Enrollment No:- 1806160021

Exam Seat No:-

PROJECT ON HOSPITAL TRAINING

Submitted in partial fulfillment of the
DIPLOMA IN HEMODIALYSIS TECHNICIAN
AFFILIMENT TO THE
MAHARASHTRA STATE BOARD OF TECHNICAL
EDUCATION, MUMBAI
Semester – Final
Batch (2018-2020)
Institute Name:-SVJCTs College of Advanced
Studies, Dervan
BY
Ms: - Pallavi Suresh Shetye

Signature of Student:-
Date:-
Signature of Examiner:-

(Internal) (External)
 DEDICATION
I dedicate this hospital training project to,
My most beloved parents,
My teachers
&
My All friends.

Ms: - Pallavi Suresh Shetye

 ACKNOWLEDGEMENT
Completion of Hospital Training cannot be done single
handed. My training was much simplified by my college and
staff of the Hemodialysis Unit.
I am grateful to the Authorities of B.K.L Walawalkar
hospital.
Dr. Suvarna Patil (Medical Director)
Mr. Prafulla Godbole (Administration)
For grating admission and providing and excellent
opportunity to complete the course.
I acknowledgement with deep gratitude, the invaluable
guidance and help received from
Mr. Anil Rahate (Hemodialysis Unit Incharge)
Mrs. Suchita Nerurkar (Hemodialysis Technician)
Mr. Premkumar Korochikar (HOD, College Of Advanced
Studies) And all the Hemodialysis and hospital staffs
including my friends.
Who have directly and indirectly helped and co-operated
during the trainer of the course, and especially during on year
of Hospital training.
 INDEX
SR. CONTENTS PAGE
NO NO.
.
1. Organization & function of Dialysis Department.
2. Work flow in Dialysis Department.
3. Admission in Dialysis Department
4. Monitoring of Dialysis Patients.
5. Preparation of Dialysis Fluid.
6. Pre Dialysis Tubing & Dialyzer Washing.
7. How to operated Dialysis Machine.
8. How to start Dialysis.
9. Monitoring & Care of vascular access.
10. Complication during Dialysis & Its management.
11. Managing of bleeding & Clotting problem during Dialysis.
12. Administration of Iron Inj.
13. Administration of Erythropoietin Inj.
14. Administration of Blood Transfusion.
15. Termination of Dialysis.
16. Post dialysis cleaning of Dialyzer & Blood lines.
17. Machine Disinfection.
18. Diet of Dialysis Patient.
19. Vaccination schedule.
20. Universal safety precautions for health care workers.
21. Safety in Dialysis Department with fogging Machine.
22. Quality control in Dialysis.
23. R.O. Plant.
24. Day-To-Day Record of Actual Work Done.
 1) ORGANIZATION AND FUCTION OF DIALYSIS
DEPARTMENT.
1) Name Of Department – Hemodialysis Department
2) Year of Establishment -2017 Working
3) Hours - 8hrs (9.00 am to 5.00 pm)
4) Location – New Hospital (I.P.D Building) Ground Flower and Near the Medicine wad
5) Function – Hemodialysis

Organization:-

B.K..Walawalkar
Hospital.
InCharge: Medical
Director.

Casualty Reception
Department

Pathology
Department

Blood Bank Hemodialysis

Department.

Cash
Counter

2) WORK FLOW IN HEMODIALYLSIS

 DEPARTMENT.
Introduction:-
The hemodialysis department B.K.L Walawalkar hospital, Diagnostic&

Research center, consists of Seven hemodialysis Machines (7 HD machines of Fresenius).The

MICU of the hospital is also equipped with portable Hemodialysis machine. The department

works for12 hours & daily on an average received 08 to 10 patient per day for dialysis.

THE ROUTINE FUNCTIONING OF THE HEMODIALYSIS

DEPARTMENT

Registration of the patients

Clinical Examination

Blood sample
Sent to lab Serological Reactive Dialysis
Test Rejected

Non Reactive

Admission in the dialysis department

Physical Check up

Dialysis Therapy

Post Dialysis Investigation

Discharge of patients

Machine Maintenance
3) ADMISSION IN THE DIALYSIS
DEPARTMENT.

The patient requiring dialysis is recommended by the Physician & sent to the dialysis

Department. The Dialysis staff registers the patient details in the registration book. Their details

Like name, address, age, diagnosis, starting date of dialysis etc., are noted in the admission book

for previously registered patient dialysis setting &total hours of dialysis per patient are checked.

Further the patient is taken for dialysis.

When the patient comes to dialysis unit, the senior nurse /technician gives information
Regarding dialysis. The information like pre-dialysis investigation & also advantage of dialysis
which will be required for the dialysis process are given to the patient as well as their relatives.

Senior nurse/ technician gives idea to the patient that how many times he has to come for
the dialysis in the week. In this way they counsel &give confidence to the patient before doing
dialysis.
 4) MONITORING OF DIALYSIS
PATIENTS.

