Download 3. Clinical Records/Documentation

Wrexham - BCUHB
Serial No.:
Ref. No.:
BLUP1/MED/00
POLICY
Home Haemodialysis
Draft No: …1... Date: 17/02/2009
Number Of Pages
Ratification Information
Ratified By
Chairperson
Ratifying
Medicine Directorate
Date
TBA
(Named Person)
Body
Management Team
Ratified
In accordance with the Validation & Ratification Schedule which was approved by Trust Board
Document Responsibilities
Originator / Author Senior Sister Julie Oliver
(Person Responsible
and the Home Therapies
For Review)
Team
Jackie Williams
Owning
Renal Department,
Department
Medicine Directorate.
Validated By
Dr Drew
Date Validated
TBA
Document History
First Operational
11/12/03
Previously Reviewed N/A
(Updated At Review - Yes/No)
N/A
Next Review Date
Operational Date
Yes / No
Yes / No
Yes / No
N/A
N/A
TBA
TBA
Yes / No
Summary Of Current Review Changes
N/A
Contains References to the following Documents
Document Title & Reference
Universal blood and body fluid precautions.
Document Title & Reference
Permission granted by Fresenius to use all their policies within the
operators’ manual. Their policies have been adapted for the use of
the renal therapies team.
Document Title & Reference
Document Title & Reference
Document Title & Reference
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Table Of Contents
1.
Mission Statement............................................................................................... 5
1.2
Purpose........................................................................................................ 5
1.3
Scope ........................................................................................................... 5
2. Orientation / Patient Information.......................................................................... 5
2.1
Medications .................................................................................................. 5
2.2
Labs ............................................................................................................. 6
3. Clinical Records/Documentation ......................................................................... 6
3.1
Treatment Records ...................................................................................... 6
3.2
Hospitalizations ............................................................................................ 6
3.3
Clinic/Home Visits ........................................................................................ 6
4. Training ............................................................................................................... 7
4.1
Staff Training................................................................................................ 7
4.2
Patient Training ............................................................................................ 7
4.4
Access Management & Evaluation .............................................................. 7
5. Infection Control .................................................................................................. 8
6. Equipment ........................................................................................................... 8
6.1
Dialysis Machine and RO Unit - AQUA UNO ............................................... 8
6.1.2
Machine Settings .................................................................................. 8
6.1.3
Routine Procedures .............................................................................. 8
6.1.4
Alarms & Troubleshooting..................................................................... 8
6.1.5
Maintenance ......................................................................................... 9
6.1.6
Water Treatment. .................................................................................. 9
7. Equipment Preparation ....................................................................................... 9
7.1
Pre- Treatment Preparation ......................................................................... 9
7.2
Treatment..................................................................................................... 9
7.3
Post- Treatment ........................................................................................... 9
8. Complications during Home Dialysis ................................................................. 10
9. Contacts ............................................................................................................ 10
10.
Procedures .................................................................................................... 10
AIR EMBOLISM ....................................................................................................... 11
AIR TRAP LEVEL MONITORING ............................................................................ 12
BLOOD LOSS .......................................................................................................... 13
DIALYZER BLOOD LEAK ........................................................................................ 14
DIALYSIS INTERRUPT AND RECIRCULATION ..................................................... 15
GIVING SALINE FLUSH MANNUALLY – If patient on HD or online bolus not
available ................................................................................................................... 16
DISASTER - FIRE .................................................................................................... 17
DRAWING POST U & E ........................................................................................... 18
FEVER AND/OR CHILLS ......................................................................................... 19
HAEMOLYSIS .......................................................................................................... 20
HYPOTENSION ....................................................................................................... 21
MANUAL SALINE RINSEBACK ............................................................................... 22
MONITOR THE DIALYSIS TREATMENT ................................................................ 24
MUSCLE CRAMPS .................................................................................................. 25
NEEDLE INFILTRATION ......................................................................................... 26
PROCEDURE FOR THE INSERTION OF SHARP NEEDLES FOR DIALYSIS ....... 27
CANNULATION OF AV FISTULA USING BUTTONHOLE TECHNIQUE STANDARD
AV FISTULA NEEDLES ........................................................................................... 29
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POWER LOSS ......................................................................................................... 32
PREPARE FOR DIALYSIS ...................................................................................... 34
RINSEBACK POST-DIALYSIS ................................................................................ 37
ARTERIAL PRESSURE DEVICE DOES NOT OPEN WHEN LINE GUIDE IS
INSERTED ............................................................................................................... 38
HAEMOCONCENTRATION WARNING................................................................... 39
COLLECT WATER SAMPLE SAMPLE FOR RESIDUAL CHEMICAL ANALYSIS .. 40
COLLECT WATER SAMPLE FOR CHLORINE TESTING ....................................... 41
COLLECT ONLINE SAMPLE FOR QA WATERS AND RO SAMPLE FOR QA AND
CHANGE DIASAFE PLUS FILTERS........................................................................ 42
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1.
Mission Statement
The home therapies team is committed in providing a service that is safe and
appropriate to our patients needs. We will continue to review and improve our
services and will benchmark with other agencies so that this can benefit our patients
or the wider community.
1.2
Purpose
To train a patient, safely, efficiently and competently in readiness to carry out home
haemodialysis.
1.3
Scope
Every trained nurse within the home therapies team.
2.
Orientation / Patient Information
Introduces the patient to the home therapies team. Potential new client’s checklist
will be completed covering aspects such as vascular access, how Haemodialysis
works and the benefits of dialysis, the training involved as listed in section 4.2,
storage of equipment required for home dialysis, holidays, and educational tools to
facilitate patient training. The patient will be informed of any necessary alterations
that may be needed within the home and the Fresenius technician will carry out a
preliminary home visit in the home to assess suitability of the Fresenius system. The
technician will inform the patient of any alterations required and will also inform the
Estates Department and Home Therapies team of all alterations necessary.
Following identification of a suitable patient the patient will be informed of the time
scale necessary prior to commencing home Haemodialysis.
The patient will be informed of training objectives to be met prior to commencing
dialysis at home, and will be required to sign his/her objectives to say they are happy
to carry out their home therapy treatment.
2.1
Medications
The home therapy team will discuss the medications used, explaining any potential
side effects. This aspect is covered in the document:Home Haemodialysis client training objectives within the nursing care plan.
The patient will be informed that drug dosages may be changed after a period of
time on home Haemodialysis due to the frequency of dialysis. It will be explained to
the patient that any alterations needed will be via GP via fax and phone calls.
The patient will also be informed that if the acid concentrate is changed the old
dialysate will need to be disposed of immediately.
