hemodialysis

- Prepared by

Under supervision

- Procedures for receiving a first-time patient

➡️Steps:

·  Patients are received at the kidney clinic, where they are examined, tested, and their condition is assessed to determine whether dialysis is needed or not.

·  The patient was received in the designated area for dialysis unit patients in the outpatient clinic.

·  The card is being issued.

·   A customized form specifying the patient's name, date of birth, assigned code number, and their financial treatment system.

· The patient goes to the unit and presents his card to the unit's secretary, who retrieves the treatment file and hands it to him.

· This file contains his monthly research, medical history, and the forms designated to monitor his condition during the dialysis session.

- Procedures for welcoming a resident patient

➡️steps  :

▪️ The unit administrator follows up by confirming appointments through the appointment card and recording the patient in the unit's accounting records.

▪️  Ask the patient to go to the restroom to avoid excessive movement during the session.

▪️  Ask the patient to wash their hands up to the elbows with soap and water to remove dirt.

▪️ Weigh the patient before entering the session and compare the baseline weight with the current weight.

▪️ Recording the patient in the unit's visitor log.

▪️  The excess weight over the normal weight is calculated so that it can be deducted.

▪️ Placing the patient in their designated spot and raising the sides of the bed.

▪️ Performing a complete set of vital signs.

▪️   Preparing the patient for a dialysis session.

▪️   Testing electrical and water connections.

▪️   Preparing the washing solution container and placing it next to the machine, then inserting the stick into the container according to the type of washing solution.

▪️ Opening the machine and conducting a test on the machine.

▪️  Placing the filter in its position on the machine.

▪️  Placing the arterial and venous grafts in their correct positions.

▪️  Connecting the arterial line to a saline solution bottle to remove air from the filter lines.

▪️  Ensure the air is expelled, place heparin in the venous connection, and create a closed loop.

▪️ Pass the solution through the machine for 30 minutes.

▪️  Connecting the patient to the designated machine.

➡️  Smile and love!

First thing, you must greet the patient with a broad smile to make them feel welcome, because dialysis can be psychologically exhausting, and a friendly atmosphere alleviates the stress.

➡️ A simple introduction to the unit

Explain to him briefly how things work in the dialysis department, the session times, and the team that will be with him. Take it easy, meaning don't let him get bogged down in too many details.

➡️ Medical inquiry

Of course, there will be a form, but the most important thing is to talk to him personally: ask him about his health condition, any symptoms, or medications he is under the supervision of the medical team.

➡️  His reassurance about the procedures

Dialysis can be scary the first time, right? Let him know that it's safe and that there will be a specialized team with him the whole time, monitoring his condition and checking the machines.

➡️  Security procedures

Introduce him to preventive measures like washing hands and wearing a mask, for his safety and the safety of others. Always make him feel like a partner in maintaining his health.

- Nursing procedures for the insertion of a subclavian catheter (Mahoker)

steps

- Nursing procedures during the insertion of a femoral catheter

steps

- Nursing procedures to start a dialysis session

Steps :

- Nursing procedures during a dialysis session

Steps :

·       Filling out nursing forms during the session for each patient: weight, vital signs, medications, and solutions during the session. Recording excess weight, pump speed.

·       Observe any signs of low blood pressure (dizziness, sweating, fainting, lack of concentration).

·       Administering the heparin dose at the scheduled times.

·       Monitoring blood pressure every hour during the session.

·       Observing any changes that occur in the patient during the dialysis session (bleeding from the arteriovenous fistula site - continuous monitoring of the dialysis machine - vomiting... etc.)

- Nursing procedures for a patient with dialysis access.

Steps :

- Nursing interventions during the occurrence of dialysis complications

A)  Low blood pressure

Steps

·       Withdrawal is stopped after the doctor's review.

·       Reducing the withdrawal rate after consulting the doctor

·       Increasing the sodium and calcium solution in the dilsate converter after consulting the doctor

·       Reducing the temperature of the dilsate after consulting the doctor

·       Stopping high blood pressure medication about 4 hours before the session after consulting the doctor.

·       Administering blood pressure-raising medications as directed by the doctor, such as Midodrine 6 mg, half an hour to an hour before the session.

·       All the previous procedures are carried out in the presence of the doctor and under their instructions

B)   Muscle cramp .

steps :

·       Reducing the withdrawal rate after consulting the doctor.

·       Giving a saline solution after consulting the doctor.

·       Massage the tense area.

C)   Imbalance

Steps  :

·       Using small-sized filters after consulting the doctor.

Reducing the blood flow rate (the pump) and the dialysate after consulting the doctor.

C )Chest pain

Steps  

• Reducing the blood flow rate to 200 ml and stopping the suction.
• The patient is placed in a sitting position.
• Giving oxygen and pain relief as per the doctor's instructions.
• If the pain does not subside, the session will be terminated and an ECG will be performed on the patient.

- Nursing procedures to finish a dialysis session

Steps  :

·       Handwashing

·       Preparing the necessary supplies (bandage + sterile gauze)

·       Wearing protective clothing (apron - gloves - mask - goggles)

·       Measuring blood pressure before ending the session to determine the type of solution used, saline or glucose.

·       Closing the blood pump and closing the artery valve and artery needle

·       Placing the arterial line in the solution bottle and opening the blood pump.

·       Activating the connections and filter to ensure that blood does not clot in the filter.

·       Raising the arterial-venous fistula needle and applying gentle pressure on it.

·       Disinfect the arteriovenous fistula site with Betadine, sterile gauze, and a plaster after ensuring there is no blood at the fistula site.

·       Disposing of connections, filters, and all patient-related consumables, and changing the bedding.