Pre- dialysis procedure :-

Operating of RO machine

Operating of dialysis machine &preparing for dialysis

Water service for dialyzer.

To determine weight of hemodialysis patient

To determine Blood pressure

To determine pulse rate

To determine body temperature.

Priming of dialyzer & blood line

Choice of dialyzer

History of bleeding

History of surgery if any indoor patient

Preparing of Heparin dose

During dialysis procedure

Any intra-dialectric complication

Vascular access.

Records of Dialysis treatment

Each dialysis treatment shall be recorded

Long term monitoring of dialysis patient.

Blood investigation shall done regularly three month intervals more often as necessary.
5) PRARATION OF DIALYSIS FLUID.

A) Principle-

Dialysis solution used in dialyzer as dialysate flow for electrolyte balance in patient

Blood

B) Procedure -

Take 10 liter. Purified hot water

Mix 660 gm sodium bicarbonate powder & sodium chloride powder in hot water

Shake well the solution to dissolved powder

This dialysis fluid used for dial sate flow.

 6) PREE DIALYSIS TUBING & DIALYZER
WASHING

Procedure

1) Keep Normal saline ready with blood set.

2) Wash out the Rena clean solution which is filled during post dialysis tubing washing.

3) Hold the whole blood tubing set to the blood line clips on the machine. The end tip

of Arterial line is to be attached to the blood set.

4) First wash the arterial chamber line with minimum100 of normal saline.

5) Start the Blood pump with flow 100-150ml/min. Clamps the arterial line with

arteryforceps which is attached to the dialyzer & wash the Heparin line with 100 ml

of normal saline.

6) Then wash dialyzer minimum 500 ml normal saline &speed of the blood pump

should be300-400 ml/min.

7) Attach the venous line to the dialyzer.

8) Wash the venous chamber line (long& small) with 100 ml ns. Start the bloodpumpwith

200- 230 ml/min. Clamp the small line &end clamp of venous line. Wash the long venous

line the small line &end the whole tubing by the opening of the end clamp of venous line.
PREE DIALYSIS TUBING & DIALYZER WASHING
 7) HOW TO OPERATE DIALYSIS MACHINE
The normal progression of the machine operation for a dialysis treatment is power on stand by
after dialysis (& the patient disconnected), the treatment data is recorded, the fluid path is rinsed &
the fluid path is disinfected as required.

Procedure:-

POWER ON

Standby

Rinse

Self Test

Prime

Dialyze

Then given a comfortable portion to the patient & start the dialysis
 8) HOW TO START DIALYSIS

1) Check that all equipment (i.e., Dressing tray, IV NS 500 ml. Blood tubing set attached

withdialyzer, inj. Heparin, AV Transducer, etc. ) and machine are ready to start dialysis.

2) Check the weight of the patient, tally it with the prevent post dialysis weight of the patient

&record iton the “ Flow chart file”.

3) Give a comfortable position to the patient.

4) Wash the hand thoroughly & wear sterile gloves.

5) Check the patency of the IV line for dialysis.

1) IF DOUBLE LUMEN IS PRESENT

Procedure:-
1) Open the dressing around the catheter carefully.

2) Clean the exposed lumens with sprit properly.

3) Check the blood flow from both the lumens by aspirating andreinserting blood

with help of disposable syringe 10 mlor 20 ml (Sterile ).

4) Clean the Arterial (Red) lines of the blood tubing set with spritand Attach to the

Arterial lumen & the clamps of both tube.

5) Start the blood pump with speed 150ml to 200ml.

6) Stop the blood pump and clamp the venous line immediately, assoon as blood will be visible

in the venous chamber

7) Clean the venous line with spirit and attach venous line of the catheter and open the clamps

of both tubes.

8) Start the Blood pump with speed 150ml to 200ml/min.

1. STARTED THE DOUBLE LUMEN
PROCEDURE
 2) IF FISTULA IS PRESENT
Procedure:-
1. Palpate the Fistula and developed veins through it.
2. Clean the patients hand with spirit at least 3 time (central to peripheral).
3. Prick the well-developed veins (visibly as well as palatably prominent) by using
fistula needle (no. 16 to 17) one directing towards fistula and another directing
opposite toFistula. Fix the needles by using micro pore sticking.
4. Remove the air from needles with the helps of syringe and check the position of needle
in the vein by using IV NS line.
5. Clean the arterial (Red) lines of the Blood tubing set with spirit and attach to the arterial
line (needle directing towards fistula & open the clamps of both tubes.
6. Start the blood pump with speed 150 ml to 200 ml/min.
7. Stop the blood pump and clamp the venous line immediately, when blood will be visible
in the venous chamber.
8. Clean the venous line with spirit and attached to the venous line (needle direction
opposite tofistula) & open the clamps of both line.
9. Start the blood pump with speed 150 to 200 ml/min.
2. STARTED THE FISTULA PROCEDURE.
a) Clean the venous line of the blood tubing set, below the venous chamber and inner

portion Of the inner detector with spirit swab.