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2.2
Labs
Frequency of required blood, and water testing will be explained to the patient.
Request forms, details of blood tests and water testing will be included within the
patient’s care plan and will be discussed during the training.
3.
Clinical Records/Documentation
Within the Nursing care plan documentation will be included:- Patient diagnoses,
patient care plans and physician orders (meds, labs, and treatment settings).
Dialysis Prescriptions Policies/Procedures include staff instructions/forms on
recording, updating and maintaining these records. Home Haemodialysis Patient
Training Schedule and Objectives forms.
3.1
Treatment Records
Within the patients care plan documentation will be included: - Patient treatment
Fresenius system prescription settings, maintenance information, due dates of
bloods and water testing, blood forms and bottles required for specific tests. Water
samples, and details required for specific tests, home dialysis policies, and useful
contacts and telephone numbers.
3.2
Hospitalizations
Documents dates, admitting diagnosis within the nursing care evaluation and
progress report.
The patient is also informed of any problems with their machine, to inform the home
Haemodialysis team as the patient may require Haemodialysis on the renal unit
whilst the machine is being repaired. This is discussed within the home
Haemodialysis client training objectives.
3.3
Clinic/Home Visits
Clinic appointments and where the clinics are held, what to bring along to clinic and
who will be available to be seen are explained within the client training objectives
document.
Home visits and support is also explained within the client training objectives
document.
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4.
Training
4.1
Staff Training
Staff training is carried out over a three week period by a clinic nurse specialist from
Fresenius.
The staff are required to achieve the 5008 System Training Schedule and complete
these objectives prior to training their clients.
4.2
Patient Training
Documents patient home training program/skills assessment and continuing
education/training and evaluation
a)
b)
c)
d
Use of the Home Haemodialysis Patient Training Schedule and Objectives
Home Haemodialysis information booklet
Use of the 5008 Therapy System – Training and Resource Guide
Use of the 5008 Therapy System Brief Operating Guide
Once the patient is competent to carry out home haemodialysis, home modifications
are complete, the Home Haemodialysis machine has been commissioned and
passed microbiology and chemical analysis, the trained nurse will follow the patient
home and spend the first few days ( 1 week ) with the patient to ensure that
everything is in place and can competently carry out his or her dialysis, facilitating
the transition from Hospital to Home.
4.3
Anemia Management & Evaluation
The patient’s Haemoglobin and ferritin will be monitored every month and
documented within the nursing care plan on the blood results document.
Any changes in erythropoeitin doses are faxed to either GP or the appropriate home
delivery company.
I.V. iron clinics are carried out within the renal unit on an outpatient basis.
The patient’s results are continually audited via our anaemia audit tool.
4.4
Access Management & Evaluation
The access co-ordinator educates the patient to self-needle and care for his/her
access. Where indicated Central Venous Catheter training will be carried out (if
vascular access has failed or for those patients where Central Venous Catheter is
their access). She explains correct needling technique, the importance of correct
procedure and demonstrates the correct procedure. She identifies signs of infection
of vascular access and the treatment of infection. This is taught in the home
haemodialysis client training objectives.
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5.
Infection Control
During patient training the importance of infection control will be highlighted, and the
patient will be required to meet client training objectives. The area where home
haemodialysis is to be carried out will be free from infection, the patient will also be
advised on how to keep the area clean and tidy. The patient will be taught hand
washing and hand hygiene and the importance of using the technique. Universal
precautions will be discussed and the patient will need to meet the training
objectives. Included, will be the importance of disposing needles and sharps, the
patient will be taught the safe disposal of needles and sharps into the provided
sharps bins. Clinical waste will be explained and the importance of disposing all
clinical wastes into the correct bags, the patient will be informed of the procedure for
clinical waste collection as per local and national guidelines. As the home
haemodialysis machine is used for one patient only, the cleaning of the machine is to
be as per recommendations from Fresenius.
6.
Equipment
6.1
Dialysis Machine and RO Unit - AQUA UNO
The home haemodialysis team during training will define the technical requirements
for the dialysis machine and the use of RO unit.
a)
b)
Technical requirements
The patient will be briefly taught how the haemodialysis machine and the
Aqua Uno RO works
6.1.2 Machine Settings
During the patient training the patient will be taught how to enter/change treatment,
prescription and machine settings on the dialysis machine as per Fresenius training
checklist.
6.1.3 Routine Procedures
Describes how to perform general and / or more frequent procedure
6.1.4 Alarms & Troubleshooting
Describes how to respond to- information message (Info), Warning message
(Warning) and Alarm message (Alarm) alarms and to perform troubleshooting
procedures. Use of 5008 Haemodialysis System Operating Instructions.
a)
b)
Problem solving – issues that may arise
Brief guide and troubleshooting for the Fresenius 5008
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6.1.5 Maintenance
Every 12 months the technician carries out Function Check and Electrical Safety
maintenance on the home haemodialysis machine, and every 2 years Major service
is carried out.
a)
Fresenius maintenance programme.
6.1.6 Water Treatment.
Describes the water treatment system (water pre-treatment and RO) and importance
of water treatment. Instructs staff/patient on monitoring, maintenance and
documentation. Policies/procedures may include instructions/forms re monitoring.
Procedures:
a) Monthly QA waters from machine and RO as per policy
b) Monthly change of Diasafe Plus Filters
c) 6 monthly waters for Trace Elements from RO
d) Disinfection of RO and machine as per policy
7.
Equipment Preparation
7.1
Pre- Treatment Preparation
Describes procedures performed during dialysis preparation in conjunction with
Patient Prescription.
Procedures: –
a)
T1 Test and Preparing and lining the dialysis machine
b)
Preparation of the treatment area and consumables for needling
c)
Patient preparation
d)
Completion of pre treatment checklist and dialysis data record sheet
7.2
Treatment
Describes procedures performed during treatment.
Procedures:
a) Monitoring the prescribed Dialysis treatment
b) Discontinuation of the prescribed dialysis treatment
7.3
Post- Treatment
Describes procedures performed during treatment.
Filling in the dialysis data sheet and records any problems encountered.
Reports any problems to the Home Therapies Nurse / Technician.
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8.
Complications during Home Dialysis
Describes how to treat patient complications and natural events that occur during
dialysis.
Procedures:
Air embolism – Page 10
Disaster- fire – Page 20
Haemolysis – Page 23
Muscle cramps – Page 28
Power loss – Page 31
Dialyzer blood leak – Page
Blood loss – Page
Fever and/or chills – Page
Hypotension – Page
Needle infiltration (needle blow ) – Page
Haemoconcentration – Page
Arterial Pressure Device - Page
9.
