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Your Hemodialysis
Your Hemodiaylsis
Treatment
Treatment
Your Guide to Home Hemodialysis
Module 3: Your Hemodialysis
6.0959 Treatment
in
module 3
Self-Assessment
Your Hemodialysis
Treatment
Before you begin your treatment you will be instructed to do a self-assessment.
This includes your weight, blood pressure (BP), pulse and temperature. These are recorded on your
treatment record and are necessary to assist you in calculating how much fluid will be removed
during treatment, which is then programmed into your machine. It is important to keep a record of
your treatment, as this will assist your healthcare team in deciding if any changes in your treatment
or medications are needed.
Weight
A dry (target) weight will be set by your nephrologist. This is the weight you would be at if you
didn’t have any extra fluid and would give you the best blood pressure. Your weight is recorded
before and after your treatment. It is advised you limit weight gain, which can come mostly from
the fluids you drink. The amount recommended will vary from patient to patient depending
on your dialysis prescription. Removing too much fluid too quickly can make your treatment
uncomfortable and increase the risk of low BP. You must add in the amount of any fluid you drink
during your treatment as well as the rinse back (saline required to return your blood when your
treatment is completed) to your total fluid removal target.
Weighing yourself:
1. Weigh with the same amount of clothes on each time
2. Zero the scales as instructed
3. Make sure scales are on a hard, flat, level surface
4. If the weight seems out of line, double check
Calculating total fluid removal target:
SCALE WEIGHT – TARGET WEIGHT + ORAL FLUID + RINSE BACK = TARGET WEIGHT
E.g. 75.0 kg – 74.0 kg + 200mls + 400mls = 1600 mls (1.6 kg) to remove
Gaining too much fluid weight can lead to “fluid overload”, but removing too much can cause
dehydration – both of which can be dangerous for you.
See the chart on the following page for the warning signs.
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
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Your Hemodialysis
Treatment
!
FLUID OVERLOAD
DEHYDRATION
Higher than normal BP
Shortness of breath, cough
Swelling in hands, feet, face
Headache
Low BP, increased pulse
Muscle cramps
Nausea, vomiting
Dizziness, tiredness, weakness
!
It is important to speak with your nurse to receive guidance if these signs should occur. If you have
been feeling ill and not eating you may have lost weight, and failure to lower your target could
result in fluid overload. Likewise if you are eating more than usual and have gained body weight,
using the same target weight could lead to dehydration.
Blood Pressure
Your BP is made up of two numbers – the top number (systolic) is the pressure in your artery when
your heart pumps and is usually between 110-130 mmHg (millimetres of mercury). The bottom
number (diastolic) is the pressure when your heart relaxes and is usually between 60-70 mmHg.
Your nurse will give you specific instructions on how to check your BP and guidelines as to what
your BP range should be.
Blood pressure is a very important guide when
doing a self-assessment. It is used along with other
indicators such as how you look and feel to help you
decide if you are using the correct target weight. It
is checked before and after your treatment, sitting
and standing. It is common for your BP to be higher
before dialysis and lower after dialysis. It is also
checked during dialysis (usually every hour) to
monitor how you are tolerating fluid removal. This
is not done if you dialyze overnight as fluid is gently
removed over an extended period of time. You will
be instructed how to manage your machine settings
in relation to your BP.
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
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Temperature
Your Hemodialysis
Treatment
You will get to know what your normal temperature is, as it can vary throughout
the day. It is important to take your temperature before and after dialysis and anytime you
feel warm or think you may have a fever, have the chills or feel cold. If this occurs while you are
dialyzing, you must call your nurse immediately as this could indicate a serious blood infection.
Normal temperature = 36˚C to 37.5˚C
A low grade fever
= 37.6˚C to 37.9˚C
A fever
= 38˚C or higher
36
36.5
Celcius
37.5 38
37
Low
Fever
Normal
96.8
97.7
98.6
99.5
A temperature above
normal is a sign of infection
38.5
Fever
100.4 101.3
Fahrenheit
!
