Part Three

- Procedures for starting a hemodialysis session

Steps:

·      Routine hand washing.

·      Preparing supplies

·      Wash your hands (hygiene) before starting work

·      Wear protective clothing (gloves, mask, glasses).

·      Vital signs are measured before the session, and blood pressure is measured every hour during the session and whenever the patient’s condition requires

·      Disinfect the site of the venous and arterial connection in the patient’s hand with Betadine, taking into account the time the Betadine comes into contact with the Vistula catheter in the patient’s arm, after ensuring that the catheter is fixed in the patient’s arm and connecting the patient to the device.

·      Connecting the closed artery connection to the closed artery needle

·      Open the valve after ensuring that there is no air in the connections.

·      Open the blood pump slowly and give the amount of heparin agreed upon with the treating physician

·      Close the intravenous connection valve when blood reaches it and close the blood pump

·      Connect the end of the closed stopcock patient connector to the end of the closed intravenous needle 5

·      Open the blood pump slowly while opening all closed valves

·      Ensure that the blood level in the air barrier rises and gradually speed up the blood pump

·      Wrap the extensions around the patient’s hand in a safe manner and secure them

·      Routine hand washing  Hemodialysis supplies

Work procedures during a hemodialysis session

Steps:

·      Fill out the follow-up paper data during the session for each patient, including weight, vital signs, medications, and solutions during the session. Record excess weight, pump speed.

·       Notice any signs of low blood pressure (dizziness, sweating, depression, lack of concentration).

·      Give the dose of heparin at the specified times.

·      Monitor blood pressure every hour during the session.

·      Observing any changes that occur in the patient during the hemodialysis session (bleeding from the site of the blood connection - continuous monitoring of the patient’s hemodialysis machine - vomiting...etc.

Action steps for a patient with laundry hooks

Steps:

◾    Inspect the vest or graphite daily to ensure its efficiency.

◾    Ensure that there are no signs of infection (redness and swelling).

◾    Wash the session from the arm that has the vestula or graphite daily with water and soap daily and before starting.

◾    Warning to change the location and take the needles  with the vestula so as not to expand their size

◾    Light pressure on the location of the needles after removing them and putting spare ones on them for a few minutes until ensuring that the blood has stopped and that there is no bleeding before leaving the unit.

◾    Warning to remove the spare parts from the Vistula the next morning

Catheter handling:

◾    Hygienic hand washing.

◾    Wear personal protection.

◾    Place the sterile spare parts on the catheter site after completing the session.

◾    Giving  treatment to help thin the blood according to the doctor’s instructions.

◾    After completing routine hand washing.

◾    Warning the patient to keep the dressing dry, especially (when showering) and between                     sessions.

◾    Inform the doctor when the temperature rises to prescribe appropriate treatment 7

◾    Warn the patient to be careful and be gentle when putting on and taking off clothes, when putting on          and uncovering the blanket, and when sleeping.

Nursing actions  during hemodialysis complications

A) Low blood pressure

Steps:

◾  Withdrawal is stopped after reviewing the doctor.

◾   Reduce the withdrawal rate  after consulting a doctor

◾   Increase the sodium and calcium solution with the dilazit converter after consulting the doctor

◾   Reduce the dilazite temperature after consulting a doctor

◾   Stop treating high blood pressure about 4 hours before the session after consulting the doctor

◾   Giving medications to raise blood pressure as directed by the doctor, such as midodrine 6 mg, half an hour to an hour before the session.

◾   All previous procedures are performed in the presence of the doctor and according to his instructions.

B- Muscle tension

Steps:

◾   Reduce the withdrawal rate after consulting a doctor

◾   Give a salt solution after consulting a doctor

◾   Follow up on reaching the ideal weight rate

C- Imbalance

◾  Steps:

◾   Use small-sized filters after consulting a doctor.

◾   Reducing blood flow rate (PMP) and dilazit after consulting a doctor

Taking an intravenous diazepam injection as directed by the doctor and the HIV virus

Ending the hemodialysis session

Steps:

·      Routine hand washing

·      Prepare the necessary supplies (no coverall + sterile gauze).

·      Wear protective clothing (apron, gloves, mask, glasses).

·      Measure blood pressure before ending the session to determine the type of solution used: salt or               glucose

·      Hand washing is hygienic

·      Close the blood pump and close  the artery stopcock and the artery needle

·      Place the artery connection in the solution bottle and open the blood pump

·      Activate the connections and filter to ensure that blood does not clot in the filter

·      Raise the vestula and apply gentle pressure on it

.      Disinfecting the site of the vestula with betadine and sterile gauze and no cover after ensuring that there is no blood in the site of the vestula.

.      Dispose of the connections, filters, and all consumables belonging to the patient and change the furnishings.

·      Disinfect the machine from the outside with chlorine and alcohol

·      Weigh the patient and record this in the medical file

·      Measure blood pressure before allowing the patient to leave the unit

·      Recording all supplies and medications and signing the responsible nursing staff

·      Follow up on the patient’s signature on the session and confirm the date of the next session.

·      Follow up on the patient’s discharge when he leaves the unit by the worker.