Contacts
Renal unit home therapies telephone numbers 01978 727101 / 727103 between
9am-5pm.
24 hr on call service out of hours ring 01978 291100 and ask switch board to put you
through to the on call home therapies team / CAPD nurse on call.
The patient is issued with our contact numbers and the Fresenius technicians
telephone numbers on commencement of training.
10.
Procedures
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Procedure
AIR EMBOLISM
Description This procedure describes how to treat an infusion of air into the patient’s
bloodstream
Purpose
Loose or cracked arterial connections, separation of arterial blood tubing
from arterial needle or catheter can introduce air into the blood tubing and
dialyzer. Operator error when troubleshooting venous air in blood alarms or
machine malfunction may inadvertently allow air to enter the patient. Not
correcting Air / Blood levels in venous bubble trap, venous blood line not
inserted correctly in Blood air optical detector.
The dialysis machine safety monitors, and secure and tight connections
along the access, dialyzer and blood tubing can prevent an air embolism.
Procedure
Rationale
Call 999
Stop the Blood pump.
Clamp the patient’s access and blood
tubing lines.
Place the patient on left side with head
down and feet up higher than head.
Monitor patient’s vital signs i.e. Blood
pressure and pulse. Do not panic.
Stops blood pump and closes arterial and
venous clamps.
Traps air in right atrium and minimizes risks to
the patient.
Call home training nurse.
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Procedure
AIR TRAP LEVEL MONITORING
Description This procedure describes how to monitor for any loose connection in the
blood tubing set via the blood/air optical detector seated below the venous
bubble trap.
Purpose
Loose connections between the blood tubing, injection site and access lines
can cause air to leak into the blood tubing and result in frequent air trap
leveling and blood tubing set error alarms.
Reference
Fresenius 5008 Operators Manual –Alarm Processing 2 parts
(1)Air detected below the Venous Bubble Catcher
(2)Micro Bubbles detected below the Venous Bubble Catcher
Supplies
None
Procedure






If the blood level is lower than 1cm from top
of bubble trap PRESS Blood System key
and use the arrows to raise the level or
PRESS Level Set Key – machine will set
automatically.
Check that all the connections are secure.
If required the machine will request the user
to follow informational messages on the
screen to remove the air.
If necessary disconnect from dialysis,
connect the arterial and venous blood lines
to a bag of normal saline, until air is
removed form lines following instructions on
the dialysis machine.
If, after careful observation, the above
conditions continue, discontinue treatment
and call Fresenius Technical Service
Center and the renal unit.
If in HD Mode prime with 1.0L to reduce the
risk of air bubbles.
Rationale
Discontinuing a treatment earlier than
prescribed may require the patient’s
schedule to be adjusted.
During the air removal procedure the
blood pump will run at a rate of 50ml/min
N.B. The blood pump speed will require
increasing back to prescribed speed
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Procedure
BLOOD LOSS
Description This procedure describes what to do in the event of a needle slippage, or
tubing disconnection.
Purpose
Reference
Supplies
Recirculation
Reinsertion of a new needle
None
Procedure
Rationale
Stop the Blood Pump by pressing the red LED
key on left of monitor. If the needle is dislodged
immediately apply pressure on the site.
Clamp access lines and blood tubing.
Assess blood loss and check vital signs i.e.
blood pressure and pulse.
Follow procedure for recirculation
Circulation key right hand side of monitor
Commence recirculation - using recirculation
band

Blood will be pulled from the intact
access/blood tubing assembly as air is
pushed out of the disconnected
tubing.

N.B. The blood pump speed will
require increasing back to prescribed
speed
Insert a new needle by following the reinsertion
of a new needle procedure.
Following reinsertion of new needle reconnect
blood lines to access to resume dialysis.
Remembering to clean the patient connector
on the blood tubing with an alcohol wipe prior
to reconnection (to reduce the risk of infection).
NOTE: Patient’s blood in the tubing may be at
risk for clotting therefore if this occurs
discontinue dialysis NOTING therapy time
remaining and UF remaining.
Notify the home training unit.
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Procedure
DIALYZER BLOOD LEAK
Description This procedure describes what to do in case of dialyzer rupture.
Purpose
Leaks or tears in the dialyzer membrane can cause red blood cells to cross
over into the dialysate. When this occurs treatment must end.
Reference
Supplies
Fresenius 5008 Operator’s Manual
Procedure
Rationale
When the machine detects blood in the
dialysate a blood leak warning alarm is
displayed on the touch screen.
2
Check the dialyser for signs of blood in the
dialysate fluid
Check Dialysate line ( blue) draining away from
the dialyser
If you can identify blood (rusty or pink ) in
dialysate fluid STOP blood pump, clamp
machine lines and patient lines. DO NOT
WASH BACK.
The redundant filtering system
protects against contamination of the
ultrapure dialysate that is infused into
the patient.
Disconnect. Flush needles.
Discard blood circuit and dialyser
Contact nurse on call Home Therapies.
If there is no evidence reset alarm. If blood
leak alarm continues x3 presume you have a
microscopic blood leak and wash back.
Discard blood lines and dialyser.
Note the time left and amount of UF left to be
removed
Put machine through heat disinfectant
BEFORE restarting next dialysis session
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Procedure
DIALYSIS INTERRUPT AND RECIRCULATION
Description
This procedure describes how to temporarily disconnect a patient from the 5008 Fresenius
machine during treatment, recirculate blood in the Extracorporeal circuit (EC), reconnect a
patient and continue with dialysis.
Purpose
Dialysis can be temporarily interrupted when the patient needs to disconnect from the
extracorporeal circuit. Dialysis will continue after the patient is reconnected to the
extracorporeal circuit.
Reference
Supplies
Fresenius 5008 Operator’s Manual
1 – Recirculation connector
2 – 2 x 10 ml syringes with saline for flushing needles
Procedure
Rationale
Use alcohol rub and universal precautions when
performing this procedure.
Ensure all connections are secure when connecting and
disconnecting the blood tubing set.
1. Disconnect and Prepare for Recirculation.
 Gather supplies.
 Press the options menu and select circulation. Press
recirculate.This will automatically stop pump and
switch off UF.
 Clamp the arterial blood line and arterial needle.
 Clamp the venous blood line and the venous needle.
 Disconnect both lines from both needles and
connect to the recirculation connector.
 Attach a 10ml syringe of saline to the arterial and
venous needles, flush needles as necessary.
 Release the clamps on arterial and venous blood
lines and press recirculate on screen.