REMEMBER TO CALL THE NURSE IF YOU HAVE
• LOWER OR HIGHER BP THAN USUAL
• FEVER
• HIGHER OR LOWER PULSE THAN USUAL
Preparing To Do Your Dialysis Treatment
It is very important to keep your dialysis treatment area clean and organized. Where your machine
is located depends upon when you are going to do your treatment. Obviously, if you dialyze while
sleeping, the machine needs to be in your sleeping area. Otherwise any area in your home which
has accessible water and an electrical hook-up can be used.
Keep these following points in mind:
• Area should have good lighting
• Phone /cellphone within reach
• Pets contained
• Use an easy to clean work surface
• Extra/emergency supplies within reach
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Hand Hygiene Your Hemodialysis
Treatment
Proper hand hygiene is the best way to protect yourself from germs
that can cause infections. The use of an alcohol-based hand rub
(ABHR) is the preferred method to clean your hands. Use soap and
running water to remove visible soil. (www.oahpp.ca)
Alcohol – Based Hand Rub (ABHR)
ABHR kills germs and should be used often
during your dialysis treatment including
preparing the machine, changing CVC dressing,
hook-up and disconnection.
1. Put face mask on if indicated (ie. you have a cold, changing CVC dressing)
2. Pump enough solution to palms of dry hands
to rub for 15 seconds.
3. Rub solution to hands, including palms, back of hands, thumbs and finger tips.
4. Allow to air dry, do not use towel or paper towel.
Washing Your Hands Properly
!
This is needed only when you have
visible dirt, otherwise use the ABHR
above. A proper hand washing with
soap and water should take 90 seconds.
1. Wet hands with warm water
2. Apply soap
3. Rub hands together vigorously, including palms, back of hands, thumbs, finger tips
4. Lather for 15 seconds
5. Rinse well
6. Dry hands with clean towel or paper towel
7. Use towel to turn water off.
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
• Discard pump soap
container when empty,
do not refill to avoid
contamination
• Allow bar soap to
dry in between use.
Use of pump soap is
recommended.
• 15 seconds of latheriing
with soap is required to
remove germs
Key Points
• Sterile means
completely
germ-free
• Everything that
comes in contact
with your blood
must be sterile
• Good hand
hygiene
decreases the
germs on your
hands making
them clean but
not sterile
• Touching a sterile
part of an item
contaminates it
and puts you at
risk of infection
“Adherence to
hand hygiene
recommendations
is the single most
important practice
for preventing the
transmission of
microorganisms
(germs) in health
care and directly
contributes to
patient safety”
- Public Health
Agency of Canada
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“No Touch Technique”
Your Hemodialysis
Treatment
Using this technique prevents germs from entering your bloodstream.
This method is used in addition to hand washing and using ABHR. This is
accomplished by not touching anything underneath a protective cap. This cap guarantees that
what is under it is sterile. These caps are found on the ends of the dialyzer, blood tubing, syringes
and needles. You should also not touch any area that you have just disinfected, such as the rubber
on your medications vials, your fistula or graft and the tips of the catheter or connector device if
used. If you do touch any of these areas you must discard and get a new one or re-sterilize with
disinfectant.
Preparing The Hemodialysis Machine
1. Gather the following equipment necessary (or as directed) for your treatment and check
sterility and expiry dates
• Dialyzer
• Blood tubing
• Saline bags
• Dialysate
• Syringes, needles, alcohol swabs, gauze packages, mask (if directed)
• ABHR
• Heparin or alternate blood thinner (as directed by your clinic)
• Locking solution for catheter
• Clamps
• Fistula needles for fistula or graft
• Tourniquet for fistula
• Chlorhexidine or other disinfectant as directed
• Sharps container
2. Follow your unit’s specific instructions for preparation of your machine
Dialysate Circuit
As mentioned, water is a very important part of the dialysis treatment. Carefully follow your unit’s
instructions for looking after your water system and preparing it for your treatment. You will also
have dialysate concentrate specifically ordered for you by your nephrologist – check that you have
the correct solution and expiry dates are within range. Your dialysis machine will mix the water and
the concentrate solution. This is how your dialysis treatment regulates your electrolytes and other
items in your blood.