b) Insert the venous line in to the Air Detector. Close the chamber and open the clamp

ofvenous pressure monitoring line immediately.

c) Press the button of ‘DIALYZE’ & ‘VERIFY’ on the screen of machine.

d)Stop the blood pump as soon as machine gibes an alarms and press he ‘RESET’ button .

e) Restart the blood pump with 150 to 200 ml/ min, when machine show

DIALYZE MODEOn the screen.

f)Give 2 to 3 ml bolus of inj. Heparin and set the rate of ‘HEPARIN PUMP’ with

1ml/ min.

g)Set the conductivity as per requirement of the patient (If the patient’s BP is high

i.e., More than 160/90 mmHg set the conductivity lowest i.e., 138 ml/cm. If BP is less

than 100/60mmHg. Set the conductivity highest i.e., 150ml/ cm.)

h) Enter the weight, which we want to remove per hour in “UF Rate Manual”

Column (e.g.,Patient has increase 4 kg of weight than previous post dialysis weight.

We want to remove 4kg of his weight in 4hrs. dialysis setting & 1 kg= 1 lit.

So we should enter 1.00lit/hrs. Setting, in the column of “UF Rate Manual”)

i) Adjust the time required for dialysis ‘Elapsed Time’ column(e.g.,4.00 hrs. for

Regular OPD patient but in may be varied in IPD patient)

j)Adjust level of blood in venous chamber, at least little more than the half of

chamber (so that the blood will not flow out in the venous pressure monitoring line)

k) Increase the flow of the blood pump up to 200 to 250 ml/min.

l) Record all the setting made on the machine for the patient in the ‘flow chart file’ &

TPR Chart file.

m) Check the BP of the patient half hourly & record it in the ‘TPR chart file’

n) There is a separate line to give an injection to the patient during Dialysis,

‘venous chamber’ (small file )

o) IV NS 500 ml bottle should be attached to the Dialysis Blood tubing set at

the ‘Arterial chamber ‘(Small line ).

 9) MONITORING & CARE OF VASCULAR
ACCESS.
Continuous assessment for signs Symptoms of vascular Access complication shall

be performed during each hemodialysis.

A) Fistula:
1) Blood flow
2) Venous pressure
3) Thrombosis
4) Mechanical failure
5) Infection
6) Arterial insufficiency / steal syndrome
a) Care of post Dialysis Fistula
1) Bruit to be Heard on standing
2) Do not use belt to tighten in new fistula
3) Low BP patient do not send home immediately. Let patient rest for 1hrs / till BP comes
on standing

B) Catheter
1) Exit site infection
2) sign of catheter thrombosis
3) symptom& sign of catheter blood stream infection

b) Care of jugular catheter

1) Use sterile gloves / not clean gloves
2) Use sterillium before touching
3) Keep jugular covers in betadine solution
4) After closure use Gentamycin injection plus heparin lock (5mg gentamicyn / ml or use 20
mg vail ofgentamicyn.)
5) Daily remove dressing of jugular
6)If rigors use refine (1gm)+gentamycin(40mg) plus Febrinil.

7) Check filter. Ro plant sterilization, check no. of reuse of dialyzer. & tubing &hand

washingtechnique & sterillium use in the unit

Operating of dialysis machine
 10) COMPLICATION DURING DIALYIS & ITS
MANGEMENT
A)Hypotension :-

S/S :- Blood pressure less than 100/60mmHg.

Treatment: - Stop the Ultrafiltration rate

-Give 100 to 150 ml Normal saline Throug
The blood tubing set
- Give Head -low position to the patient
- Check thick the BP Frequently after every 5 min
- Repeat NS, if needed
- When BP will be normal, enter weight slowly
- Use high sodium dialysate
- No eating on dialysis
- NO BP tablets before dialysis
- Lower the Temperature of dialysis

B)Muscle Cramps :-
S/S patient feel restless.

-Treatment feeling of tough muscles

- Give 100 to 150 ml normal saline through the Blood Tubing Set
- Massage to the affected area
- Give the medication as per prescribed by the doctor’s order
(i.e.,- inj. calcium gluconate 10 cc / inj. soda Bicarb20 cc
C) Vomiting:-

S/S – Patient feels nauseating &also vomits some time.