 Ensure a primed bag of normal saline is connected
to the circuit.
 Warnings every 5 mins alert the user to the fact that
the circuit is recirculating.
.To go back on dialysis……
1. Press “stop recirculation”
2. Clamp the saline.
3. Clamp the arterial and venous blood lines
4. Disconnect the arterial blood line from the
connector and attach to the arterial needle.
5. Transfer the 10ml syringe to the connector.
6. Disconnect the venous line from the
7. Connector and attach it to the venous needle.
8. Release the clamps on both needles and both
blood lines.
Pauses the machine
N.B. Increase pump speed back to Prescribed
pump speed.
CHECK FOR AIR IN BLOOD TUBING AND NEEDLES
When you are happy recommence the blood pump and
recommence UF.
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GIVING SALINE FLUSH MANNUALLY – If patient on HD or online bolus
not available
Description Saline flush may be needed during dialysis if patient records a low blood
pressure or experiences symptoms of a low blood pressure i.e. Clammy,
warm or sweaty. Dizzy, light headed, nauseous, visual disturbances or
Reference
hearing disturbances.
Procedure
Procedure
Saline restores your blood pressure by
increasing the volume in your circulation.
To give saline….
1- Reduce the speed of the blood pump by
5mmhg to open the top arterial pressure guard,
and the lower venous pressure guard.
2- Turn UF off
3- Ensure saline is attached to the circuit, line
is primed , then release clamp on the saline
port.
Giving saline alters the venous and arterial
pressure.
4- Give as much saline as you need (check
blood pressure)
5- Increase the blood pump speed to the
original setting
6- Clamp the saline port. The venous and
arterial pressures will return to the original
level.
7- Recheck your blood pressure.
8. If patient still unwell post infusion dial 999
Rationale
To prevent arterial alarms while infusing
the saline.
This opens the lower arterial guard and
the top venous pressure guard.
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Procedure
DISASTER - FIRE
Description This procedure describes how to safely disconnect from the machine in the
event of an earthquake, fire or severe weather.
Purpose
To assure that the patient can safely move away from the machine to find
shelter.
Reference
None
Procedure
1.
2.
3.
4.
5.
6.
7.
Stop blood pump.
Turn off the power supply to the machine
Clamp the arterial and venous access lines
Clamp the arterial and venous blood tubing
Disconnect or cut the arterial blood tubing
Disconnect or cut the venous tubing
Keep the patient close to the floor and
move to a safe area and leave building.
8. Secure the patient’s access and check for
injuries. Call for help.
9. Contact renal unit for arrangement of
dialysis on the unit.
Rationale
Stops all pumps and closes all clamps
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Procedure
DRAWING POST U & E
Description This procedure describes how to take blood samples for monitoring
delivered dose of dialysis.
Purpose
Reference
Supplies
For the purpose of monthly blood results.
Appropriate blood bottles and 10 ml syringe.
Procedure
1. Prior to Washback - prepare supplies needed to
collect sample.
2. When time remaining equals 0
3. Lower the pump speed to 50mL/min.
4. Wait 15 seconds.
5. Press the Red Stop pump LED key.
6. Clamp the venous needle clamp and clamp the
venous blood tubing clamp.
7. Disconnect the venous blood tubing from the
venous needle.
8. Place a 10ml syringe at the end of the venous
needle, then unclamp venous needle and
withdraw post blood sample.
9. Clamp venous needle clamp, then remove syringe
and place blood sample in appropriate blood
bottle.
10. Reconnect venous needle to venous blood tubing
making sure that connection is secure.
11. Unclamp venous blood tubing clamp and venous
needle clamp.
12. Machine will show “Reinfusion” and follow on
screen instructions, and washback as normal.
13. Following treatment please bring sample to the
unit within an hour of taking the blood sample.
Rationale
Lowering the blood flow rate
prevents the potential for collecting
recirculated blood.
Allows systemic blood to reach
sample port.
To minimize inaccurate blood
results.
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Procedure
FEVER AND/OR CHILLS
Description This procedure describes what to do when a patient complains of fever and /
or chills.
Reference
Fresenius 5008 Operator’s Manual
Procedure
Check patient’s vital signs i.e. blood pressure
and pulse.
Note the temperature of the dialysate on the
screen.
Cover patient with blanket.
Determine when symptoms started.
Discontinue treatment if a pyrogen reaction is
suspected. Notify the home training unit for
further instructions.
Rationale
An elevated temperature before dialysis
and between dialysis may indicate
infection.
A normal temperature with shivering may
indicate dialysate that is too cold for the
patient.
An elevated temperature within the first
30 to 60 minutes of starting dialysis may
indicate a pyrogen reaction.
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Procedure
HAEMOLYSIS
Description This procedure describes what to do in the event of Haemolysis.
Purpose
High negative pressures, kinked or defective tubing, improperly mixed, or
overheated dialysate and contaminants from water used to make dialysate
can cause haemolysis.
The machines safety monitors and proper checks, observations and
monitoring by the operator can prevent haemolysis from occurring.
Reference
Fresenius 5008 Operator’s Manual
Procedure
Stop the blood pump.
Rationale
Stops blood pump and closes arterial
venous clamps.
Clamp arterial and venous access lines.
Ruptured red blood cells release
Disconnect patient from the machine . DO NOT potassium that can cause abnormal heart
return blood to the patient.
rhythms.
Monitor vital signs i.e. blood pressure, pulse,
breathing rate.
Patient may experience shortness of
breath, hypotension and abnormal heart
rhythms.
If necessary, give saline to replace volume of
blood lost – via saline IVI.
Call home training nurse for instructions on
care of the patient.
Call Technical Assistance Center for
assistance in troubleshooting the cause of
haemolysis.
If symptoms are severe, call 999
Patient may experience cardiac arrest.
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Procedure
HYPOTENSION
Description This procedure describes what to do when the patient’s blood pressure
drops during treatment.
Purpose
Low blood pressure can be caused by rapid removal of fluid or other medical
conditions.
Low blood pressure during treatment can cause dizziness, vomiting, visual
disturbances, loss of consciousness or seizures.
Reference
Procedure
NB. If on haemodialysis and not HDF follow
instructions for Giving Saline.
Press Emergency button +
Attach Blood pressure cuff
Lower the patient’s head and raise their feet.
Assess patient vitals signs i.e. blood pressure,
pulse.
Note signs and symptoms that led to
hypotensive episode.
.
When solution infusion is complete and blood
pressure is stabilized continue with dialysis.
ENSURE UF IS SWITCHED ON AND BLOOD
PUMP IS AT PRESCRIBED SPEED.