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Concentrate Contents
• Sodium
• Chlorine
• Potassium
• Calcium
• Bicarbonate
• Magnesium
• Glucose
Your Hemodialysis
Treatment
Preparing the blood circuit includes placing the tubing and dialyzer on the machine and priming
the blood circuit with normal saline. The purpose of priming the circuit is to remove air that is
in the tubing and dialyzer but also to check the integrity of these items. It is best to detect any
problems before you begin your treatment. Make sure you double check that all connections are
secure. Automatic alarm testing will occur throughout the machine preparation.
!
USE NO TOUCH TECHNIQUE,
CHECK INTEGRITY OF TUBING, REMOVE AIR,
DOUBLE CHECK ALL CONNECTIONS
It is necessary to use a medication during your treatment to
prevent the blood circuit from clotting. The most commonly
used medication is called heparin and is an anticoagulant.
It can be given as a bolus (single dose) or as a constant
infusion usually with a pump.
You will be prescribed a certain amount to give but it is
important to inform the unit if you have had surgery or
heavy bleeding (e.g. menstruation) so that your dose is
reduced.
REMEMBER the goal is to use just the right amount of
heparin to prevent clotting but not so much that it causes
bleeding.
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Initiating Treatment
Your Hemodialysis
Treatment
To begin your treatment it is necessary to access your bloodstream. This is done
by either inserting needles (fistula or graft) or using a catheter.
A. Using an arteriovenous fistula (AV fistula) or arteriovenous graft (AV graft)
Many people begin training thinking they will never be able to insert needles into their own
arm. Once you have mastered this, you will always prefer to insert your own needle as you
know your access best. Studies have shown that patients report less pain, less stress and fewer
problems when they do this themselves. Your nurse will give you all the support and guidance
you need including how to apply topical anesthetic, disinfecting your access, inserting the
needles and properly securing them. It is important to have good eyesight, good hygiene and
good sensation and control in your fingers and hands. If you do not, then an assistant would be
required. Two needles are required for each treatment unless you are dialyzing overnight five
or more times per week, where you may have the option of a single needle system.
Cannulation procedures
The procedure used will depend upon which access you have.
Procedure
Needle Type
AV fistula
AV graft
Rope Ladder
Buttonhole
Sharp steel or cannula
Blunt bevel
X
X
X
Rope ladder method for fistula or graft
• New cannulation sites for each treatment – about 1 cm from the site
used for the previous treatment
• Only method for a graft
• Helps develop a fistula, keeps access healthy by preventing bumps
(weakened areas) from forming on the access
• Needles are approximately 2.5 cm apart
• Needles usually inserted at a 25-45 degree angle depending on depth,
bevel up
• Can use a sharp steel needle or cannula
Rope Ladder
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Buttonhole (constant site) method
• Home hemodialysis patients prefer this method
• Exact site used each time needle is inserted - scarred tract is formed
– similar to the hole in a pierced ear – using a sharp needle 6-10 times
• Careful removal of previous scab and proper disinfecting is essential
• Needles are inserted exact angle and depth each time, bevel up
• Switch to dull bevel needle once tract is formed to prevent tearing of the tunnel
Supplies for rope ladder procedure
• Two fistula needles (sharp steel or cannulas)
• Two 10 ml syringes with saline (may also include anticoagulant - depends on renal unit’s policy)
• One gauze package (2”x 2” or 4”x 4”)
• Disinfectant – Chlorhexidine or other disinfectant as directed
• Tourniquet (AV fistula only)
• Tape of choice
• Two clamps – (cannulas only)
Rope ladder procedure – steel needles
1. Wash hands and access arm with soap and warm running water for 15 seconds, dry with clean towel 2. Remove fistula needles from package
3. Attach normal saline syringes to steel needles and prime – leave clamps open. Attach a dry syringe to first needle to be inserted if drawing blood samples (see procedure)
4. Apply tourniquet (AV fistula only) and select sites
5. Cleanse sites with disinfectant and allow to dry
6. Pinch wings of needle together, remove tip cover
7. Insert the needle into the arterial site, bevel up, 25-45 degree angle
8. Slide needle in carefully watching for flashback of blood in needle tubing
