Pre-dialysis

1. Before or around the time the patient arrives for his/her scheduled session, a dialysis machine will
be prepared. 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.

2. 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.

3. The patient arrives and is carefully weighed. Standing and sitting blood pressures are taken.
Temperature is taken.

4. Access is set up. For patients with a fistula 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. 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.

Dialysis

1. The pump and a timer are started. Hemodialysis is underway. Periodically (every half hour,
nominally) blood pressure is taken. A session of hemodialysis may typically remove 2-
5kilograms (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,
nausea, shakes, dizziness, lightheadedness, and unconsciousness.

Post-dialysis

1. 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.

2. 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, 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.'
 CLINICAL PROCEDURES V. 1.0 HEMODIALYSIS MODULE

Cover tab

After selection of a patient, this is the first tab to display. You can view current treatment information,
past treatment information by date, and vascular access monitoring information on this tab. This screen
also displays information about infectious diseases, transplant status, allergies, clinical warnings, and
advanced directives. Finally, you can use this screen to print historical result reports.
Rx and Lab Tab

Use the Rx and Labs tab to enter the dialysis prescription and view lab results.

The following information is displayed on the Rx and Lab tab:

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Order

Anticoagulants

Modeling

Dialysate Formula

Other Orders

Lab Results

Comments

Lab Tests includes:

National Lab Code Lab Test

84520 BUN (Blood Urea Nitrogen)

82565 CREATININE

84295 SODIUM

84140 POTASSIUM

82435 CHLORIDE

82830 CARBON DIOXIDE

82310 CALCIUM

84100 PHOSPHORUS

82040 ALBUMIN

84455 AST (Aspartate Aminotransferase)

84465 ALT (Alanine Aminotransferase)

84075 ALKALINE PHOSPHATASE

82250 BILIRUBIN

83020 HEMOGLOBIN

85055 HEMATOCRIT

85569 WBC (White Blood Count)

86806 PLATELETS

83057 HEMOGLOBIN A1C

82466 CHOLESTEROL

84480 TRIGLYCERIDES

82370 FERRITIN

83540 IRON

82060 TRANSFERRIN

84012 PARATHYROID HORMONE

81512 ALUMINUM

89068 HEPATITIS B SURFACE ANTIGEN

89065 HEPATITIS B SURFACE ANTIBODY

89067 HEPATITIS B SURFACE ANTIBODY

82013 HEPATITIS B SURFACE ANTIBODY

89095 HEPATITIS B SURFACE ANTIBODY

89127 HEPATITIS B SURFACE ANTIBODY

89128 HEPATITIS B SURFACE ANTIBODY

87398 HEPATITIS B SURFACE ANTIBODY

89699 HEPATITIS B SURFACE ANTIBODY

89070 HEPATITIS C ANTIBODY

87261 FLU
Pre-Treatment Tab

The Pre-Treatment tab is used to enter pre-dialysis vitals and pre-dialysis pain assessment.

The following information is entered/ displayed on the Pre-Treatment tab:

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Weight

Temperature

Blood Pressure and Pulse

Other

Mental Status

Barriers to Learning

Patient Education

Patient Transportation

Safety Checks

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Access Tab

You can enter information about vascular access sites on the Access tab. Use this tab to add, assess, select,
remove, and comment on access sites.

The following information is displayed on the Access tab:

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Flowsheet Tab

Use the Flowsheet tab to capture data from the dialysis instrument and manually enter dialysis
information and medications used during treatment

The following information is displayed on the Flowsheet tab:

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during treatment.

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The following information is entered/ displayed on the Flowsheet tab:

B/P - Blood pressure

MAP - Mean arterial pressure

HR - Heart rate

BFR - Blood flow rate

DFR - Dialysis flow rate

AP - Arterial pressure

VP - Venous pressure
 TMP - Trans membrane pressure

UFR - Ultrafiltration rate

Fluid Off - Cumulative volume of fluid removed from patient

HEP (CUM) Cumulative Heparin infusion

COND - Conductivity

BIC - Bicarbonate bath

DIAL TEMP - Dialysate temperature

IONIC DIAL - Measurement of clearance via ionic or conductivity estimation

Kt/V - Dose of dialysis

Important: Labs must be taken mid-week for the KT and KT/V calculations to return accurate results.

Medication List Columns

The following information can be entered in the Medication List:

Date - Date the entry was added.

Time

Medication

Dose

Units

Route

Given By

Reason

Outcome
Post-Treatment Tab

The Post-Treatment tab is used to enter vitals, observations, and pain assessment after the dialysis
treatment has completed.

The following information is displayed on the Post-Treatment tab:

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Weight

Temperature

Blood Pressure and Pulse

Other

Mental Status

Observations

Patient Transportation

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