·       Disinfecting the machine from the outside with chlorine and alcohol

·       The patient's weight and recording it in the medical file.

·       Measuring blood pressure before allowing the patient to leave the unit

·       Recording all supplies and medications and obtaining the signatures of the responsible nursing staff

·       Following up on the patient's signature for the session and confirming the time for the next session.

·       Monitoring the patient's discharge from the unit by the staff.

- Care for the dialysis machine

Steps  :

Wearing personal protective equipment.

Remove the solution stick from the jug and place it in the machine.

Connecting the dialysis tubes to the machine

·        Ensure that all doors (pump, blood reservoir) are closed to create a closed loop Rinse

·        Enter the program first.

·        Entering the machine into the Dis infection program.

· The necessary solution for the machine is a chlorine solution for acetate washing and a citric solution for bicarbonate washing.

·        Shut down the machine after it completes the program

Wipe the outside of the machine with diluted bleach at a ratio of 100 cm of bleach per liter of water for the machine body.

Wipe the parts of all control switches with 95% alcohol.

Protocol for sterilizing the Fresenius dialysis machine model 4008

First: In the case of washing using a solution:أسيتات

A rinse is done between each session.At the end of the day (every day), one of the two methods is followed.

First way :

Chemical cold disinfection PGM5 using a 10% diluted sodium hypochlorite.
The commercial name (Javel or Clorox)
The hot rinse program is working.برنامج الشطف الساخن

Second way :

Conduct a hot chemical decontamination on PGM2 (from the back of the yellow link) using one of the following media –

Fresenius Diasteril

Fresenius Citrosteril

- ONLINE CLEARANCE MONITORING

Purpose: Improving the quality of dialysis, enhancing health status, and reducing mortality rates.

- Monthly analysis procedures

steps :

·       Accompanying the doctor to the patient and determining the type of required tests.

·       Follow-up on writing the analyses

·       Explaining the procedure in a simple way to the patient

·       Preparing the specific tubes for the sample type.

·       Collecting samples while following infection control instructions

·       Sending the sample to the lab

·       Bringing the lab test results by the medical secretary

·       Informing the doctor of the results and recording them in the patient's file and the analysis notebook.

·       Giving a copy of the test authorization to the accounts clerk to place it in the patient's file.

·       Presenting the monthly analyses to the unit manager

The most important tests:

- Na (sodium): 135-145

- K (potassium): 3.5-5.5

- Ca(calcium): 9-11

- Mg (magnesium): 1.8-3

- Cl(chloride): 96-106

- P (phosphorus): 3-4.5

- PH: 7.35-7.45

- HCO3: 22-26

- CO2: 35-45

- Health education

1-Understanding the process of dialysis

Dialysis is a method of purifying the blood from waste and toxins that the kidneys cannot eliminate due to impaired function. The education here focuses on:

Number of weekly sessions (usually 3 times a week)

The duration of each session (usually around 4 hours).

How to purify the blood.

2. Adhering to the laundry schedule

One of the most important things is the patient's commitment to the session schedules and not missing them. Skipping a dialysis session could lead to the accumulation of toxins in the body.

3. The diet

The diet for dialysis patients is very sensitive. Some tips include:

Reducing salt intake to avoid high blood pressure and fluid retention in the body.

Reducing phosphorus and potassium, because their high levels can cause problems with bones and the heart. Foods that contain phosphorus, like nuts and legumes, and potassium, like bananas and potatoes, should be reduced.

Controlling fluid intake: Because the kidneys cannot eliminate excess fluids, it is necessary to limit the amount of fluids consumed daily.

4. Care of the arteriovenous fistula (AV Fistula)

The arteriovenous fistula is the lifeline in the dialysis process. The patient must learn how to maintain it.

Avoid lifting heavy weights or putting pressure on them.

5.Monitoring any signs of inflammation such as redness or swelling.

Ensuring to hear the "pulse" or "hum" in the area daily.

Not wearing tight clothes

Not measuring blood pressure from the same arm

Finger tapping to increase the efficiency of the arteriovenous fistula.

Not wearing any accessories on the same hand.

6-. Dealing with side effects

Dialysis can cause symptoms like:

Fatigue and exhaustion after the session.

Itching of the skin due to high phosphorus levels.

Muscle spasms. The patient must know how to deal with them and contact the medical team if there are any abnormal symptoms.

7. Maintaining physical activity

Even with dialysis, it is important for the patient to maintain light physical activity such as walking or light exercises. This helps improve both mental and physical well-being.

8. Psychological and social support

Health education also includes the psychological aspect. A dialysis patient goes through psychological and social challenges, so they need to know that psychological support is available, whether from family or support groups. Talking about their feelings and dealing with stress and depression is part of the treatment.

9. Continuous communication with the medical team

The patient must learn that any health issue, no matter how minor, should be reported to the doctor or nurse. Regular check-ups like blood tests and blood pressure monitoring are essential to maintain the stability of their condition.

- References

◾  Pagels AA, Söderkvist BK, Medin C, Hylander B, Heiwe S. Health-related quality of life in different stages of chronic kidney disease and at initiation of dialysis treatment. Health Qual Life Outcomes. 2018;10:71.

◾  Polikandrioti M, Koutelekos I, Gerogianni G, Stefanidou S, Kyriakopoulos V, Floraki E, et al. Factors associated with hemodialysis machine dependency. Med Arch. 2019;71(2):122-7.

◾  Schrier, R. W.: Renal and electrolyte disorders, 6th ed., Philadelphia:USA: Lippincott Williams & Wilkins. (2017). Pp, 227-235.

◾ Identification of patients with CKD in medical databases: a comparison of different algorithms Clin J Am Soc Nephrol, 16 (2021), pp. 543-551