9. Tape securely and remove tourniquet
10. Check needle position by pulling back on the syringe and
inject slowly checking return flow. Clamp the needle
11. Apply tourniquet (AV fistula only)
12. Follow steps 6-10 for the venous site
13. Continue with procedure to initiate dialysis
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
Your Hemodialysis
Treatment
Buttonhole
Fistula Needle
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Rope ladder procedure - cannulas
1. Wash hands and access arm with soap and warm running water for 15 seconds, dry with clean towel
2. Remove cannulas from packages
3. Twist the inner needle of the cannula to break the seal between the needle and the cannula
4. Apply tourniquet (AV fistula only) and select sites, use ABHR to clean hands
5. Cleanse sites with disinfectant and allow to dry
6. Insert the cannula into the arterial site, bevel up, 25-45 degree angle
7. Once you see blood in the hub of the needle, push the needle into place
8. Tape securely and remove tourniquet (if applicable)
9. Remove the inner needle from the cannula
10. Clamp the cannula
11. Attach a 10 ml syringe with normal saline to cannula (if drawing
blood samples use a dry syringe and follow procedure)
12. Remove the clamp and check needle position by pulling back on
the syringe and inject slowly, checking return flow
13. Clamp the cannula
14. Apply tourniquet (AV fistula only)
15. Follow steps 6-13 for the venous site
16. Continue with procedure to initiate dialysis
Your Hemodialysis
Treatment
Cannula
Supplies for Buttonhole procedure:
• Two fistula needles (blunt steel or cannulas)
• Two 18 gauge blunt tip needles
• Two 10 ml syringes with saline (may also include anticoagulant - depending on renal unit’s policy)
• Gauze package (2”x 2” or 4”x 4”)
• Disinfectant – Chlorhexidine
• Tourniquet (AV fistula only)
• Medical tape
• Clamps (cannulas only)
Buttonhole procedure using steel needles
1. Wash hands and access arm with soap and warm running water for 15 seconds, dry with clean towel 2. Remove fistula needles from package
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
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3. Attach saline syringes (may include anticoagulant) to steel needles and Your Hemodialysis
Treatment
prime – leave clamps open. If drawing blood samples – leave one fistula needle dry by attaching a 10cc syringe (follow blood sampling procedure). Use ABHR to clean hands
4. Soak buttonhole sites with disinfectant or saline soaked gauze for five minutes
5. Remove scabs by lifting them off using an 18 gauge blunt needle for each site
6. Clean the area again with disinfectant (very important to prevent infection)
7. Apply tourniquet
8. Insert the fistula needle into the tract, bevel up, slowly moving it forward. If you meet resistance, gently turn the needle as it moves forward
9. Tape securely and remove tourniquet
10. Check needle position by pulling back on the syringe and inject slowly checking return flow.
Clamp the needle
11. Apply tourniquet
12. Follow steps 6-10 for the venous site
13. Continue with procedure to initiate dialysis
Buttonhole procedure using cannulas
1. Wash hands and access arm with soap and warm running water for 15 seconds, dry with clean towel
2. Remove cannulas from packages
3. Twist the inner needle to break the seal between the needle and the cannula. Use ABHR to
clean hands
4. Soak buttonhole sites with disinfectant or saline soaked gauze for five minutes
5. Remove scabs by lifting them off using an 18 gauge blunt needle for each site
6. Clean the area again with disinfectant (very important to prevent infection)
7. Apply tourniquet
8. Insert the cannula into the tract, bevel up, slowly moving it forward. Once you see blood in
the hub of the needle, push the needle into place. If you meet resistance, gently turn the
needle as it moves forward.
9. Tape securely and remove tourniquet
10. Remove the inner needle from the cannula
11. Clamp the cannula
12. Attach a 10 ml syringe to cannula
13. Remove the clamp and check needle position by pulling back
in the syringe and inject slowly, checking return flow
For more information
14. Clamp the cannula
regarding fistula and grafts and
15. Apply tourniquet
cannulation refer to
16. Follow steps 6-13 for the venous site
www.bcrenalagency.ca
17. Continue with connection to the hemodialysis machine.
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B. Using A Central Venous Catheter (CVC)
Your Hemodialysis
Treatment
The ends of your catheter will have caps on them to keep them sterile. These
caps are removed each treatment and then replaced once you are done.
