The Procedure For Catheter Patients.

                In the last post I explained the procedure of haemodialysis. But when it comes to the starting and closing of the catheter patients, it’s a bit different. It needs more care and patience as there is a higher risk of infection for catheter patients.  The procedure remains the same till priming. After that, remove the protective covering of the catheter with the gloves we primed the dialysis set. Then remove it and don a pair of new sterile gloves. Ask the assistant to open the outer flap of the autoclaved tray. Then open the tray and ask your assistant to open and transfer all the packaged articles to it. Wet a sterile cotton ball with spirit and povidone iodine and wipe the catheter and the portion of the skin to which the catheters come in contact with.  Uncap the catheter and wipe the catheter from the opening towards the other end. Place a sterilized towel under the catheter and withdraw 2-3 ml of blood from each tube using a 5ml syringe. This is to minimize the risk of infection and thromboembolism and to avoid the mixing of old flushed heparin with the blood.  The tubes of the catheter will be of two colours- red, arterial and the blue, venous.  Ensure the free flow of blood in the catheter by repeated aspirations followed by reinfusions.  In some patients, due to careless handling and bending, the catheters may get dislodged or kinked. In such cases, we have to carefully adjust the catheter position manually or try massaging the vicinal part of the catheter insertion.  After a free flow of blood is established, connect the blood lines accordingly and run the pump at a slow rate.

                                                                          After the blood is returned at the end of the dialysis, flush the catheter thoroughly until the transparent tubes become completely clear. Then we have to do hep-locking(1ml of 25000IU heparin diluted with 5ml saline. Some entertain choosing sodium bicarbonate injection instead of normal saline. According to me, it is more preferable. This is to prevent the formation of clots until next dialysis. For some people who frequently get infections, we close the catheter with antibiotics like gentamycin or amikacin. After the flushing is complete, clean the catheter tip with betadine and spirit. No blood or clot should be allowed to remain. Close it tightly with a cap, then repeat  wiping over the entire catheter 2 or 3 times with new swabs. Cover the catheter with a sterile gauze and then by a clean adhesive plaster. Remove the plaster over the catheter insertion site for cleaning. Remove the old gloves and don the new ones. Clean the insertion site thoroughly and most importantly carefully using gauze dipped in betadine and spirit. Repeat twice and move towards periphery. Remember, once you move towards periphery; don’t come back to the insertion site. After drying the site, cover it with sterile gauze then secure with a clean plaster. That’s all….

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....

Know More About Dialysis.

WHAT IS DIALYSIS?

The incidence of renal patients has skyrocketed all over the world since the recent past. It is assumed that one’s lifestyle has the most significant role in his health and illness. People’s food preferences have changed. They like to consume palatable junk foods which destroy their health instead of fostering them. There is also a boom in the invention and modification of a number of medicines. Surely these inventions have helped mankind in many ways. But we ways fail to realize that no drug is available which doesn’t have any side effect.  Even the food or water we take will show adverse effects when taken unnecessarily. So how can we believe drugs? Most of the drugs are either nephrotoxic or hepatotoxic. For some, gene really matters. We cannot rule out the possibility of transmitting kidney disease from one generation to the next.  Other lifestyle associated conditions like diabetes and hypertension also play a remarkable role in the development of renal problems. Once an acute illness is left unnoticed or neglected, it will turn out to be a big mess. In chronic renal diseases, no pharmacological management is considered effective. So the only options left are either dialysis or kidney transplantation.

Dialysis is a treatment method of removing the waste products from blood, when one’s kidneys are not capable of performing this duty.   What waste? The wastes in the blood are urea, uric acid and creatinine. Kidneys also regulate the level of electrolytes like sodium, potassium, etc by two processes known as diffusion and osmosis. The water in excess is also removed by ultrafilteration. The kidneys are responsible for the regulation of electrolytes, BP and the buffer system. The production of erythropoietin (for RBC formation), calcitriol and renin is undertaken by these two beans.  Dialysis cannot do all these works. It’s helpful only in the waste clearance. Besides, the production works which are halted due to kidney failure should be rectified by supplementation or injections. That means dialysis can never substitute the normal kidney. Blessed are those whose organs are in good conditions.

WHO SHOULD UNDERGO DIALYSIS?

It may not be necessary to start dialysis as soon as one is diagnosed with a possible kidney failure. Acute cases may get cured by lifestyle modification and pharmacological interventions.  It is advised to start dialysis as soon as possible if the GFR is below 15ml/min. Up to 8-10ml/min is also ok, but who wants to take the risk? The blood studies also should be carried out to know the urea, creatinine and electrolyte levels. High concentrations of electrolytes are an indication for immediate dialysis. Some patients with poisoning and snake bite would benefit from haemodialysis. Those disease prone people with the baseline kidney functions and suffering from pulmonary edema will get relief from the dyspnoea associated with fluid accumulation in the lungs.  Profound edema will get a mild relief from a number of short, consecutive dialyses.

KNOW ABOUT DIALYSIS.

Hi,
I'm not a professional blogger. So you may find a lot of drawbacks in this blog. Please pay no attention to my mistakes.

I've been working as a nurse in my hometown. Hospital- its the HELL ON EARTH right? Absolutely. Because we never go there to rejoice or celebrate. All are either aching or witnessing others' ache. So its quite dreadful. In the early days of my job orientation, I was so devastated to see all the pain and sorrows suffered by others. It took me so long to churn my heart to what it is right now. From my very limited experience I realized one thing, every illness; acute or chronic, severe or minor is a curse indeed in a way or  another. But three most terrible disease conditions among them are Cancer and Liver and Kidney diseases. Because the victims of these diseases die very slowly, suffering the maximum level of pain. Though other conditions like Heart attack and Cardiac arrest are life threatening, their results are comparatively instant- "death or recovery." The earlier ones slowly suck the life, peace and wealth of the patient and his family. Ain't it sad?

My area of work is in the dialysis unit. You all know that its for those unlucky friends who's kidneys no longer work for them. When I was in the college, we had to learn about dialysis. But I hadn't realized how heart touching and painful it is until I got a job in this field. The patients live the life of corps. I mean, they do it to prolong their days, but never to live for ever or to get cured. We can read their emotions on their face and we'll see them silently telling us, "Please kill me. That's the best favour you can ever do for me." No-one can blame them because they only suffer everything throughout the procedure, not the nurse or technician.  The pain starts with a needle prick. Some develop complications like shivering, fever, hypotension, nausea and vomiting. As far as I've known from  patients, the muscle cramps are the worst. They'll scream aloud cursing their own fate. After going back home also, most of them say that they lack energy for their daily activities. HUH! I forgot to mention one of the most serious concern of the kidney patients. Money.... Money rules the world right? So who will be pleased to spend huge amount of money for such a thing that doesn't yield any pleasure. In India, the average expense for a single dialysis is as follows, Dialyzer(Artificial kidney)-850Rupees, Blood tubings-200Rs, Procedure Charge-800Rs, Erythropoietin  Injection for anemia-500 to 1250Rs. So the total expense always crosses at least 2400-3100 Indian Rupees. How can a middle class Indian family afford this? Sometimes its better not to think all these things.

Well I've just begun my blog about Dialysis. In the coming days I'll explain what is dialysis, its indications, procedure, complication and management and everything else. You should add your comments and suggestions to improve my blog. Thanks for reading....