Treatment:- - Give Kidney tray to the patients

Stop the ultrafiltration rate & Blood tubing set & decrease the
blood flow rate
- check BP of the patient

- Give 100 NS through the Blood tubing set

- Let the patient be comfortable
- then re-enter the weight & increase the ‘Blood Flow Rate’slowly
D)Allergic Reaction
S/S – Shivering, Fever,Cold Felling

Treatment:- Stop dialysis immediately & inform the

consultant

- Clamp both arterial & venous line of the dialysis Blood

Tubing set to other & Rotate the Blood by starting blood
pump (150-200ml / min)
- Treat the Patient as per Doctor’s Order
- Restart the Dialysis slowly when patient feel comfortable

E) Hypertension

S/S- Blood pressure more than 160/90mmHg

Treatment :--Decrease The sodium level of the dialysis fluid

(minimum-138, Maximum-152)

- Slowly bring down the dry weight

- 3 times a week dialysis strictly only 2kg weight gain allowed
between 2 dialysis
- Use Deepen Retard then Arnament for BP Control
- Use Ecosprin for all patient with ischemic heart disease,
stroke, diabetic patients
- Avoid sublingual Deepen (5mg) , use oral

F) Cardiac Arrest

S/S- Slow Plus, low Blood pressure, Apnea or Gaspic Breathing

Treatment:--Stop the dialysis immediately & inform to the consultant

doctor immediately
- TreatABC

- Treat the Patient as per order

 11) MANNAGNIG OF BLEEDING & CLOTTING
PROBLEM DURING DIALYSIS
ANTICOAGULANTON I WITHOUT ADDED RISK OF BLEEDING

We recommend that patients without increased bleeding risk should be given

Unfractionated heparin or LMWH during dialysis to reduce the risk of clotting of the

Extracorporeal system

ANTICOAGULATION WITH SIGINFICANT RISK OF BLEEDING

We recommend that anticoagulation should be avoided or keft to a minimum in patient with

a high risk of bleeding. This can be achieved by using a high blood flow rate and regular flushing
of the extracorporeal circuit with saline every 15-30 minutes regional citrate infusion.

ANTICOAGULATION IN PATIENT WITH HIT TYPE 2

We suggest that patient with HIT types 2 should not be prescribed unfractionated low
molecular weight heparin (LMWH).

PREVENTION AND DETECTION OF VENOUS FISTULA NEEDLE OR VENOUS LINE

DISCONNECTION

We suggest that all hemodialysis staff should follow standard operating procedure to
minimize to risk of accidental venous needle/ line disconnection. in patient who are restless of
undergoing hemodialysis at home consideration should be given to use of commercially available
monitoring system.

SUGERY WITHIN THE PREVIOUS24 HOURS DO NOT USE HEPARIN

One must be particularly concerned about bleeding any dialysis patient who has had surgery within
the previous 24 to 48 hours. Who has recently been injured? Who may have hemorrhagic lesion of
the gastrointestinal tract.

CLOTTING PROBLEM DURING DIALYSIS PROCESS

At the same time such patient may show an amazing propensity to clot dialyzer circuit. These
frequent clotting time patient should be maintained with short clotting times, either by very tight
heparinization (small dose, frequent clotting time determinations)

12) ADMINISTRATION OF IRON INJ.

Infusion:-

1) Iron sucrose may be administered by fusion (into the dialysis line for hemodialysis

patient)

2) Infusion must be administered as every 5 ml.

3) Iron sucrose diluted exclusively in a maximum of 100ml NS, immediately prior to

Infusion the solution must be infusing at a rate of 100ml of iron over a period of at least

15 minutes.

4) Unused diluted solution must be discarded.

 13) ADMINISTRATION OF ERYTHROPOIETIN
INJ.

A) DOSEGE AND ADMINISTRATION.

1) Anemia Associated with chronic renal failure.

2) The recommended range for the starting dose of erythropoietin is 50 to 100 units /kg TIW

for adult patient. the dose of erythropoietin should be reduced as the hematocrit approach

36% or increase by more than 4 point in any 2-week period.

3) Erythropoietin may be given either as an IV or S. C.injection.

4) During therapy, hematological parameter should be monitored regularly.

5) Dose adjustment should not be made more frequently than once a month unless.

clinically indicated.

B) Preparation And Administration Of Erythropoietin.

1) Do not shake as vigorur shaking may denature any glycoprotein, rendering it biologically

in active.

2) Use aseptic technique in durg administration

3) Use one dose pre filleted syringe. The discard unused portion, do not dilute/ administer in

conjunction with other solution

 14).ADMINISTRATION OF BLOOD
TRANSFUSION.

1) In case of C.R.F patient with HB – below 7 gm.

2) In order to avoid overload / pulmonary edema.

3) Only pack cell volume bag given to dialysis patient.

a) Procedure:-
Advice Blood Transfusion During Dialysis.

Collect Blood sample for cross match.

Patient's relative has to pay for cross match & Issue.

Cross match form send to Blood Bank.

Then check BT, of same Blood group with Doc, Doe with
serology test Negative Started to patient after consultants
Order.

It reaction comes.

In that case Inj Hydrocort's, inj Avil given to patient.

/ stop BT.

