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Pre-dialysis

1. Before or around the time the patient arrives for his/her scheduled session, a dialysis machine will
be prepared. The technician or nurse will set up plumbing on the machine in a moderately
complex pattern that has been worked out to move blood through the filter, allow for saline drip
(or not), allow for various other medications/chemicals to be administered.

2. The pressure point will roll around through the 270 degrees, forcing the fluid to move (see also
peristaltic pump). It is characteristic of dialysis machines that most of the blood out of the
patient’s body at any given time is visible. This facilitates troubleshooting, particularly detection
of clotting.

3. The patient arrives and is carefully weighed. Standing and sitting blood pressures are taken.
Temperature is taken.

4. Access is set up. For patients with a fistula numbing the entry sites before the needles are inserted
— the two most common are lignocaine (lidocaine), a local anaesthetic injected under the skin,
and there is also a cream called EMLA which is applied to the skin 45 minutes before the needles
are inserted. For other patients, access may be via a catheter installed to connect to large veins in
the chest. Other arrangements can be made as well.

Dialysis

1. The pump and a timer are started. Hemodialysis is underway. Periodically (every half hour,
nominally) blood pressure is taken. A session of hemodialysis may typically remove 2-
5kilograms (5-10 pounds) of fluid from the patient. The amount of fluid to be removed is set by
the dialysis nurse according to the patient's "estimated dry weight". This is a weight that the care
staff believes represents what the patient should weigh without fluid built up because of kidney
failure. Removing this much fluid can cause or exacerbate low blood pressure. Monitoring is
intended to detect this before it becomes too severe. Low blood pressure can cause cramping,
nausea, shakes, dizziness, lightheadedness, and unconsciousness.

Post-dialysis

1. Temperature, standing and sitting blood pressure, and weight are all measured again. Temperature
changes may indicate infection. BP discussed above. Weighing is to confirm the removal of the
desired amount of fluid.

2. Care staff verifies that the patient is in condition suitable for leaving. The patient must be able to
stand (if previously able), maintain a reasonable blood pressure, and be coherent (if normally
coherent). Different rules apply for in-patient treatment.

Post-dialysis washout

Following hemodialysis, patients may experience a syndrome called "washout". The patient feels weak,
tremulous, extreme fatigue. Patients report they "are too tired, too weak to converse, hold a book or even
a newspaper." It may also vary in intensity ranging from whole body aching, stiffness in joints and other
flu-like symptoms including headaches, nausea and loss of appetite. The syndrome may begin toward the
end of treatment or minutes following the treatment. It may last 30 minutes or 12-14 hours in a
dissipating form. Patients though exhausted have difficulty falling asleep. Eating a light meal, rest and
quiet help the patient cope with washout until it has 'worn away.'

1. and vascular access monitoring information on this tab. CLINICAL PROCEDURES V. . allergies. you can use this screen to print historical result reports. this is the first tab to display. Finally. clinical warnings. past treatment information by date. This screen also displays information about infectious diseases. You can view current treatment information. and advanced directives.0 HEMODIALYSIS MODULE Cover tab After selection of a patient. transplant status.

Rx and Lab Tab Use the Rx and Labs tab to enter the dialysis prescription and view lab results. The following information is displayed on the Rx and Lab tab:  Error: Reference source not found  Order  Anticoagulants  Modeling  Dialysate Formula  Other Orders  Lab Results  Comments Lab Tests includes: National Lab Code Lab Test 84520 BUN (Blood Urea Nitrogen) .

82565 CREATININE 84295 SODIUM 84140 POTASSIUM 82435 CHLORIDE 82830 CARBON DIOXIDE 82310 CALCIUM 84100 PHOSPHORUS 82040 ALBUMIN 84455 AST (Aspartate Aminotransferase) 84465 ALT (Alanine Aminotransferase) 84075 ALKALINE PHOSPHATASE 82250 BILIRUBIN 83020 HEMOGLOBIN 85055 HEMATOCRIT 85569 WBC (White Blood Count) 86806 PLATELETS 83057 HEMOGLOBIN A1C 82466 CHOLESTEROL 84480 TRIGLYCERIDES 82370 FERRITIN 83540 IRON 82060 TRANSFERRIN 84012 PARATHYROID HORMONE .

81512 ALUMINUM 89068 HEPATITIS B SURFACE ANTIGEN 89065 HEPATITIS B SURFACE ANTIBODY 89067 HEPATITIS B SURFACE ANTIBODY 82013 HEPATITIS B SURFACE ANTIBODY 89095 HEPATITIS B SURFACE ANTIBODY 89127 HEPATITIS B SURFACE ANTIBODY 89128 HEPATITIS B SURFACE ANTIBODY 87398 HEPATITIS B SURFACE ANTIBODY 89699 HEPATITIS B SURFACE ANTIBODY 89070 HEPATITIS C ANTIBODY 87261 FLU .

Pre-Treatment Tab The Pre-Treatment tab is used to enter pre-dialysis vitals and pre-dialysis pain assessment. The following information is entered/ displayed on the Pre-Treatment tab:  Error: Reference source not found  Weight  Temperature  Blood Pressure and Pulse  Other  Mental Status  Barriers to Learning  Patient Education  Patient Transportation  Safety Checks  Error: Reference source not found  Error: Reference source not found .

select. remove. assess.Access Tab You can enter information about vascular access sites on the Access tab. and comment on access sites. The following information is displayed on the Access tab:  Error: Reference source not found  Error: Reference source not found  Error: Reference source not found  Error: Reference source not found  Error: Reference source not found  Error: Reference source not found  Error: Reference source not found  Error: Reference source not found  Error: Reference source not found  Error: Reference source not found . Use this tab to add.

 Error: Reference source not found The following information is entered/ displayed on the Flowsheet tab:  B/P .Blood flow rate  DFR .Dialysis flow rate  AP .Flowsheet Tab Use the Flowsheet tab to capture data from the dialysis instrument and manually enter dialysis information and medications used during treatment The following information is displayed on the Flowsheet tab:  Error: Reference source not found – Data sent from instrument or entered in manually during treatment.Mean arterial pressure  HR .Heart rate  BFR .Blood pressure  MAP .Venous pressure .  Error: Reference source not found – Other medicines used during treatment.Arterial pressure  VP .

Cumulative volume of fluid removed from patient  HEP (CUM) – Cumulative Heparin infusion  COND .Ultrafiltration rate  Fluid Off .Conductivity  BIC .Trans membrane pressure  UFR .Bicarbonate bath  DIAL TEMP .Dialysate temperature  IONIC DIAL .  TMP . Medication List Columns The following information can be entered in the Medication List:  Date .Measurement of clearance via ionic or conductivity estimation  Kt/V .  Time  Medication  Dose  Units  Route  Given By  Reason  Outcome .Date the entry was added.Dose of dialysis Important: Labs must be taken mid-week for the KT and KT/V calculations to return accurate results.

Post-Treatment Tab The Post-Treatment tab is used to enter vitals. The following information is displayed on the Post-Treatment tab:  Error: Reference source not found  Weight  Temperature  Blood Pressure and Pulse  Other  Mental Status  Observations  Patient Transportation  Error: Reference source not found  Error: Reference source not found  Error: Reference source not found . and pain assessment after the dialysis treatment has completed. observations.