Another option your unit may choose is to use needleless access caps which
are replaced once per week. These needleless access caps have a silicone cover with a tiny
slit which allows you to attach syringes and the bloodlines without removing the caps. Two
examples of these caps are the Tego™ and Interlink systems. Again it is extremely important to
wash your hands with soap and water before you begin. Some units may also ask you to wear
gloves.
Supplies for CVC (without needleless access device)
• Two 10 ml syringes filled with normal saline.
• 4” x 4” gauze
• Two 3 ml syringes
• Two Chlorhexidine swabs
• ABHR
• Masks for you or your assistant (if recommended by your renal team or if either of you
have a cold)
Procedure for access (without connector device)
1. Clean hands with ABHR
2. Place 4”x 4” gauze under catheter caps
3. Make sure catheter clamps are closed
4. Remove cap from the port
5. Place the end in the Chlorhexidine swab package and rub briskly – do not touch the ends of
the catheter
6. Remove the catheter from the chlorhexidine swab package, allow it to dry for one minute
and attach a 3 ml syringe. Open the clamp and withdraw 3 mls (blood and locking solution)
noting the ease of flow. It is very important you do not let the port end of the catheter touch
anything after you have removed the package or you must clean it again.
7. Clamp the catheter, remove the 3 ml syringe
8. If drawing blood samples follow procedure
9. Attach 10 ml syringe with saline, open the clamp and inject the normal saline, clamp the
catheter
10. Leave the syringe attached
11. Repeat steps 4-9 for the other port
12. Continue with connection to the hemodialysis machine
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Supplies for CVC using needleless access cap example #1 – Tego™ system
• Two 10 ml syringes filled with normal saline
• 4”x 4” gauze
• Two 3 ml syringes
• Six alcohol swabs
• ABHR
• Masks for you or your assistant (if recommended by your renal team or if either of you have a cold)
Your Hemodialysis
Treatment
Procedure for access using needleless access cap example #1 – Tego™ system
1. Clean hands with ABHR
2. Place 4”x 4” gauze under catheter port ends
3. Make sure clamps are closed
4. Scrub the end of the Tego™ using an alcohol swab – for at least 10 seconds and allow to dry –
do not let the Tego™ touch anything after you have cleaned it or you must clean it again
5. Attach a 3 ml syringe, open the clamp and withdraw 3 mls (blood and locking solution). Close the clamp
6. Remove the 3 ml syringe and discard
7. If drawing blood samples, follow procedure
8. Repeat #4
9. Attach the 10 ml syringe with saline, open the clamp and flush the catheter, close the clamp
10. Remove and discard the syringe
11. Repeat steps 4-9 for the other Tego™
12. Proceed with connection to hemodialysis machine making sure you scrub the ends of the
Tego™ again with alcohol for 10 seconds and allow it to dry prior to attaching the bloodlines
Supplies for access using needleless access cap example #2 – Interlink System
• Two 10 ml syringes filled with normal saline.
• 4”x 4” gauze
• Two 3 ml syringes
• Four threaded lock cannula adaptors (attach one to each 3 ml and place in packages to keep
tips sterile)
• Six alcohol swabs
• ABHR
• Masks for you or your assistant (if recommended by your renal team or if either of you have a
cold)
• Tape or locking box
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
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Procedure for access using needleless access cap example #2 – Interlink System
Your Hemodialysis
Treatment
1. Clean hands with ABHR
2. Place 4”x 4” gauze under catheter port ends
3. Make sure clamps are closed
4. Scrub the end of the Interlink cap using an alcohol swab for at least 10 seconds and allow it
to dry – do not let the cap touch anything after you have cleaned it or you must clean it again
5. Attach a 3 ml syringe with adaptor, open the clamp, withdraw locking solution, close clamp
6. Remove the adaptor and 3 ml syringe and discard the syringe, keeping the adaptor sterile
7. If drawing blood samples, follow procedure
8. Repeat #4
9. Attach the 10 ml saline syringe with adaptor, open the clamp and flush the catheter. Close the clamp
10. Repeat steps 4-9 for the other Interlink cap
11. Do not remove the 10 ml syringes and adaptors (keep adaptors sterile) until you are ready to
connect to the blood tubing on the dialysis machine.