If Control If no control
Restart BT Patient shifted to ICU
 15) TERMINATION OF DIALYSIS.
1. Stop the ‘Heparin pump’ by setting ‘0 ml /hrs. rate. Clamp the Heparin line & Remove
the heparin.
2. Enter the rate ‘0’ in ‘UF Rate Manual’
3. Stop the blood pump
4. Clamp arterial lines of both the (i.e., Dialysis Blood Tubing & Double Lumen / Fistula
Needle)
5. Attached the IV Ns line to the Arterial line of the Dialysis Blood Tubing set with the
help of connector & open the clamp of it.
6. Now start the blood pump with speed 150 -200ml/min
7. Remove the NS line when arterial line of the Dialysis Blood Tubing set will show
complete clean NS in it.
8. Stop the blood pump, when venous line will show near by clean NS in it & clamp both
venous lines of Dialysis Blood Tubing Set. & Double Lumen / Fistula needle.
9. Now attach the venous line of Dialysis Blood Tubing set Arterial Line of Double
Lumen/ Fistula Needle.
10. Allow the NS to flow through it, until the arterial line will be clear. The clamp both that
lines.
11. Remove the venous line of Dialysis Blood Tubing set & attached it to the arterial line
Dialysis Blood Tubing set.
12. Remove the Dialyzer Drain.
13. Remove the venous line from ‘Air Detector’ & Set the machine to the ‘RINSE’ mode
IF DOUBLE LUMEN CATHETER
1) Clean the exposed catheter with spirit

2) Push the dilute heparin (1: 5 i.e., 1cc inj. heparin diluted in4cc IV NS) In both

lumen &close those lumens with caps properly.

3) Dressing should be done by using sterile dressing material only

IF FISTULA IS PRESENT
1) Remove the fistula needle & give an adequate pressure (i.e., - blood will stop but

at the same time fistula will not get much pressure so that it will function normally)

at the prick site tostop bleeding.

2) Put a bundle of gauze pieces on the prick site & tight with help of tourniquet.

Fix cotton sticking on it to fix the position.

3) Reminds the patient to remove it after 4 hrs.

 Check BP & Weight of the patient respectively & record it on the “flow chart
file”.
 Record all the data from first on the ‘Hemodialysis Record Card’ of the
patient. put next appointment Date & Time & Return it to the patient.
16) Post dialysis cleaning of dialyzer and blood line.
1) After Dialysis tubing washing is very important.

2) Disconnect the arterial and venous line form the dialyzer

3) First flush the dialyzer with water (RO plant water) and the then give the

pressure cork and Hansen’s connector/daily sate line to remove the blood/

blood clots from fibers.

4) Then connect the to tubing with tubing connector and the open the cork and

clamp of the tubing. Flush the tubing with water.

5) Remove the water form the tubing and put out sodium hypochloride

(2.5 lit Hypo: 7.5lit water). If blood clots are dissolved then remove the

hypochloride from tubing.

6) Again Flush with water and finally insert the renaclean.(400 ml renaclean

/ 9600 ml water) in whole to and close the dialysis blood tubing set in

endings with the caps.

7) Then again wash the dialyzer with water. Check properly that all the blood

clots are removed from fibers.

8) Remove the water from dialyzer and insert the renaclean in the dialyzer.

NOTES:- Do not wash dialyzer with hypochloride.

Renaclean solution’s hypochloride solution should be prepared daily

9) Then proper storage of blood lines and dialyzer in self as per patient’s name for

reuse of the same patient in the next shift.

POST DIALYSIS TUBING & DIALYZER
WASHING
 17) Machine disinfection

Since a recalculating disinfection method is needed to disinfect the powdersections of

thefluid path machine recommends weekly disinfection with bleach then heat for machines

equipped with powder bicarbonate option. Machine recommends that value regular cultures

betaken of the dialysate to ensure that the bacterial level in the dialysate acceptable. To properly

disinfect the powder system a strict disinfection scheme must be followed.

The following are the recommended combinations that will the most effectivedisinfection.

Every treatment day disinfect with either one :-

1) Rinse machine (Before & After Dialysis)

2) Formaldehyde

3) Hypochlorite & Bleach

4) Acetic acid

5) Heat cleaning
 1. RINSE MACHINE BEFOR DIALYSIS

PROCEDURE:-

TURN ON THE WATER SUPPLY

TURN ON THE MACHINE.