If necessary, decrease target fluid to remove,
or extend patient’s treatment.
Document observations. Document total
solution infusion given and any treatment
setting changes.
Rationale
Switches off UF, reduces pump speed,
takes blood pressure and gives bolus of
online fluid 150 ml intervals.
Assessment will determine intervention
Querry reduce UF volume
Lowers the ultrafiltration rate
Solution infusion and changes to fluid to
be removed is included in the post weight
assessment.
Low blood pressure may be due to other
medical conditions.
If patient’s blood pressure does not stabilize,
notify home training unit –
-Weight assessment may be required
-Blood pressure medication may need
adjusting
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Procedure
MANUAL SALINE RINSEBACK
Description This procedure describes how to manually return the patient’s blood during
alarm conditions that prevent an automated rinse back.
Purpose
Alarms that require a manual saline rinse back include:
Unrecoverable alarms
Recoverable alarms that do not allow rinse back and online infusion not
available
Reference
Supplies
Power failure
Fresenius 5008 Operators Manual
1 – 1,000 mL bag of sterile saline
1 – IV administration set with recirculation band connected
1 – IV pole on Machine
Procedure
Rationale
Note: Use the alcohol rub and universal
precautions when performing this procedure as
taught during training.
Ensure all connections are secure when
connecting and disconnecting the blood tubing set.
1. Set up and Connection
 Hang the saline bag on the IV pole and attach
the IV administration set with attached
recirculation connector to the bag. (Make sure
connections are secure). Close roller clamp and
half fill the chamber with saline. Undo the roller
clamp and fill the giving set and recirculation
connector with saline. Close the roller clamp on
the I. V. administration set, ensuring there is
no air present in the set.
 Press the reinfusion button
 Select NaCl
 Follow on screen instructions for Nacl
 Close the pinch clamps on the arterial blood
and arterial access line.
 Disconnect the arterial blood line from the
arterial needle and attach it to the recirculation
connectorat the end of the saline bag
 Once connected unclamp arterial clamps and
open the roller clamp on the saline
administration set and press ok
2. Rinse Back Blood
 Dialysis ends when clear fluid is detected below
the bubble trap.
 Press continue if more is required and stop the
pump using on screen control.
 Disconnect patient.
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





Press remove lines button.
Deal with access as appropriate.
Empty dialyzer
Replace concentrate suction tube and remove
bibag when empty.
Remove all blood lines ensuring substitute port
is firmly closed.
Close doors –machine will automatically go into
disinfect.
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Procedure
MONITOR THE DIALYSIS TREATMENT
Description This procedure describes the dialysis parameters and safety monitors
displayed during the treatment.
Purpose
Standard operating procedures in a clinic dictate that treatment records are
documented and maintained.
Reference
Fresenius 5008 Operators Manual
Supplies
1 – Haemodialysis flow sheet
1 – Patient prescription
Procedure
1. Review the treatment parameters on the
screen.
 Dialysis temperature and conductivity
 Blood and dialysate flow rate settings
 Fluid removed and ultrafiltration rate
 Treatment time remaining
 Arterial pressure
 Venous pressure
 Arterial and venous pressure trending on
treatment key
 Heparin information
 OCM monitoring (OCM key – personal data
for details of Kt/v
Rationale
Operator can verify that treatment
information displayed on the screen
matches the prescription or treatment
settings. Operator can observe that
the blood and dialysate circuit
monitoring system does not exceed
prescription limits.
2. If necessary press the Dialysate menu, UF
menu or treatment menu
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Procedure
MUSCLE CRAMPS
Description This procedure describes how to treat cramping during dialysis.
Purpose
Muscle cramps can be caused by rapid removal of fluid or change in target
weight.
Reference
Procedure
Press the options key.
Press the emergency key. Turn UF off.
Press the bolus key.
If necessary decrease the target fluid to remove,
change back flush interval to zero or extend
patient’s treatment.
If necessary give further bolus as above
Document observations. Document total solution
infusion given and any treatment setting changes.
Notify the renal unit.
Inform the renal unit as your target weight may
need changing.
Rationale
Target or dry weight may need reevaluation.
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Procedure
NEEDLE INFILTRATION
Description This procedure describes what to do in the event of an arterial or venous
needle infiltration (needle blow) or hematoma.
Purpose
During needle insertion the needle tip may go into the graft or vein through
the other side allowing blood to escape into the surrounding tissues. An
infiltrated needle (blown needle) requires another needle stick.
Reference
Procedure
Press the pump to stop immediately
Press the options key.
Press the circulation key to recirculate whilst
addressing the blow.
If heparin has not been given, pull the needle and
hold pressure.
If infiltration (needle blow) occurs after heparin
has been given, leave needle in.
If arterial needle infiltrated (blown), insert the new
needle below the infiltration (blow).
If the venous needle infiltrated (blown), insert the
new needle above the infiltration (blow).
Prior to inserting a new needle, flush the
unaffected needle with 10mls of saline.
Press the Green key to resume operation.
Rationale
Stops the blood pump and closes the
arterial and venous clamps.
Minimizes the risk of bleeding during
dialysis.
To prevent the unaffected needle from
clotting during recirculation.
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PROCEDURE FOR THE INSERTION OF SHARP NEEDLES FOR DIALYSIS
1.









Action
Gather equipment:
Basic procedure pack
2x 10ml syringes
10mls 0.9% saline
2x dialysis needles
Tourniquet
Alcohol wipe
2ml syringe
Green needle
Adhesive tape
2.Assessment and disinfection of
fistula
 Wash Hands as instructed
 Examine fistula/graft prior to
needle insertion.
 Use alcowipe/trigene wipes to
clean fistula. Allow to dry
3.Insertion of needles
 Place the 10ml syringes on to the
needles after priming syringes
with saline
 Place tourniquet onto the upper
arm and apply moderate
pressure- fistulas only
 Insert the Arterial needle first
 Holding the needle by its wings ,
with the bevel of the needle facing
up insert the needle at an angle of
25 degrees and a “flash back” of
blood should be obtained
 Release the pressure on the
tourniquet
 Thread the length of the needle
into the fistula/graft and confirm
the flow of the blood by pulling
and pushing back on the syringe
 .Ensure no air is present prior
to pushing back blood into the
fistula/graft.
 Clamp the needle tubing and tape
securely
Rationale
To ensure that all equipment is at
hand.
To prime needles
Needle size is individual e.g. 15gauge
A tourniquet is not needed for PTFE
grafts
To administer heparin
To secure needles
To prevent contamination
Avoid any areas that feel problematic
e.g. lump/,bumps, infection.