12. Attach adaptors to blood lines
Connection to the Hemodialysis Machine
Once you have successfully accessed your fistula, graft or catheter, it is time to begin your
treatment.
1. Attach needle/catheter tips to tubing on the machine using no touch technique, making
sure you connect the correct needle/catheter limb to each line as directed by your unit.
2. Remove clamps and turn on the blood pump
3. Give anticoagulant (heparin sodium) as directed
4. Pay attention to machine pressures to ensure blood flow is adequate
5. Gradually increase blood pump speed
6. Secure lines using tape, add locking box if using Interlink System
7. Follow your unit’s instructions for machine operation
Monitoring Your Treatment
It is important that you monitor and record your BP, pulse and machine settings as you dialyze
and make adjustments as necessary. This is usually done every hour or more often (unless you are
dialyzing overnight where the treatment is gentler). If you feel unwell you must take immediate
action. You will receive instruction on how to handle any issues with your BP, your access as well
as your machine during your training period. There will be alarms and warnings to alert you of any
problems you need to address. Your records will be reviewed at clinic to assist your healthcare team
in making changes to your target weight and medications.
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
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Completing Your Treatment (Rinse back)
Your Hemodialysis
Treatment
Returning your blood at the end of your treatment can be done in a variety of
ways. If you are drawing post dialysis blood work, follow the procedure to draw blood prior to
rinse back. The instructions below are an example of a simple procedure that does not include
disconnection until rinse back is complete. However, you should always follow your unit’s specific
instructions.
1. When your machine indicates your treatment is complete, stop the blood pump.
2. Clamp the arterial line and open the saline administration line clamp.
3. Turn your blood pump on at 120-150 mls/min. and return your blood. As the saline pumps
through the circuit, the bloodlines become clear. Make sure you return all your blood.
4. Once the venous line is clear, stop the blood pump.
5. Clamp the venous line and venous access.
6. Open the clamp on the arterial line which allows the normal saline to flow by gravity and
clear the line and access, watching closely for air in the tubing.
7. Clamp the arterial line and access.
8. Proceed with post dialysis procedures (access care, completing your records and post dialysis
assessment)
Post Dialysis Access Care
Fistula or Graft
Supplies
• 2”x 2” gauze packages
• Two bandages
• Antibiotic cream (if used)
• ABHR
• Sharps container
Procedure for removing needles
1. Clean hands with ABHR
2. Disconnect your fistula needles from the blood lines
3. Remove tape on upper needle
4. Place gauze over needle site using two fingers
5. Gently remove the needle applying pressure once needle exits the skin
6. Only apply enough pressure to stop the bleeding, do not obstruct the blood flow in your
access. It usually takes 5-10 minutes for the bleeding to stop
7. Remove gauze and apply antibiotic (if used) and bandage
8. Repeat with the second needle
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
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Catheter (CVC) Without Needless Access Cap
Your Hemodialysis
Treatment
Supplies
• ABHR
• Two 10 ml syringes filled with normal saline
• Locking solution: (as per unit protocol) 2 - 3 ml syringes with 4% sodium citrate or 2 - 3 ml
syringes with prescribed volume of heparin - may or may not be diluted with saline
• Two Chlorhexidine swabs
• 4”x 4” gauze package
• Two caps
Procedure for disconnecting
1. Clean hands with ABHR
2. Make sure catheter clamps are closed and use the no touch technique for the following steps
3. Open caps but do not remove from package
4. Place 4”x 4” gauze under catheter
5. Disconnect bloodline from one of the catheter ends.
6. Place the end of the port in the Chlorhexidine package and rub briskly then remove the
package and allow it to dry. Do not allow catheter tip to touch anything between steps
7. Attach a 10 ml syringe filled with saline to the end of the catheter, open the clamp and flush
the catheter limb, clamp (do not pull back on the syringe).
8. Remove the syringe and attach the 3 ml syringe with locking solution.
9. Open the clamp and inject the prescribed amount.
10. Clamp the catheter and remove the syringe
11. Attach the cap to the end of the catheter.
12. Follow steps 5-11 for the other catheter limb.
CVC using example #1 needleless access cap – Tego™ system
Supplies
• ABHR
• Two 10 ml syringes filled with normal saline
• Locking solution: (as per unit protocol) 2 - 3 ml syringes with 4% sodium citrate or 2 - 3 ml
syringes with prescribed volume of heparin - may or may not be diluted with saline.
