·   The artificial kidney unit consists of two wards, one for hemodialysis and another for peritoneal dialysis. It is preferable to have central air conditioning.

First: The bloody cleansing suite:

·  It is a room whose size varies depending on the number of machines designated for hemodialysis that will be used in the unit, and it must be taken into account that the entire space is open so that it allows all patients to be seen at the same time.

A) Machines:-

·   It should be taken into account that each machine and bed should have a space of about 3 meters wide and 2.70 meters long, and there should be next to each machine: -

·   Places for its own electrical connections and more than one backup electricity source

·   Water connections necessary to supply the machine with treated water

·   Connections for dispensing the products of the hemodialysis process, especially for each machine

·   Oxygen connections next to each bed

·   Liquid suction connections next to each bed

B) The family: It must have the following:

·   The ability to move, whether from the head or the feet, and the ease of moving from one place to another

·   The ease of movement of the chair designated for hemodialysis, which is preferred by some patients, and that it has the ability to place the patient horizontally when any emergency situation occurs.

·   The mattress must be covered with tarpaulin or plastic to avoid the possibility of contamination with blood or used solutions.

·   Each bed is allocated 2 sheets and a coverlet or blanket, depending on the weather condition.

·   Each bed is allocated 2 pillows, one for use at the head, and another smaller one for use by some patients, so that the hand with the vestula is placed in a more comfortable position.

C) Sterile supplies:

·  There must be 4 large cupboards (it is preferable that the cupboard be built into one of the walls of the room so as not to disturb the space of the suite), where the cupboard is not less than 3m x 1.5m, divided into shelves to place sterilization packages consisting of the following: -

The first cupboard:-

First shelf:

·   Hemodialysis packets. The number of packets is determined according to the number of patients each day, and 20% more than the daily use must be added as a reserve.

·    Sterilization is reviewed daily in the morning by one of the nursing staff members assigned to that purpose, and one is allocated weekly or monthly to be responsible for sterilization by the unit supervisor. When assigned, it is noted that she is present daily in the morning during the period of her responsibility to review the sterilization dates and carry out the daily pickup and delivery process.

·   Jawan packets (the number is determined according to the number of working health team members in each shift, with the addition of about 20% reserve packets).

·  Masks placed over the nose and mouth, and sterile gloves, whose sizes are determined according to the people working in the unit. A 20% reserve is added, and their numbers are determined according to the number of patients present daily, so that each patient is allocated a sterile glove that is used when installing the vestula, and another glove is used when ending the session (it is possible to use a non-sterile glove or Single-use glove when ending the session)

Second shelf:-

The following is allocated: sterile devices such as: -

·   Intravenous devices (2 per patient per day)

·   The candidate and his connectors (one connector is allocated to each patient daily)

·   Fistula needles (2 per patient per day), taking into account the sizes used for each patient

·   Single-use syringes of different sizes (2, 5, 10 mm). One syringe of each of the previous sizes is allocated for each patient.

·    3 large-sized plaster rolls per day (make sure it is of the transparent type so as not to cause infections for patients).

·   It is taken into account to allocate a daily reserve that represents the need for an additional 5 patients per day to confront any emergency. This is reviewed daily by a member of the nursing staff and allocated by the unit supervisor on a weekly or monthly basis, provided that she is present every day in the morning so that she can continue working, as she must prepare What is needed daily in the morning so that she can continue working, as she must prepare what is needed daily in the morning and not leave the unit before completing it, provided that all the supplies are prepared, present and ready to connect patients to the devices for the next day in the morning. Usually the installation is done early due to the length of time the patient stays on the machine (from 4 to 5 Hours) Therefore, it is expected that patients will be connected to the devices around 7 a.m. daily.

Third shelf:-

It includes disinfection and skin cleaning fluids, which are as follows:

·   Betadine  to disinfect and clean the patient’s skin before and after installation (if the patient does not suffer from allergies when using it).

·  Alcohol for disinfection as well and can be used in chemical sterilization.

·   Savlon for cleaning machines from the outside when they are contaminated with dust and blood.

