Dialysis- The Procedure....

Though the basic procedure of the haemodialysis  is same all over the world, the way people perform it may vary according to the conventional system of different countries, fund available and moreover, convenience of the staff performing it. It's up to the staff. But one thing we have to keep in mind is that, there is a standardized procedure that we can modify according to our comfort but never neglect the fundamental things.

Articles needed: A medium sized autoclaved steal tray or a disposable sterile tray containing cotton swabs, a small bowl for the saline, an artery forceps(not necessary if you are confident that you can maintain asepsis) and a sterile towel. Other articles needed included the a dialyzer, blood tubings, fistula needles, transducer protector, adhesive plasters, a 5-10ml syringe, a 10 ml syringe for heparinization, heparin injection and Hydro-cortisone injection(optional).

Transducer Protector

Dialysis Machine

Fistula Needle

Dialyzer connected with blood tubings and dialysate couplings.

Check the weight and vital signs of the patient and set the machine parameters according to it. Hygiene of the patient skin as well as the staff is of a primary concern. Because by sticking the needle, there will be a great risk for the entry of various organisms. Remember, these patients are already weak either by their illness or recurrent hydrocortisone therapies. The nurse should wash hands before and after the procedure to prevent cross infections. Put on clean(no need to put on sterile gloves) gloves. Prime the tubings and dialyzer with at least 2litres of Normal saline. We should ensure that even a small quantity of air is not remaining in the dialyzer to prevent embolism. After priming connect the dialysate couplings to the dialyzer.  Have someone to assist you. Ask your assistant to open the outer flap of the autoclaved tray. Remove your old gloves and put on sterile gloves. Open the tray and fill your bowl with normal saline.Ask your assistant to open all the packets and transfer the equipments to the sterile tray. Wipe the pricking area with a cotton swab applied with spirit and povidone iodine. Then pat dry with another cotton ball. Place the sterile towel under the area. Using a 5ml syringe, prime the fistula needle and stick. Secure the needles with plasters. Always remember to prick at least one inch away from the fistula or graft. Connect the lines and run the pump at a slow rate. Take 1ml of 25000IU heparin in a 10ml syringe and dilute it with rest amount of saline. Set the heparin pump and connect the venous pressure line to a transducer protector. Then change the preparation mode to dialysis mode after all other procedures. It is important because it is the safe mode that detects any air or clot in the bloodstream. Check vital signs every thirty minutes and watch for any complication.

Usually the duration of a maintenance dialysis in clinical setting is 3-5hours. It is determined according to the patient's weight and blood reports. After completing the required time period, its time for ending the procedure. Stop the pump and clamp all the main lines and fistula needles. Connect the arterial line to normal saline and run the pump after releasing the clamps. About 100ml saline is infused to return all the blood to the patient's vein. After returning the blood completely and carefully, remove the needles one by one applying a finger pressure with a rolled gauze piece. Observe for any bleeding. Now the next task is to cleanse the dialysis kit for next use. I'll explain it in the next post....