• Four alcohol swabs
• 4”x 4” gauze package
• Unsterile gloves (may be optional)
Procedure for disconnection
1. Clean hands with ABHR
2. Make sure catheter clamps are closed and use the no touch technique for the following steps
3. Place 4”x 4” gauze under catheter
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
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4. Disconnect bloodline from one of the catheter ends
Your Hemodialysis
Treatment
5. Scrub the end of the Tego™ with an alcohol swab for 10 seconds and allow it to dry
6. Attach a 10 ml syringe filled with saline to the end of the catheter, open the clamp and flush the catheter limb, clamp (do not pull back on the plunger)
7. Remove the syringe and scrub the end with another alcohol swab, allow it to dry
8. Attach the 3 ml syringe with locking solution.
9. Open the clamp and inject the prescribed amount.
10. Clamp the catheter and remove the syringe
11. Follow steps 4-10 for the other catheter limb.
CVC Using Example #2 Needleless Access Cap – Interlink System
Supplies
• ABHR
• Two 10 ml syringes filled with normal saline
• Locking solution (as per unit protocol) 2 - 3 ml syringes with 4% sodium citrate or 2 - 3 ml
syringes with prescribed volume of heparin – may or may not be diluted with saline.
• 4”x 4” gauze package
• Unsterile gloves (may be optional)
• Two threaded leur adaptors – keep tips sterile and attach to saline filled syringes
• Two Chlorhexidine swabs
Procedure for disconnection
1. Clean hands with ABHR
2. Make sure catheter clamps are closed and use the no touch technique for the following steps
3. Place 4” x 4” gauze under the catheter
4. Disconnect threaded leur adaptor from arterial bloodline
5. Cleanse end of Interlink cap with Chlorhexidine and attach threaded leur adaptor and saline
syringe
6. Open clamp and flush the catheter limb, clamp (do not pull back on the plunger)
7. Repeat steps 4, 5 and 6 for venous bloodline
8. Remove threaded leur adaptor and syringe from arterial side of catheter, attach threaded
leur adaptor to locking solution syringe
9. Attach to arterial side of catheter, open clamp, infuse locking solution – careful not to infuse
air, clamp and remove threaded leur connector and syringe
10. Repeat steps 8 and 9 for venous side of catheter
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
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Changing Needleless Access Caps (Weekly or as Directed)
Your Hemodialysis
Treatment
Supplies:
• 4”x 4” sterile gauze package
• Four chlorhexidine swabs (alcohol free)
• Two Tego™ caps OR two Interlink caps
• Mask
• Non-sterile gloves
Procedure:
1. Wash hands with ABHR, mask and glove.
2. Open Tego™/Interlink and chlorhexidine packages
3. Insert port end of each catheter limb into a chlorhexidine packages and scrub x 10 seconds
4. Make sure clamps are closed
5. Place 4”x 4” gauze under catheter – do not allow chlohexidine packages to touch the gauze
6. Remove chlorhexidine packages and place catheter port ends on gauze and allow to dry for
one minute
7. Remove one of the Tego™ /Interlink caps, scrub with chlorhexidine swab for 10 seconds,
allow to dry x 1 minute and attach new Tego™/Interlink cap.
8. Repeat #7 for other lumen.
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
module 3
Blood Sampling
Your Hemodialysis
Treatment
You will collect your own blood samples at home. These blood tests are
important as they indicate if your treatments are working.
Samples are done at the beginning and end of a treatment, usually once per month or as
directed. Follow the instructions you have been taught when handling blood specimens for
the most accurate results.
Collecting Pre (Before) And Post (After) Dialysis Blood Samples - AV fistula or AV graft
There are different ways to obtain blood samples – this is one of the simpler examples – but
your unit will give you directions on which method they would like you to follow.
Supplies
• 10cc syringe with needle
• Blood tubes
• Alcohol swab
Pre Dialysis
Post Dialysis
1. Insert first fistula needle (dry) with 10cc
syringe attached.