To remove any bacteria.
Applying pressure engorges the fistula
with blood to make it firm and assist
needle insertion
This applies to fistulas and not PTFE
grafts
The “flash back” of blood confirms you
are in the correct area
The blood should flow in and out of
the syringe freely. If it does not, then
withdraw the needle slightly and
rethread at a slightly different angle.
i.e. deeper/more superficial. No pain
should be felt at this point
To prevent air embolism
To prevent blood loss and needle
becoming dislodged
If the tape is too tight and the fistula is
superficial it may impede the flow of
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the blood. Adjust tape if necessary
Confirm the blood flow again with the
syringe
4. Repeat the above steps to insert
the venous needle
5.Draw up prescribed heparin using
2ml syringe and green needle.
Remove 10ml syringe from the
arterial needle and attach heparin
syringe. Inject heparin prior to
connection to dialysis circuit.
6.Dispose of all materials safely as
per policy
NB.The vibration or “thrill” of the
fistula should be felt for every day. If
the “thrill” has diminished or is absent
contact the Renal Unit immediately.
To prevent clotting of the dialysis
circuit.
Prevent cross infection and
contamination
The fistula may be at risk of stopping
or have stopped.
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CANNULATION OF AV FISTULA USING BUTTONHOLE TECHNIQUE
STANDARD AV FISTULA NEEDLES
What is Buttonhole Needling?
With this technique the haemodialysis needles are inserted into the
same spot, at the exact same angle and the exact same depth for each
dialysis treatment. The buttonhole cannulation site needs to be
established by the same person cannulating the site every time for
approximately 8-10 cannulations until the track is established.
A thorough assessment of the fistula must be completed to evaluate any
potential or existing problems the access may possess. The site for
buttonhole cannulation must allow for the needles to be placed a
minimum of 6cms apart and in an area of the fistula that allows ease of
insertion for both the nurse and the self cannulator.
 With NOTE : It takes approximately six to eight cannulations
using a sharp needle to create a scar tissue tunnel track in a given
site. Once a scar tissue tunnel track is well formed Dull Bevel
needles can be used
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CANNULATION OF AV FISTULA USING BUTTONHOLE TECHNIQUE WITH
DULL BEVEL NEEDLES
ACTION
Equipment
 2x AV fistula needles
 2x 10ml syringes
 10mls 0.9% saline
 Basic procedure pack
 Tourniquet
 Sterile gauze
 10mls 0.9% saline solution
 Alcowipe/Trigene wipes
 2ml syringe
 Green needle
1. Select cannulation sites carefully.
Consider straight areas, needle
orientation, and the ability of the patient
to self-cannulate. Sites should be
selected in an area without aneurysms
and with a minimum of two inches
between the tips of the needles.
2. Remove any scabs over the
cannulation sites using an aseptic
technique as per renal unit protocol.
3. Disinfect the cannulation sites using
alcohol wipe.
4. Prime each needle with 5mls saline.
.Using a sharp AV fistula needle, grasp
the needle wings, and removes the tip
protector.
Align the needle cannula, with the bevel
facing up, over the cannulation site and
pull the skin slightly taut.
5. Cannulate the site at a 25-30 degree
angle.
It is important to cannulate the constantsite in the exact same place, using the
same insertion angle and depth of
penetration.* This requires that a single
cannulator perform all cannulations until
the sites are well established.
6. A flashback of blood indicates the
needle is in the access. Lower the angle
of insertion. Continue to advance the
needle into the fistula until it is positioned
appropriately within the vessel.
7. Securely tape into position and repeat.
RATIONALE
Needle size as prescribed
To prime needles
If required
To soak scabs to enable easy removal, if
not using Emla cream
To disinfect skin
To administer prescribed heparin
To avoid any potential cannulation/flow
problems.
The participation of a carer in the
cannulation process is an advantage.
Prevent infection and trauma to the
insertion site.
Helps prevent the tip of the needle
clotting during insertion.
A tract will only be properly formed using
a single cannulator, thus removing any
possible errors.
Lowering the needle angle prevents
infiltration of the vessel wall.
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ACTION
Equipment
 2x AV fistula dull needles
 2x 10ml syringes
 10 mls 0.9% saline
 Basic procedure pack
 Tourniquet
 Sterile gauze
 20ml 0.9% saline solution
 Alcowipe/Trigene wipes
 2ml syringe
 1 green needle
RATIONALE
Needle size as prescribed
To prime needles
To soak scabs for easy removal if not
using Emla cream
To administer heparin as prescribed
1. Remove scabs over cannulation sites Prevent infection and to enable insertion
using aseptic technique as per renal unit of dull needles.
protocol.
2.Disinfect cannulation sites using
alcowipe
3. Grasp the needle wings, and remove
the tip protector. Align the needle
cannula, with the bevel facing up, over
the cannulation site and pull the skin taut.
4. Carefully insert the needle into the
established cannulation site. Advance
the needle along the scar tissue tunnel
track. If mild to moderate resistance is
met while attempting to insert the needle,
rotate the needle as you advance it using
gentle pressure.
5. A flashback of blood indicates when
the needle is in the access. Lower the
angle of insertion. Continue to advance
the needle into the AV fistula until it is in
the appropriate position within the vessel.
6. Securely tape into position and repeat.
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Procedure
POWER LOSS
Description This procedure describes how to return the patient’s blood in the event of
power loss.
Purpose
Reference
Supplies
The dialysis machine will have battery back up and then will switch itself off.
The UF pump stops, substitute pump stops and dialysis flow off therefore
manual wash back is necessary.
Fresenius 5008 Operators Manual
1 – 1,000 mL bag of sterile saline
1 – IV administration set with recirculation connector attached.
1 – IV pole
Procedure
Note: Use alcohol rub and universal
precautions as per training guidelines when
performing this procedure.
Ensure all connections are secure when
connecting and disconnecting the blood
tubing set.
Rationale

Handling the blood tubing and saline
administration sets improperly can cause
machine contamination and / or patient
injury.
Setup and connection
1. (a)Hang the saline bag on the IV pole
and
Attach the IV administration set with
attached recirculation connector to the
bag. (Make sure connections are
secure). Close roller clamp and half fill
the chamber with saline. Undo the roller
clamp and fill the giving set and
recirculation connector with saline. Close
the roller clamp on the I. V.
administration set, ensuring there is no
air present in the set.
Press the Re-infusion button
Select NaCl
Press the 1/O buttonFollow on screen
instructions
(b)Close the clamps on the arterial blood
tubing and arterial access line.
