register the table values: CO, HR, SBP or DBP + MBP, PASP + PDAP or PMAP, PVC , PCP or PCWP, Weight, Height. 9. Perform Calc 10. Copy values to the control sh eet Hemodynamic Monitoring -16 Procedures Manual ___________________ MATERIAL FOR ONLINE MAP - IV Catheters (abocacath options caliber) - Glove procedure - Gaze (1pacote) Chlorhexidine - Micropore - tape - Extension for serum (3un.) - taps - Membrane - pressure transducer - Support for transducer - MAP Support for serum cardiac Monitor Module PRESS Equipo 20 ml Syringe for infusion pump SF. 0.9% 250 ml + 0.3 ml heparin infusion pump Equipo drops serum (flush) SF. 0.9% 250 ml (flush) to level Ruler Cape module press membrane pressure transducer taps Extender w / PAM Procedures

Manual -17 Intra-aortic balloon ______________ (With specific transducer) MATERIAL Intra-aortic balloon catheter Control Console cable console for cardiac monitori ng electrodes (5un.) Tray subclavian puncture sterile glove (Pair) Gauze (3 Pack s) Chlorhexidine Field sterilized (2 pcs. Large) 2 or 1% Xylocaine without epine phrine syringe Needle 10 ml 25 x 06 (2 pcs.) SF 0.9% 250 ml (bottle) Syringe 20 ml (3un.) taps (5 pcs.) Extension for serum (2un.) membrane pressure (dome) Tran sducer specific (Island) Support for serum cardiac Equipo Monitor for infusion p ump 250ml 0.9% SF +0.3 ml heparin Procedures Manual -18 -

Infusion pump Equipo drops serum (flush) 0.9% 250ml SF (flush) Material for dres sing (obs. routine) Micropore Ruler for CRP level car - BIA with a specific transducer Membrane pressure (dome) Cape console w / cardiac monitoring Extender specific B IA Via taps w / BIA pressure monitoring (pressure) transducer specific console Procedures Manual -19 Intra-aortic balloon ______________ (No specific transducer) MATERIAL Intra-aortic balloon catheter Control Console cable console for cardiac monitori ng electrodes (5un.) Tray subclavian puncture sterile glove (Pair) Gauze (3 Pack s) Chlorhexidine Field sterilized (2 pcs. Large) 2 or 1% Xylocaine without epine phrine syringe Needle 10 ml 25 x 06 (2 pcs.) SF 0,9% 250 ml (bottle) Syringe 20 ml (3un.) taps (5 pcs.) Extension for serum (2un.) membrane pressure (flat) tran sducer (heart monitor) support Support for serum transducer module PRESS Cardiac monitor catheter for infusion pump Procedures Manual -20 -

250ml 0.9% SF +0.3 ml heparin infusion pump Equipo drops serum (flush) 250ml 0.9 % saline solution (flush) Material for dressing (obs. routine) Micropore Ruler f or CRP level car

- BIA without specific transducer Module cable press-membrane pressure transducer (flat) Procedures Manual -21 BIRD MARK 7_______________________ BIRD MARK 8_______________________ -22 Procedures Manual BEAR ______________________________ Oxygen Extender VENTURI MASK _______________ MASK TRACHEA PIPE VALVE Extender OXYGEN Procedures Manual -23 SERVO 300 _________________________ Gray wire long gray wire short MASK CPAP _____________________ (With valve) -24 Procedures Manual MASK CPAP _____________________ (FiO2 control) MASK CPAP _____________________ (With Bird) Procedures Manual -25 CLEANING AND MASKS BREATHERS _______________________ BIRD MARK 7, MARK 8 and 5 BEAR 1) Remove and rinse the circuit with warm water and soap enzyme (soak for 30 min utes.). 2) Rinse in running water. 3) Dry the material. 4) Put in glutaraldehyde for 30min. 5) Remove the material from the glutaraldehyde, rinsed in sterile di

stilled water and dried with compressed air on the sterile field. 6) Establish a nd adjust the respirator assembly, protecting the length of the trachea. SERVO SERVO 900 and 300 1) Remove the respirator and replace the green filter short internal circuit. 2) Clean the respirator externally with a damp cloth. 3) Wash the circuit with war m water and soap enzyme (soak for 30 minutes.). 4) Remove the soap, brush and ri nse under running water. 5) Dry the material in compressed air. -26 Procedures Manual 6) Assemble the circuit (with having the unit) and send it, properly identified, the CME, with IC. 7) The respirator should be fitted with loose circuit sterili zed. NOTE: a) Thermometer SERVO - damp mop with water and soap (not wet the plug) - pass we t cloth to rinse and dry. b) Sensor temperature control circuit of the Servants (gray wire) - Skip cloth dampened with water and soap, rinse and dry. - Replace in place. - When assembling the circuit, pass gauze soaked with 70% alcohol only in the tip of the plug circuit. c) Sensor electrical internal circuit - should be immersed in a tank round with 70% alcohol for 30min. - After dry, put it back in its place. Procedures Manual -27 CPAP MASK 1) Wash the mask with warm water and soap enzyme, along with the clip (soak for 30 minutes.). 2) Dry and store in plastic box dry, clean and closed 3) The expir atory valve, the plastic hose and connector should be washed with soap and water enzyme (soak for 30 minutes.), Rinsed in running water and dry. 4) After should be placed for 30min. in glutaraldehyde and rinsed with sterile distilled water. Should be dried in the air on the sterile field. 5) After dried must be packed in plastic box with the mask. VENTURI MASK 1) Wash the mask, the trachea, the valve and nebulizer (pipe) in warm water and soap enzyme (soak for 30 minutes.). Remove secretions and / or crusting. 2) Rins e with tap water and dry the material. 3) Place the material in glutaraldehyde f or 30min., Remove and rinse in sterile distilled water. 4) 1sec in the compresse d air on the sterile field. 5) placed in boxes, dried, cleaned and closed. -28 Procedures Manual