Verify and review the patient's medical history. Understand their past conditions, treatments, and any other relevant information. This task is crucial to ensure the safety and appropriateness of hemodialysis for the patient. Are there any pre-existing conditions that need special attention? Any medications that might interfere with hemodialysis? Make sure to meticulously go through the medical records and consult with other healthcare professionals if needed.
Evaluate appropriateness for dialysis
Assess the patient's suitability for hemodialysis based on their medical history and overall condition. Look for any contraindications or factors that might affect the outcome of the procedure. Is the patient medically stable? Does their condition necessitate immediate dialysis? Consult with the patient's primary care physician or nephrologist for recommendations. If there are any concerns, address them before proceeding.
1
Start dialysis immediately
2
Delay dialysis
3
Consult with nephrologist
Approval: Nephrologist
Will be submitted for approval:
Evaluate appropriateness for dialysis
Will be submitted
Schedule hemodialysis session
Coordinate and arrange a convenient time for the hemodialysis procedure. Consider the patient's availability, the availability of the dialysis facility, and any other scheduling constraints. Ensure that the patient understands the importance of adhering to the scheduled session and the potential consequences of missing or rescheduling the procedure. Provide necessary information and instructions to the patient regarding the session.
Prepare dialysis machine
Set up the hemodialysis machine and ensure its proper functioning. Check for any errors or malfunctions in the equipment. Verify the availability and functionality of necessary components and accessories such as filters, tubing, and dialysate solution. Follow the manufacturer's instructions for machine preparation and perform any required tests or calibrations. Ensure that the machine is ready for the upcoming hemodialysis session.
1
Fresenius
2
Baxter
3
Nipro
4
NxStage
5
Gambro
Set up dialysis supplies
Organize and prepare the necessary supplies for the hemodialysis procedure. Ensure the availability and integrity of essential items such as dialysis catheters, gloves, disinfectants, dialysis solution, and medication trays. Set up a clean and sterile work area to prevent complications or infections. Check the expiration dates of supplies and discard any expired items. Have all the required supplies ready for use.
1
Dialysis catheters
2
Gloves
3
Disinfectants
4
Dialysis solution bags
5
Medication trays
1
Normal saline
2
Hartmann's solution
3
Bicarbonate concentrate
4
Acetate concentrate
5
Citrate concentrate
Prep patient for hemodialysis
Prepare the patient for the hemodialysis procedure. Verify their identification and confirm their consent for the procedure. Explain the process, benefits, and potential risks to the patient. Ensure that the patient has removed any jewelry or accessories that could interfere with the procedure. Provide appropriate clothing or gowns for the patient. Comfort and reassure the patient to alleviate any anxiety or concerns.
1
Yes
2
No
1
Patient gown
2
T-shirt and shorts
3
Hospital gown
4
Own clothes
5
Other
Monitor patient vitals prior to procedure
Record and monitor the patient's vital signs and other relevant parameters before initiating the hemodialysis procedure. Assess the patient's blood pressure, heart rate, temperature, and respiratory rate. Evaluate their overall physical condition and any signs of discomfort or distress. Document the baseline measurements for future reference and comparison during and after the procedure.
Insert needles into dialysis access point
Cannulate the patient's dialysis access point using sterile techniques. Insert the appropriate needles into the predetermined access site, ensuring proper placement and minimizing the risk of complications such as bleeding or infection. Apply the necessary dressing or secure the needles in place as per the facility's guidelines. Confirm the patient's comfort and tolerance during the cannulation process.
1
16 gauge
2
17 gauge
3
18 gauge
4
19 gauge
5
20 gauge
1
Comfortable
2
Slight discomfort
3
Significant pain
Begin hemodialysis procedure
Initiate the hemodialysis treatment according to the prescribed parameters and settings. Start the dialysis machine and monitor the blood flow rates, dialysate flow rates, and pressures within the acceptable ranges. Ensure the patient's comfort and adjust the treatment parameters if necessary. Maintain close observation of the entire procedure to prevent any complications or adverse events.
1
100
2
200
3
300
4
400
5
500
1
200
2
300
3
400
4
500
5
600
1
3
2
4
3
5
4
6
5
7
Monitor patient vitals during procedure
Continuously monitor the patient's vital signs and other relevant parameters throughout the hemodialysis procedure. Regularly check their blood pressure, heart rate, temperature, and respiratory rate. Assess the patient's overall condition and response to the treatment. Make note of any deviations from the expected values or signs of complications. Ensure the patient's safety and well-being during the entire procedure.
Ensure proper filtration of blood
Regularly check and monitor the efficiency of blood filtration during hemodialysis. Ensure that the dialyzer is functioning correctly and effectively removing waste products from the patient's blood. Verify the color and clarity of the dialysate fluid, which should reflect the successful elimination of waste substances. Take appropriate action if any abnormalities or decrease in filtration efficacy are observed.
1
Polyflux
2
Revaclear
3
Fresenius Fx
4
Gambro Polyflux
5
Hemophan
Monitor fluid removal rates
Monitor and regulate the rate of fluid removal during the hemodialysis procedure. Keep track of the patient's fluid balance and ensure that excess fluid is removed appropriately. Adjust the ultrafiltration rate as required based on the patient's condition, tolerability, and fluid status. Continuously assess the patient for any signs of hypotension or intradialytic hypotensive episodes.
Complete dialysis procedure and remove needles
Terminate the hemodialysis treatment once the prescribed duration or treatment goals are achieved. Gradually slow down and stop the dialysis machine following the appropriate protocols. Safely remove the needles from the patient's access point ensuring proper hemostasis. Apply the necessary dressing or bandage to the puncture site to prevent bleeding or infection. Confirm patient comfort and readiness for post-procedure care.
1
Slow down blood and dialysate flow
2
Stop blood flow, then dialysate flow
3
Stop dialysate flow, then blood flow
4
Other
1
Comfortable
2
Minor pain
3
Excessive pain
Monitor patient vitals post-procedure
Monitor and assess the patient's vital signs and overall condition immediately after the hemodialysis procedure. Check their blood pressure, heart rate, temperature, and respiratory rate to identify any post-procedure changes or adverse events. Look for signs of hypotension, electrolyte imbalances, or other complications. Document and report any abnormalities or concerns to the appropriate healthcare providers.
Evaluate post-procedure patient condition
Evaluate the patient's condition and response to the hemodialysis procedure. Assess their immediate well-being, including any changes in symptoms, general comfort, or potential adverse reactions. Address any patient concerns or questions about the procedure. Determine if additional interventions or treatments are necessary post-procedure. Communicate findings to the primary care physician or nephrologist for further evaluation or guidance.
1
None
2
Fluid restriction
3
Medication adjustment
4
Lab tests
5
Other
Post-procedure evaluation summary
Approval: Physician
Will be submitted for approval:
Evaluate post-procedure patient condition
Will be submitted
Schedule follow-up appointment
Arrange a follow-up appointment with the patient to monitor their progress and make any necessary adjustments to the hemodialysis treatment plan. Coordinate with the medical team and the patient to find a suitable time and date for the appointment. Ensure that all required documentation and information are provided for the follow-up.
Update patient's medical records
Following the completion of the hemodialysis procedure and the evaluation of the patient's condition, it is essential to update their medical records. Document the details of the procedure, the patient's response, any complications, and the plan for future treatments. Ensure accurate and comprehensive record-keeping to facilitate continuity of care.