START THE RINSE MODE

TOUCH RINSE BUTTON

TOUCH VERIFY BUTTON

DISINFECT THE FLUID PATH

B) RINSE MACHINE (AFTER DIALYSIS)

 (PATIENT DISCONNECTED)
PROCEDURE:-

CONNECT THE CONCENTRATELINES TO THE MACHINE

INITIATE THE RINSE MODE

RINSE THE MACHINE WITH WATER

FOR 10 MINUTES

DISINFECT THE MACHINE

ASREQUIRED

TURN OFF THE MACHINE

(PRESS THE FRONT PANEL ON /OFFSWITCH)

TOUCH THE POWER OFFBUTTON

TOUCH THE VERIFY BUTTON

TURN OFF THE WATER SUPLY

2) Rinse with formaldehyde

PROCEDURE:-
TOUCH THE RINSE MENU
 CHEMICALMENU

FORMALDEHYDE

VERIFY BUTTON

PUT THE YELLOW LINE IN THE CHEMICALSOURCE FORMALINE,THEN

PINK TOTHEYELLOW PORT.

THE MACHINE WILL AUTO MICALLY INFUSE FORMALINE

IF THE CONDUCTIVIY IS ABOVE1.0 MS/CM

THEN AFTER AROUND 3 MINUTES IT WILL AGAIN PROMT YOU TO PUT

YELLOW LINE INTO YELLOW PORT &PINK LINE IN TO PINPORT.

THE MACHINE WILL RECYLE FORMALIN FOR5 MINUTS & WILL

SWITCH OFFAUTOMATICALLY.

3. Hypo chloride or Bleach.

PROCEDURE:-

TOUCH THE RINSE MENU

CHEMICAL MENU
 HYPO CHLORIDE/BLEA

VERIFYBUTTON

PUT THE YELLOW LINE IN THE HYPO CHLORIDE THEN PINKLINE

TO THE YELLOW PORT.

THE MACHINE WILL AUTO MATICALLY

INFUSE HYPOCHLORIDE

IF THE CONDUCTIVITY IS ABOVE 1.0 S/CM.

AFTER 15 MINUTE OF INFUSION THE MACHINE WILL PROMT YOU TO

CONNECTTHE YELLOW LINE TO YELLOW PORT & PINK LINE TO
THE PINK PORT.

MACHINE WILL GO IN TO FORCE RINSE FOR 10 MINUTES

ATER FORCE RINSE THE MACHINE WILL GIVE AMESSAGEIS

FREE OF CHEMICAL RESIDUE

THEN PRESS YES MACHINE WILL COME INRINSE MODE.

WITH MACHINE IN RINSE MODE PRESS POWER OFF & VERIFY

BUTTON& ALSO SWITCH OF THEMAIN SUPPLY.
 THEN SWITCH OF THE MACHINE FROM THE MAINPOWER.

THEN NEXTDAY MORNING THE MACHINEWILL DIRECTLY COME

IN CHEMICAL MODE.

THE MACHINE WILL BE IN FORCERINSE FOR20 MINUTES&

AFTER 20 MINUTES IT WILl ASK IS FREE OF CHEMICAL
RESIDUE.

THEN PRESS YES TO ENTER IN RINSE MODE

4). ACETIC aCID

PRODCEDURE:-

TAKE THE ACETIC ACIDSOLUTION

THEN PUT THE PINK LINE IN THE

ACETIC ACID SOLUTION.

PASS 5%TO 10% ACETIC ACID SOLUTIONFROM THE

PINK LINE FOR MINIMUM TO 10 MINUTES.
 REMOVE THE PINK LINEFROM ACETI ACID

CAN & CONNECT BACK TO THE MACHINE.

ALLOW THE MACHINE TO BE IN THE RINSE

TAKE
MODE20FOR
GRAMS OF CITRIC
MINIMUM ACID
15 MINUTES
POWDER & DILUTE IN 200 ML OF

WATER& MIX IT THOROUGHLY.

5). heat cleaning

PROCEDURE:-

TAKE 20 GRAMS OF CITRIC ACID POWDER & DILUTE IN 200 ML

OFWATER& MIX IT THOROUGHLY.

INFUSE 200 ML OF CITRIC ACID FROTHE PINK LINE WHILE THE

MACHINEIS IN RINSE MODE& CONDUCTIVITY NEAR ZERO
(0.1,0.4)

IF THE CONDUCTIVITY RISES TOABOUT 0.9

AFTER 10 MINUTES DISCONNECT THEPINK LINE FROM

CITRIC ACID & PUT IT BACK TO PINK RINSE PORT.
 TOUCH THE RINSE MENU

HEAT CLEAN MENU

VERIFY BUTTON

AFTER 10 MINUTES DISCONNECT THE PINK LINE FROM

CITRIC ACID & PUT IT BACK TO PINK RINSE PORT

THE MACHINE WILL HEATCLEAN AUTOMATICALLY TO

ABOVE 85C&WILL CIRCULATE THE FLUID FOR15 MINUTES

AFTER 15 MINUTES THE MACHINEWILL COOL DOWN TO

NORMAL TEMPERRATURE & THEN IT WILL GO INTO RINSE MODE
 AFTER 15 MINUTES THE MACHINE

WILL COOL DOWN TO NORMAL

18) DIET OF DIALYSIS PATIENT
TEMPERRATURE & THEN IT WILL

GO INTO RINSE MODE

Eating the right foods can helps improve your dialysis and your health. Your clinic has a dietitian
to help you plan meals. Follow the dietitian’s advice closely to get the most from your
hemodialysis department. Here are a few general guidelines.