1. Disconnect the arterial patient connector
from the access line and attach it to the
recirculation connector.
To Rinse back blood
1. Open the roller clamp on the saline
administration set.
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2. Open the arterial clamp
3. Once connected press ok.
4. Dialysis ends when clear fluid is detected
below the bubble trap.
5. Press continue if more fluid is required
and stop the pump using on screen
control.
6. Disconnect patient .
7. Press remove lines.
8. Deal with access as appropriate.
9. Empty dialyzer.
10. Replace concentrate suction tube and
remove bibag when empty.
11. Remove all blood lines ensuring
substitute port is firmly closed .
12. Close the door and the machine will
automatically go into disinfect.
13. If power is lost and the machine turns
off, when power is restored select the
cleaning menu and select heat disinfect
program.
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Procedure
PREPARE FOR DIALYSIS
Description This procedure describes how to connect a patient to the PHD System for
dialysis.
Purpose
Standard operating
Reference
Fresenius 5008 Operators Manual and 5008 Therapy system Brief
Operating Guide
Insertion of needles for dialysis procedure
1 – sharps container
Tape - narrow and wide
Tourniquet
2 x dialysis needles
Sterile green needle
1 x basic procedure pack
1 x alcohol wipe Trigene wipes
1 x 10 ml syringes 1 x 30 ml leur lock syringe
2 x Heparin 5000 iu per/ml or Clexane
Sterile saline administration set with recirculation connector attached
1,000 mL bag of sterile saline
Liquid Hand Washand Alcohol rub
Concentrate and Bibag
Dialyser and pack of 5008 BVM Lines
Procedure
Rationale
Supplies
Note: Using Trigene and Alcohol rub and
universal precautions when performing this
procedure as explained during training.
1. Switch on the machine
2. Select treatment ( or disinfection )
3. Connect concentrate and bibag (ensure
correct concentrate is selected in dialysate
menu).
4. T1 test starts automatically.
5. Follow instructions for lining. Arterial lines
first. Make sure you hear the sound when
inserting the red plastic ‘alpha clip’ into the
lineguide. Make sure placed correctly, dome
in pressure device and line in arterial clamp.
6. Insert heparin syringe correctly and securely.
7. Attach venous line ensuring line below
venous chamber is firmly placed in the
blood/air detector groove.
8. Place safe line ( sub tubing ) into HDF pump,
ensure the sound is generated on insertion
of the clear plastic ‘alpha ‘ clip into the line
guide, then connect the arterial line.
9. Connect the rinse connector to venous line.
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10. On completion of T1-test, place insert
safeline into the upper port (BLUE) and the
rinse connector ( on the venous line) into the
lower rinse port (GREY).
11. Any damaged items, cracked connections or
casings, necessitates replacement of that
item.
12. Close the doors.
13. Connect dialysate arms ( RED to BLUE
BLUE TO RED ).
14. Press the blood pump button on the screen
to commence prime.
15. Priming is complete when volume has
reached 1000mls.
16. Enter U/F, treatment time, heparin data,
Check conductivity, temperature, time and
dialysate tank.
17. When full prime volume has been achieved
stop the prime by pressing the blood pump
button on the screen.
18. A message choices- ‘continue’ or ‘exit’ are
displayed, press “exit”.
19. Follow on screen instructions
20. Hang ‘A’ and ‘V’ lines on the dialysate
armand clamp both lines.
21. Insert needles as per policy.
22. Complete checklist to ensure safety i.e.
23. Isolators are securely attached
24. Clamps on venous ports are closed.
25. Blood pressure has been checked.
26. Heparin is set correctly and clamp removed.
27. U/F has been set to correct amount.
28. Dialysate has been been set to correct time.
29. Dialysate arms are attached to dialyzer.
30. Lines and needles are free from air.
31. Venous bubble trap is filled 1cm from the
top.
32. Connect access to ‘A’ and ‘V’ lines.
33. Follow onscreen instructions for hook-up.
34. Ensure the rinse port is closed, close the
doors, open clamps and confirm start blood
pump message.
35. Dialysis commences when blood is sensed
below the venous trap, confirm with button
below message.
36. Increase blood flow to prescribed level.
37. U/F starts automatically if data is already set.
38. Heparin starts automatically, bolus needs to
be given if required.
39. Check U/F has been switched on.
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40. Spare bag of saline is within reach.
41. Spare syringes, clamps,tape,cottonwool and
gauze are within reach.
42. Baseline observations are very important
and values should be recorded i.e. start
time,blood flow rate, Blood Pressure, Arterial
and Venous Pressures, U/F rate, TMP.
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Procedure
RINSEBACK POST-DIALYSIS
Description This procedure describes how to rinse back the patient’s blood.
Purpose
Reference
Supplies
Fresenius 5008 Operators Manual
Procedure
Rationale
Note: Use aseptic technique and universal
precautions when performing this procedure.
Ensure all connections are secure when
connecting and disconnecting the blood tubing
set.
1. When treatment goal is reached, collect
equipment and prepare for disconnection.
2. message will appear on screen prompting
next phase.
3. Press reinfusion and follow onscreen
instructions.
4. Once connected press ok ( only press
NaCl if you have run out of acid/bicarb
and need to use manual saline to
washback).
5. Dialysis ends when clear fluid is detected
below the bubble trap.
6. Press continue if more is required and
stop the pump using on screen control,
clamp venous blood tubing.
7. Disconnect patient then press remove
lines button.
8. Deal with access as appropriate.
9. Empty dialyzer.
10. Replace concentrate suction tube and
remove bibag when empty.
11. Remove all blood lines ensuring
substitute port is firmly closed.
12. Close doors . Machine automatically goes
into hot disinfect.
13. EARLY DISCONNECTION
14. Press reinfusion button
15. Press ‘1/O’ button.
Follow the above instructions from 4 onwards
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Procedure
ARTERIAL PRESSURE DEVICE DOES NOT OPEN WHEN LINE GUIDE
Description IS INSERTED
To ensure arterial pressure devise opens to allow the line guide to be
inserted or removed.
Purpose
Reference
Supplies
30 ml syringe
Procedure
Rationale
1.Close and reopen door, press line guide to
generate sound.
2.If this does not resolve problem, open diasafe
housing and locate small tube above the filters
and instill approximately 30ml of air. This will
push the mechanism forward.
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Procedure
HAEMOCONCENTRATION WARNING
Description
During haemodialysis, the pressure across the membrane (transmembrane
pressure) is related to it’s ability to allow fluid to pass through it. This will be
higher or rise as it becomes more difficult for fluid to pass across the
Purpose
dialyser.