·   Chlorosidex for disinfecting machines (see the section on disinfecting and sterilizing machines).

The second cupboard: is designated for solutions

First shelf:-

·   Salt solution - Each machine is allocated one liter of salt solution per day for each treatment session, and each patient is allocated one liter of salt solution per day as a reserve (that is, when installing 10 patients per day, 20 liters must be available, i.e. 40 packages of salt solution).

Second shelf:-

Glucose 5% is allocated to each patient once daily as a precaution

Third shelf:-

·   It is designated for solutions that are not used routinely and are used only in emergency situations or in some cases determined by the treating physician, such as: -

·   Glucose 25% sodium bicarbonate. Half-liter containers are required. They are kept in the refrigerator and each container is replaced when used.

·   Mannitol 10%, 15% and is required for about 10% of the number of patients present daily, usually in cases where renal dialysis is performed for the first time or when needed.

·   The concentrated solution designated for the machines, and the quantity and number are determined according to the number of patients per day, with an additional 10% as a reserve.

The third and fourth wheels:-

First shelf:-

·   It is allocated for sheets and the number of sheets is determined according to the number of beds, so that each bed is allocated 2 sheets.

·   When implementing 3 therapeutic departments while keeping a reserve percentage representing 20% ​​of the total daily number used, it is noted that a member of the nursing staff is appointed to review the presence of clean sheets with one of the assistant categories of the nursing staff in the department.

·   It is ensured that the morning work administration supplies for the next day are complete and prepared so that patients are attended and connected directly to the equipment.

Second shelf:-

·  It contains coverlets and pillowcases, as many as the number of beds, noting that there is a 20% reserve.

Third shelf:-

·   It contains blankets, 2 blankets are allocated for each bed, and a 10% reserve is allocated.

Location of the nursing staff in the hemodialysis room:

·   It should be in the middle of the room and allow all the beds, patients, and equipment to be seen.

·   The nursing staff’s place contains a nursing station with a number of drawers or shelves that allow the files of patients present during treatment to be placed in one shift.

·   A place for the phone.

·   A place for the emergency cabinet containing emergency medications, the quantity of which is determined according to the number of patients present daily and hospital policies.

·   Location of emergency supplies used in emergency situations, such as (stomach tube, laryngeal incision, laryngoscope, tongue depressor, urinary catheters (regular, Foley), oxygen mask, ambubag (artificial respirator).

·   A place where a solid object is kept for use in cases of cardiogenic shock

·   A scale to weigh patients before and after treatment sessions.

·   A place to store blood pressure devices, and there must be a number of at least 5 devices for a unit containing 15 machines, meaning that each number (5 patients) will be allocated a blood pressure measuring device, and any device that malfunctions will be replaced immediately, with a note of keeping (3) new spare pressure devices. In the unit's warehouse to deal with emergency situations.

·   It is necessary to have a number of stethoscopes with pressure devices

·   A place to store thermometers. A thermometer is allocated for each patient who brings it with him during every treatment session or when the patient comes for an emergency examination, in implementation of the infection control system among patients - while ensuring that there is a reserve of thermometers for new patients for emergency cases.

·   There must be a sink and a water source next to the nursing staff’s place, and it should be designated for them only, and no one is allowed to use it, and the faucet should be prepared for use in washing hands before wearing sterile gloves (i.e., so that it can be easily closed using the elbow).

·   Allocate a number of sinks at the entrance to the hemodialysis room immediately before patients enter, as the patient must wash his hands up to the elbows before entering the room for treatment. Cold and hot water must be available in these sinks, as well as soap or disinfectant and towels for drying.

·   It is preferable to use liquid soap and dry the hands to prevent the spread of infection and skin diseases.

Tools that should be available in the hemodialysis room:

·   A television placed in a place that allows all patients to see it from all angles

·    It is possible to have one television for each patient to help pass the time and not get bored.

·   An hour or more so that each patient can know the time when needed.

·   An electric refrigerator is designated for storing medications (heparin, sodium chloride, and insulin), and patients are not allowed to use it.