 Fluids – Extra fluid can raise your blood pressure, make your heart work harder, and
increase the stress of dialysis treatment. Remember that many food such as soup, ice-
cream and fruits contain plenty of water. Ask your dietitian for tips on controlling your
thirst.

 Potassium – The mineral potassium is found in many foods, especially fruits and
vegetables. Potassium affect how steadily your heart beats, so eating foods with too much
of it can bevery dangerous to your heart. To control potassium levels in potatoes and
dried fruits. You can remove some of the potassium from potatoes and other vegetables
by peeling and soaking them in a large container of water for several hours, then cooking
them in fresh water.

 Phosphorus – The mineral phosphorus can weaken your bones and make your skin itch
if you consume too much. Control of phosphorus may be even more important than
calcium itself in preventing bone disease and related complications. Foods like milk and
cheese, dried beans,peas, colas, nuts, and peanut butter are high in phosphorus and should
be avoided. You’ll probably need to take a phosphate binder with your food to control the
phosphorus in your blood between dialysis sessions.

 Salt (sodium chloride) –Most canned foods and frozen dinners contain high amount of
sodium. Too much of it makes you thirsty, and when you drink more fluid, your heart has
to work harder to pump the fluid throught your body. Over time this can cause pressure
and congestive heart failure. Try to eat fresh foods that are naturally low in sodium, and
look for product labeled “low sodium”.
 Protein –Before you were on dialysis, your doctor may have told you to follow a low –
protein diet to preserve kidney function. But now you have different nutritional priorities.
Most people on dialysis are encouraged to eat as much high– quality protein as they can.
Protein helps you keep muscle and repair tissue, but protein breaks down into urea (blood
urea nitrogen, or BUN) in your body. Some sources of protein, called high-quality proteins,
produce less waste than other. High-quality proteins come from meat, fish, poultry, and eggs.
Getting most of your protein from these sources can reduced the amount of urea in your
blood.

 Calories – Calories provide your body with energy. Some people on dialysis need to gain
weight. You may need to find ways to add calories to your diet. Vegetable, oils- like olive,
canola, and safflower oils- are good sources of calories and do not contribute to problems
controlling your cholesterol. Hard candy, sugar, honey, jam, and jelly also provide calories
and energy. If you have diabetes, however, be very careful about eating sweets. A dietitian’s
guidance is especially important for people with diabetes.

 Supplements – Vitamins and mineralsmay be missing from your diet because you have to
avoid so many foods. Dialysis also removes some vitamins from your body. Your doctor
mayprescribe a vitamin and mineral supplement designed specifically for people with
kidney failure. Take your prescribed supplement after treatment on the days you have
hemodialysis. Never take vitamins that you can buy off the store shelf, since they may
contain vitamins or minerals that are harmful to you.
 19) Vaccination schedule.

1) A four 4 (dose) double-strength vaccination schedule is recommended at zero (0),

one(1) two(2) & (6 ) months.

2) Check anti-HbsAg tires for those are already given vaccination & repeat yearly.

3) Separate be sheet (color cording) blanket, pillow, stethoscope, BP instrument,

Heparin,transducer protector, IV set files Stationary.

4) SeparateTechnician, machine & wash room.

5) Use sterillium after terminating.

6) All Blood stains clean with bleach – no blood stain anywhere to be left behind.

20) Universal safety precautions for health care

workers.
1) Proper hand washing before & after contact with each patient & handing patient specimens.
 2) Use of gloves. Mask, Gowns & protective Eye wear.

3) Prevent needle stick injuries & injuries with the sharp instrument.

 DO not Bend & RECAP NEEDLES.

 DO not leave sharp on bed or Bedside

 Uses container to carry Needle & other sharps

 Disposable all sharps in puncture prop container

4) Avoid spills of blood & any body Fluids, if it occurs, it with Absorbent material like
Gauge lover which 5% hypochlorite solution of sodium Hypochlorite should be poured
and leftfor 10 minutes (ideal 30 minutes) Remove this with Gloves hands & discard
as infectious waste Red Bag, Clean the area with & Bleach Mop. Wash & Dry the mop.

5) Proper segregation & disposal of Biomedical waste.

6) Efficient sterilization of instrument & Disinfections

7) In case of needle pick --- injuries or cuts, wash properly with soap & water,

contact Doctorimmediately for post exposure prophylaxis

8) Immunization for Hepatitis ‘B’

21) SAFETY IN DIALYSIS DEPARTMENT WITH

FOGGING MACHINE
PROCEDURE:-
1) Take 1000 ml (1 liter) water in a tank & add 10 ml insider solution in

that.[change quantity of water & solution as per area].

