Nephrology

1225 Guide For Haemodialysis Outside 7 West Dialysis Unit

  • Guide For Haemodialysis Outside 7 West Dialysis Unit 

    To establish haemodialysis machinery in an external setting, and function safely.

    Patient Preparation

    Suitable access i.e. dual lumen CVC (see 2.7), femoral vas-cath or established fistula

    Patient should be located close to water supply (e.g. hand basin)

    NB: On lower floors of R.C.H. (e.g. ICU), water pressure is adequate to maintain flow through R.O.  (requirement is > 444 KPa)

    Establishment of Machinery

    HDx machine ( + R.O.) from 7 West

    Plumbing extension (includes hose for direct tap connection, plus 5 Micron Carbon filter and 1 Micron filter inside filter housings)

    Procedure for connecting plumbing

    On 7 West 

    • Disconnect Hoses x3 from back wall, (water in x1; RO drainage x1; Machine drainage x1
    • Disconnect electricity.

    Outside 7 West

    • Attach electricity
    • Unscrew connections at tap outlet
    • The other end of the plumbing extensions is attached to the R.O.  "Dialysis Water Supply" (water in) hose connection.
    • Drain outlet hoses (x2) can be placed in hand basin or drain, and taped securely during treatment

    Trolley requirements

    • ACT machine and cartridges
    • Clamps x6
    • Sterile gloves
    • Syringes
    • Needles
    • Alcohol wipes
    • Recirculators
    • Dead End caps
    • Isolators
    • Spare Dialysers
    • Spare blood lines
    • Blood specimen tubes
    • Heparin 5000 U/5ml
    • Additive Labels
    • Tapes
    • Haemodialysis dressing packs
    • Saline 10ml amps
    • Betadine
    • Chlorhexidine in Alcohol

    Other

    • HDx Manual
    • Mannitol
    • IV Normal Saline flasks (1/2 + 1 litre)
    • K1 & K2 Dialystate 5 litre
    • Bicart (bicarbonate cartridges)
    • Potassium additive to dialysate acid component.

    Prior to commencing HDx

    Obtain Medical Treatment Orders.  Medical Support if acute patient.  (i.e. Doctor present for commencement of treatment and throughout treatment if child unstable).  This need can be determined at the time.

    Ensure that the following are in place

    • Orders are in accordance with HDx manual
    • Check desired urea clearance, and suitability of dialyzer and blood flow rates
    • Total priming volume of lines and dialyzer <10% of child's total blood volume
    • Does the patient require Albumin/Blood product as prime?
    • Heparin requirements in accordance with 2.3 of HDx manual.  ACT's performed ½ hourly/as required
    • Does patient require mannitol?