·   A room attached to a glass wall is allocated that allows seeing and observing the progress of work inside the unit and is allocated for the doctors supervising the work in the unit. It also allows the patient’s family to check on them through this glass wall.

Special service areas for the hemodialysis room:-

- Locker room

a. Allocate a dressing room for nursing staff members

B. Allocate a locker room for female patients

C. Allocate a locker room for male patients

- Bathrooms :-

a. Private bathrooms for unit workers

B. Private bathrooms for patients and kept in them (urinal and bidet in a special cupboard for use when necessary).

A place for the unit secretary to be located:

There must be a unit at the entrance to receive and guide patients, and it must be permitted as follows:

·   A large cupboard for storing patient files. It is preferable to have a cupboard in the wall equipped with shelves. The shelves are divided and their area according to the area and size of the patient files. It is divided so that patient files for the years are kept on the upper shelves and patient files for the current year are kept on the nearby shelves.

·   A different color is assigned to the files for each group of patients, for example:

- Green color for morning shift patients, blue color for evening shift patients

- Red color for nocturnal patients

·   The files are arranged in shelves designated for the following days:

·   A shelf for a group of days (Saturday, Monday, and Wednesday) and a shelf for a group of days (Sunday, Tuesday, and Thursday) in all morning, evening, and night periods.

·  A place is allocated for the files of absent or deceased patients, which include a summary of the period of their stay in the unit, the complications that occur to them, the causes and manner of their death, or the reasons for their discontinuation of attendance, for use in patient research and statistics. It is preferable to have a computer to store the information.

·   A place is allocated to store office supplies and monthly orders, including papers, pencils, ballpoint pens, carbon paper, slottapes, files, paper clips, staplers, needle pins, plastic, colored felt-tip pens, and envelopes of regular, medium and large sizes.

·   A computer and a printer to write medical reports or leave letters to direct to the patient’s employer or anything else that the patient’s condition may require, as well as to create a database for the unit.

·   It is preferable to also have a camera to use when needed.

·   There must be a special telephone for the unit’s secretariat.

NB :-

The medical secretary is for the entire unit, and there must be at least two secretaries, one for the morning shift and another for the evening shift.

Second:- Peritoneal drainage suite

Family:-

·   A large room whose size varies depending on the number of beds that will be placed in it, and it must be taken into account that the position of the beds allows all patients to be seen at the same time.

·   It must be taken into account that each bed has the same space as before, 3 meters x 2.70 metres.

·   Each bed should have a solution holder attached to it on one or both sides.

·   The same previous specifications should be taken into account in the beds for hemodialysis in terms of ease of movement and transfer.

·   There must be oxygen connections, suction, and electrical outlets next to each bed.

·   There should be a table or nightstand next to each bed to store medications and the patient’s special tools (thermometer - cup for drinking water).

·  Pillows, sheets, and blankets must be available, as in the hemodialysis unit.

Cupboards:-

The first cupboard for storing sterilization supplies:

First shelf:-

·   Peritoneal dialysis packets (their number is determined according to the number of patients per day), so that a packet is allocated to each patient and 20% of the packets are kept as a reserve.

·   Packets of jaundice according to the number of patients, where a jaundice is used when installing each patient and 20% is kept as a reserve.

·   Jaun packs for nursing staff members or doctors to use during installation and while in the unit to handle cases (their number is determined according to the unit’s workers and reserve percentages are determined as previously).

·  Sterile protective gloves for installation, as previously mentioned, in hemodialysis, as well as for single use.

Second shelf:

·   For sterile devices, which are: - intravenous devices, devices used in peritoneal dialysis, plastic syringes, bags to collect peritoneal fluid after it leaves the patient’s abdomen and are determined according to the number of patients and the reserve percentage (20%) is added.

Third shelf:-

·   Disinfection and skin cleaning fluids, which are as follows:- Betadine or alcohol, to disinfect the patient’s skin before and after application. The quantity is determined according to daily use and the number of patients.

The second cupboard is designated for solutions

First shelf

·   It contains 2-liter peritoneal dialysis bags of low concentration (the quantity and number of bags are determined according to the number of patients per day).