2) Keep fumigation machine on 4-5 feet height on instrument trolley with edges
 so it will not fall down while running.

3) Adjust metering valve [small round blue knob on tank] on low compulsory

so it will give minimum micron particle for better fog and penetration.

4) Adjust machine diagonally opposite to another corner with approx.45degree

tilt towards sky. Make part clear for fog to float in air longerperiod

5) Start machine for 20 minute for 1- lit water and 40 min for 2- lit water.

6) Put off machine after completion of time and keep HD close or seal

for minimum 1-2 hour.

7) Wash filter under running water after very fogging, which is on back s

side of machine and keep it back on place after washing.

8) Empty the machine tank and use balance solution for mopping. Add some plane

water in tank and machine for 2 min. It will clean internally.

9) Daily mopping of HD is compulsory with solution add 15 ml insider in1 lit water.

22) Quality Control in Dialysis

1) Cleaning of the filter Acid and Bi-carbonate solutions

2) Hot rinse and getting rid of Calcium.

3) Cleaning the blood leakage monitor.

4) Cleaning the filtering net of liquid supply and return.

5) Change seal loop of Acid / Bi-carbonate solution tubes

6) Change seal loop of supply return fast adaptor.

7) Power failure working with battery till shut off machine.

8) Cleaning the filtering net of Acid and Bi-carbonate pump.

9) Safety check of Main power supply (wire, plug & socket)

10) Safety check of protection of electronic leakage.

11) Check if the adaptor of water inlet and outlet is connected firmly.

12) Check the function of the fan.

13) Safety check of visual inspection for rust, corrosion and distortion.

14) Safety check of Ground wire resistance.

15) Check if the main metal parts rust corrode or loops.

16) Test the function of heparin pump clog alarm.

17) Test the function of water empty alarm.

18) Test the function of distinguishing tubes diameter.

19) Test the function of water empty alarm of adjusting pump.

20) Test of alarm volume.

21) Safety check of function inspection of blood level sensor.

22) Safety check of inspect blood leak function.

23) Safety check of function inspection of air bubble detector.

24) Inspect the venous line clamp function.

25) Calibrate the blood pump head gap.

26) Calibrate the spare pump head gap.

27) Calibrate the blood pump flow.

28) Calibrate the spare pump flow.

29) Calibrate the flow pump acid and bi-carbonate.

30) UF volume calibrates.

31) Calibrate temperature of acid solution.

32) Calibrate temperature of heat chamber.

33) Calibrate mixing temperature.

34) Calibrate conductivity of disinfection solution.

35) Calibrate conductivity of post dialysis.

36) Calibrâtes dialysate flux.

37) Calibrâtes venous pressure.

38) Calibrate artery pressure.

39) Calibrate TMP.

40) Calibrate blood pressure meter.

41) Calibrate adjusting pump flow.

42) Calibrate heparin pump flow.

43) Calibrate temperature of outlet water.

44) Calibrate temperature of disinfect solution.

45) Calibrate temperature of post dialysis.

23) r. o. plant
Reverse Osmosis
Is be upon the fundamental Pursuit for balance. Two fluid containing different
concentration of dissolved solids that comes in contact with each other will mix until the
concentration is uniform. When these two fluid are separated by a semi permeable membrane

(Whichlets the fluid flow through while dissolved solid stay behind), a fluid containing a lower
concentration will move through the membrane into fluid containing a higher concentration of
dissolved solids. (Bennie e.a 2002) After a while the water level will higher on the side of the
membrane. The difference in height is called the osmotic pressure
By pursuing pressure uon the fluid column, which exceeds osmotic pressure, one will get a
reversed effect. fluids are pressed back through the membrane , while dissolved solids stay behind
in the column using the techniques, a larger part the salt content of the water can be removed.

123

1) Water flow from a column with a low dissolved solid content to column with a high

dissolved solid content.

2) Osmotic pressure is the pressure that is used to stop the water from flowing through the

membrane in order to create balance.

3) By pursuing pressure the exceeds the osmotic pressure, the water flow will be reversed; water

flows from the column with a high dissolved solids content to the column with a low dissolved

solid content.

23) Softener regeneration

Procedure:-

15 MINUTE BACKWASHES

15 MINUTE RINSES
 FILTER

CONCULUSION
The 3 & 4 semester training of Hemodialysis Technician was very exiting interesting. The through
training in Hemodialysis section have enhanced my practical knowledge & the technical skill A
part from Theoretical knowledge I gained actual practical experience of handling the patient &
Dialysis Machine individually.

It was really a golden opportunity for me to a work in the well maintain a managed Hem dialysis
Department of B.K.W. Walawalkar Hospital. The department has not only helped me to gain
proper practical knowledge but also in additional have trained me to perfection. Definitely I would
concluding as Hemodialysis Technician will give me Extra Knowledge in the future to serve with
perfection & satisfaction.