Reference
Supplies
None
Procedure
Rationale
The pressure is likely to rise if;
1. the patient is nearing their dry weight and
fluid is no longer available to remove
2. the patient has poor refilling
3. Arterial pressure is low (<-200mmHg)
4. the patient has a high haematocrit due to
an increased blood count through use of
erythropoietin
5. the dialyser has a low KUf and a high Uf
rate is being used
6. there is insufficient anticoagulation
7. combinations of the above
8. the patient is nearing their dry weight and
fluid is no longer available to remove
9. the patient has poor refilling
10. Arterial pressure is low (<-200mmHg)
In Haemodiafiltration, the Uf rates are
higher in the kidney to create
convection. A formula is used to
calculate the safe HDF fraction and on
5008, this is calculated for you. In post
dilution HDF, there is a risk of
haemoconcentration to the point that the
blood may start to clot. Part of the online
program is looking at the
transmembrane pressure and this is
constantly monitored. If a rise of
20mmHg occurs then the Substitution
rate will be reduced by (%age). If this
occurs three times there will be an alarm
and a message in a red box will state
“Haemoconcentration Warning”.
The remedy is to eliminate the cause, increase
heparin, assess dry weight, assess fluid
management during treatment, reduce epo etc.
All of the above 7 points (individually or
in combination) could contrive to cause
clotting but there is an added risk in
HDF post dilution due to the higher UF
rate. If this alarm appears you have
several options (as well as those
mentioned above).
Worst case scenario is a lost circuit.
Post dilution HDF results in better middle
molecule removal. However, if clotting is a risk
Pre dilution, where the clearance is a little less
efficient, may be the safer option. Change the
mode and change the safeline position to the
pre dilution position.
Generally a little more anticoagulation is
required in HDF, a bolus might help to
offset clotting acutely and reassessment
of maintenance dose can be done
(ACTs are useful).
If the problem persists in this mode change to
Haemodialysis for the rest of the treatment.
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Procedure
COLLECT WATER SAMPLE SAMPLE FOR RESIDUAL CHEMICAL
ANALYSIS
Description This procedure describes how to collect a water sample post RO to check
for any residual chemical following chemical disinfection of the RO.
Purpose
Reference
Supplies
The Aqua UNO RO unit is chemically disinfected each month , to prevent
bacterial growth.
Reverse Osmosis Aqua UNO Operators Manual (section 5-19 )
Peracetic Acid Test Kit
RO connector
1 sample collection container
Procedure
Rationale
1.Read the Peracetic Acid Test Kit
instructions carefully before using the test kit.
2.Check the content of the kit for any
expiration dates.
Expired test kits can give inaccurate
results.
Following disinfection of RO BEFORE re connecting RO back to machine
- connect RO connector which will allow
water to flow from RO and use test
dipstick to sample post RO water.
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Procedure
Description
COLLECT WATER SAMPLE FOR CHLORINE TESTING
This procedure describes how to collect a water sample post RO
to test for chlorine or chloramine removal.
Purpose
Pre RO Carbon filters have a limited capacity to remove chlorine
and chloramine. Failure to detect chlorine or chloramine
breakthrough results in the degradation of RO effectiveness.
To meet Renal Association Standards – Chlorine < or = 0.1
Reference
Reverse osmosis Fresenius Aqua UNO manual
Supplies
As needed - Chlorine Test Kit (Aquachek water quality test
strips)
1 - Sample collection container
RO connector
Procedure
Rationale
Testing of post RO water for Total Chlorine
and Free Chlorine should be done daily or
each day they are dialyzing.
1. Read the chlorine test kit instructions
carefully before using the test kit.
2. Check the content of the kit for any
Expired test kits can give inaccurate
expiration dates.
results.
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Procedure
COLLECT ONLINE SAMPLE FOR QA WATERS AND RO SAMPLE FOR
QA AND CHANGE DIASAFE PLUS FILTERS
Description To monitor the infused dialysate solution for injectable quality criteria.
Purpose
The sample should meet a microbial limit of < 0.1 CFU / mL and an
endotoxin level of no more than 0.03 EU/ml To meet European
Pharmacoepia and Renal Association Standards.
Reference
5008 Fresenius Operators Manual
Supplies
Chlorhexidine spray
Five sterile 50ml, pyrogen-free sample collection containers
1 Sterile alcohol wipes
1 Sterile 50ml Luer lock Syringe
1 Pair of sterile gloves
1 Basic procedure pack ready for preparation for dialysis.
2 Diasafe Plus Filters
Procedure
Rationale
On completion of T1 test Set up the machine
for an Online treatment. Once Rinse Volume
has been achieved ( 1000 mls) ;
1. Set supplies up following the dialysis
center’s procedure for sample collection
2. Wash hands using liquid soap and use
alcohol rub as explained during training.
3. Open sterile pack and place on sterile
gloves.
4. Open the left hand door ENSURING the
Sub pump is still rotating.
5. Swab the end of the arterial port above the
BVM monitor and remove cap (keep clamp
closed).
6. Attach sterile syringe and ensuring sub
pump is rotating take sample.
7. Ensure all three pots are full of sample
water following a non touch technique
8.Replace a new cap onto arterial port, close
doors and proceed with dialysis OR
discontinuation of treatment. If treatment is
being discontinued PRESS Blood System Key
and PRESS Remove Lines. Select cleaning
screen.
9. Press change filters. Follow instructions on
screen and change both diasafe filters.
10. Leave machine switched on.
11.Swab injection port on RO line and spray
with chlorhexidine and allow to dry.
.12. Ensuring no contamination, aseptically
take samples x2 with sterile needles and
syringes.
13.Disconnect RO from machine
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14. Press right hand side key on the RO and
select ‘stand by-on’
15. Select ‘disinfect ‘ and keep finger on button
until ‘injection’ comes on screen.
16. Inject 200mls of Dialox or 100mls
Puristerile into RO,You have 2 minutes.
Remember goggles and gloves.
17. Machine will automatically change to
‘Rinsing In’.( takes 2 hours to rinse in)
18. Once rinsing is complete reconnect RO to
machine and put machine through heat
disinfect.
19.Place the samples with the ice packs into
the cool box provided
20. Ensure the sample arrives at the unit they
must arrive in quality assurance in pharmacy
within 1hr 30minutes. Sample to be sent with
renal porter.
21.The samples must be labeled with the
patients name, machine and RO identification
number, time and date of sample, so quality
assurance can identify machine and test to
correct levels.
22.Staff to inform Claire / QA Staff in quality
assurance that sample is on its way down.
23.Results will be monitored as per water
policy.
43