2. Fill syringe with required amount of
blood, clamp, loosen tourniquet, tape
needle.
3. Remove syringe, flush fistula needle with
saline, clamp.
4. Attach needle to blood filled syringe and
inject blood into the tubes.
5. Rotate tubes and spin blood in
centrifuge.
6. Continue with second needle as per
procedure.
1. Treatment is complete.
2. Turn off ultrafiltration and dialysate flow,
set blood pump speed to 100ml/min and
wait 15 seconds.
3. Swab arterial injection port with alcohol
and allow it to dry.
4. Insert needle into port and remove
required amount of blood.
5. Inject blood into the tubes.
6. Rotate tubes and spin blood in centrifuge.
7. Continue with rinse back.
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
module 3
Collecting Pre (Before) And Post (After) Dialysis Blood Samples Central Venous Catheter
There are different ways to obtain blood samples – this is one of the simpler
examples – but your unit will give you directions on which method they would
like you to follow.
Your Hemodialysis
Treatment
Supplies
• Two 10cc syringes
• 18 gauge, one (1) inch needle
• Blood tubes
• Alcohol swab
• Threaded leur adaptor for Interlink system (attach to 10 ml syringe)
Pre Dialysis
Post Dialysis
1. Withdraw 10 mls from catheter (locking
solution and blood). Clamp catheter limb.
2. Remove syringe, scrub port /cap with
alcohol for 10 seconds, allow it to dry,
attach10 ml syringe, withdraw required
amount of blood. Clamp catheter limb.
3. Attach needle to syringe and inject blood
into the tubes.
4. Rotate tubes and spin blood in centrifuge.
5. Continue with procedure for accessing
catheter for initiation of dialysis.
1. Treatment is complete.
2. Turn off ultrafiltration and dialysate flow,
set blood pump speed to 100ml/min and
wait 15 seconds.
3. Swab arterial injection port with alcohol
and allow it to dry.
4. Insert needle into port and remove
required amount of blood.
5. Inject blood into the tubes.
6. Rotate tubes and spin blood in
centrifuge.
7. Continue with rinse back
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
module 3
How To Use A Centrifuge Your Hemodialysis
Treatment
The purpose of a centrifuge is to spin the blood to allow the red cells to separate. This keeps the sample stable for an extended period of time to help get accurate results.
Procedure:
1. Open the cover
2. Load the tubes in the holders opposite each other to balance the tubes while spinning
3. Close the cover
4. Turn the timer on for prescribed amount of time
5. Once spinning is stopped, open cover and remove tubes
6. Refrigerate if directed
!
SAFETY TIP:
NEVER UNLATCH THE COVER
WHILE IT IS SPINNING
Centrifuge
Discarding and Disinfecting Equipment
Your unit will instruct you on how to properly discard your bloodlines according to municipal
bylaws – either by usually double bagging your garbage or by rinsing the lines with a diluted
bleach solution prior to disposal. Plastic concentrate containers can be recycled. Needles are placed
in a sharps container and generally taken to your clinic or local pharmacy/hospital for disposal.
You will also be shown how to keep the outside of your machine clean as well as how to regularly
disinfect and test the hemodialysis machine. It is essential that this is done following each
treatment and if you do not use your machine for a few days.
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment
module 3
Single Needle Hemodialysis
System
Your Hemodialysis
Treatment
If you are using a fistula or graft and your prescription allows it (dialyzing overnight and more than
3 times per week), you may be able to use a single needle system. This only requires one needle
to be inserted in your arm. The needle is very similar to the regular ones you would use but have
2 limbs instead of 1.The system will vary depending upon the equipment your unit uses. Most
systems involve the use of 2 pumps – the first one pumps blood from one side of the needle tubing
and fills a balance chamber, the pump stops and then the second pump starts and runs until the
balance chamber is almost emptied, pumping the blood back to you through the other side of the
needle tubing. This sequence is repeated throughout your treatment. This system is not as efficient
as when you use 2 needles but with the extended time and frequency of your treatment, you will
obtain adequate treatment. Only using one needle is the most obvious advantage of this system.
Notes
Your Guide to Home Hemodialysis | Module 3: Your Hemodialysis Treatment