The second shelf

·   It contains peritoneal dialysis bags with a capacity of 2 liters of high concentration (the quantity and number of bags are determined according to the number of patients per day and according to use).

Third shelf:-

·   It includes solutions for use in case of emergency, such as: - salt solution - glucose solution 5%, glucose 25%, mannitol 10%, sodium bicarbonate 15% (the required quantity is determined every two weeks according to the number of patients visiting the unit. 20% percentage determines the required quantity every two weeks According to the number of patients attending the unit, the reserve rate is 20%.

The third cupboard:-

·  First shelf: for sheets

·  Second shelf: covers and pillowcases

·  Third shelf: blankets

Location of the nursing staff in the peritoneal recovery room:

·   It should be taken into account that the location of the nursing staff is in the middle of the patients, so that the nursing staff present can observe all the patients and the assistant nursing staff members while they are caring for the patients.

·   All the above-mentioned specifications must be met with the unit of hemodialysis.

Tools that should be available in the peritoneal drainage room:

·    TV - electric refrigerator.

Special service areas attached to the peritoneal recovery room:

·   A dressing room, water departments, and a room attached to the main room. It has a desk and a glass wall for the presence of doctors, and through the glass wall it allows the patient’s family to check on him with the same specifications mentioned above.

Note :

·   If the hospital instructions allow for the treatment of patients with chronic kidney failure and hepatitis, an isolated place must be allocated for them in which all the previous things are provided, whether in the hemodialysis or peritoneal infusion room, provided that members of the nursing staff are allocated to them to care for them, using the aforementioned isolation steps. And I hope you take it into consideration

Emergency vehicle:

First drawer	Number	Morning time	Evening period	Sleeping period
Adrenaline	5
lasix.mg40	5
Dopamine	5
Depotrex	5
Noradrenaline	5
Aminophylline	5
Trideal	5
Calcium	5
Magnesium sulfate	5
Soyum bicarb	15
Potassium chloride	10
Coradaron	10
Solio Cortef	5
Isopten	5
Andral	5
Epanutin	5
Xylocaine vial	1
The department is yours	5
Second drawer	Number	Morning time	Evening period	Sleeping period
10mm syringe	10
5 mm syringe	10
3mm syringe	10
Cannula sizes	10
[Gauze bandage	3
Blaster	1
Sterile gel	1
Tongue depressor	1
IV device	10
Blood transfusion device	10
Rail syringe	5
Latex glove box	1
Intravenous connection	5
Arterial connection	5
Triple link	5
50 mm syringe	5
Identification bracelet	5
Laboratory tubes (various)	10
Sterile gaskets	10
Heart drawing paper	1
Electrode bag	1
Third drawer	Number	Morning time	Evening period	Sleeping period
Laryngoscope	1
Laryngeal tubes (sizes)	10
Air passage (sizes)	5
Ampoubag Mask (Sizes)	5
Oxygen mask (adults - children)	5
Nebulizer mask (adults - children)]	5
Get oxygen	5
Extra batteries	4
Fourth staircase	Number	Morning time	Evening period	Sleeping period
Gastric tube (rail) sizes	5
Urinary catheter (sizes)	5
Suction catheter (sizes)	5
Urine collection bag	5
Chest tube + jar	1
I wanted a steriliser	1
Sterilized scissors	1
catheter cvp	2
Guide wire for cvp	1
Silk stitches	5
Surgical condition	10
Betadine 10% (bottle)	1
A box of alcohol swabs	1
wind	1
searchlight	1
Fifth staircase	the number	Morning time	Evening period	Sleeping period
Salt solution...9%	5
Ranger	5
Glucose 5%]	5
Glucose 10%	2
Glucose 25%	2
Hesteril	2
Hemagel	2
Mannitol 20%	2
on the roof	Number	Morning time	Evening period	Sleeping period
Electric shock device	1
Pressure device	1
Earphone	1
Large ampobag	1
Small ampoubag	1
solid cpr board	1
Oxygen cylinder	1
Solution holder	1
The signature