Part Two
- Patient reception policy
Receiving a new patient for the first time
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Policy:
Receiving a new patient into the artificial kidney unit according to the standards of specialized medical centers and the standards of international quality organizations.
Purpose:
Providing treatment services at a distinguished level according to the standards of specialized medical centers and the standards of international quality organizations to all our clients in order to satisfy them while preserving the environment according to the standards and objectives of environmental protection institutions and following occupational health and safety policies and infection control standards.
Procedures:
◾ The unit supervisor and the accounts employee interview the patient and present him to the unit director.
◾ The patient was presented to the unit doctor and examined.
◾ Determine the patient’s financial transaction by the accounting employee.
◾ Writing permission for virus tests for the patient by the doctor.
◾ Taking the sample from the patient by nursing staff.
◾ Virus results appear.
◾ Registering the patient in virus registries.
◾ The result is positive for viruses B, AIDS. The patient is referred because there is no positive machine.
◾ Create a personal data card by the accounts employee.
◾ Determine the timing of the sessions by the unit director and unit supervisor, and give an appointment card.
◾ Nursing staff weighs the patient before entering the session.
◾ The weight in excess of its normal weight is calculated in order to be withdrawn.
◾ Make a sheet for the patient by the doctor.
Responsible for implementation: unit supervisor, accounts officer, unit manager.
References:
Proposed specifications for the dialysis unit.
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Policy for receiving regular patients in the unit
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Policy:
Regular patient reception at the artificial kidney unit according to the standards of specialized medical centers and the standards of international quality organizations.
Purpose:
International quality for all our customers in order to satisfy them while preserving the environment according to the standards and objectives of environmental protection institutions and following occupational health and safety policies and infection control standards.
Procedures:
◾ The accounting employee confirms the appointment through the appointment card.
◾ Recording the patient in the unit’s records.
◾ Nursing staff weighs the patient before entering the session.
◾ Recording the patient in the unit’s visitor book.
◾ Calculating the weight in excess of the normal weight in order to be withdrawn.
◾ Connecting the patient to the machine designated for him.
◾ Preparing the machine for a hemodialysis session.
◾ Testing of electricity and water connections.
◾ Prepare a jerry can of washing solution and place it next to the machine.
◾ Place the stick inside the jerry can according to the type of washing solution.
◾ Open the machine and perform a test of the machine.
◾ Place the artery and vein connections in their correct place.
◾ Place the artery connection in a bottle of salt solution to remove the air from the filter and line.
◾ After ensuring that the air has exited, he placed an ampoule of heparin in the intravenous connection and made a closed circuit.
◾ Pass the solution for 15 minutes in the machine.
Responsible for implementation: nursing staff members in the unit, accounts officer.
References:
Proposed specifications for the dialysis unit.
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Dry weight assessment policy for renal failure patients
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Politics:
It is the weight that the patient has after the session in the following case:
He does not have difficulty breathing.
No swelling of the feet and legs.
Normal pressure (not low or high).
The patient does not experience muscle tension.
To reach this weight, the patient is advised to do the following:
Do not consume salt in all its forms.
Reduce drinking fluids in general, not just water, so that the fluid intake rate is one liter per day.
The patient's dry weight must be reviewed as it is a value that is subject to change (at least every month).
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Mahurker (Clavicular Catheter Set) Installation Policy
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Politics:
Installation of a Mahurker (clavicle catheter set) according to the standards of specialized medical centers and the standards of international quality organizations.
The Purpose:
Providing treatment services at a distinguished level according to the standards of specialized medical centers and the standards of international quality organizations to all our clients in order to satisfy them while preserving the environment according to the standards and objectives of environmental protection institutions and following occupational health and safety policies and infection control standards.
Procedures:
Preparing the necessary supplies and medications by the doctor and with the assistance of nursing staff.
Sterilize the installation site by a doctor.
Giving Xylocaine solution to the site of application by the doctor.
Installation of a clavicle catheter set by a doctor.
Transferring the patient to the radiology department for a chest x-ray by the worker in the presence of nursing staff.
Show the x-ray to the doctor to follow up on the location of the catheter.
The catheter is installed by a doctor and assisted by nursing staff.
Starting the session on the dialysis machine.
After the end of the session, a 10 cm ampoule of heparin is given into the arterial and venous connection.
A silk plaster is placed on the place of the hook.
Responsible for implementation:
Doctors and nursing staff in the unit.
References:
Proposed specifications for the dialysis unit.
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Femoral catheter installation policy
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Politics:
Installation of a femoral catheter according to the standards of specialized medical centers and the standards of international quality organizations.
The Purpose:
◾ Providing treatment services at a distinguished level according to the standards of specialized medical centers and the standards of international quality organizations to all our clients in order to satisfy them while preserving the environment according to the standards and objectives of environmental protection institutions and following occupational health and safety policies and infection control standards.
Procedures:
◾ Prepare the required supplies.
◾ Sterilize the catheter site (groin) with Betadine.
◾ Giving Xylocaine at the site of installation.
◾ Catheter installation by a doctor.
◾ The catheter is installed by the doctor and the assistance of nursing staff.
◾ Starting the session on the dialysis machine.
◾ After the session ends, the femoral catheter is removed.
◾ Pressure on the catheter site for 10 minutes while doing exercises with the leg where the catheter is.
◾ After the bleeding stops, a sterile pad is placed on the catheter site and a plaster is applied.
Responsible for implementation:
◾ Doctors and nursing staff in the unit.
References:
◾ Proposed specifications for the dialysis unit.
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Policy for serological examinations of patients
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Policy:
Serological examinations for patients in the dialysis unit according to the standards of specialized medical centers and the standards of international quality organizations.
The Purpose:
◾ Providing treatment services at a distinguished level according to the standards of specialized medical centers and the standards of international quality organizations to all our clients in order to satisfy them while preserving the environment according to the standards and objectives of environmental protection institutions and following occupational health and safety policies and infection control standards.
Procedures:
◾ Viral tests are performed for patients in sections every 3 months (HCV-HBV-HIV) and no dialysis is performed for any new patient before performing a pre-test using the ELISA method. In the event of an extreme emergency, a session is held for the patient in the emergency room and a sample is drawn for analysis using the ELISA method.
◾ Sectional serological examinations are performed using the ELISA method.
◾ If a patient’s result is positive for HIV using the ELISA method, in this case another sample is taken and sent to the central laboratories of the Ministry of Health and Population so that it can be analyzed using the Western Blot method. If it is confirmed that he is positive for the infection, the patient is transferred to undergo dialysis in a hospital. Fever.
Responsible for implementation:
◾ Unit director, unit nursing staff members
The Reviewer:
◾ Proposed specifications for the dialysis unit
◾ National Infection Control Guide.
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Policy for starting a hemodialysis session
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Politics:
The start of the hemodialysis session in the artificial kidney unit according to the standards of specialized medical centers and the standards of international quality organizations.
The Purpose:
Providing treatment services at a distinguished level according to the standards of specialized medical centers and the standards of international quality organizations to all our clients in order to satisfy them while preserving the environment according to the standards and objectives of environmental protection institutions and following occupational health and safety policies and infection control standards.
Procedures:
Nursing staff wash hands (routine washing) before starting work.
Nursing staff wear protective clothing.
The nursing staff measures the pressure, pulse, and temperature before the session, and the pressure is measured every hour during the session and whenever the patient’s condition requires.
Nursing staff wash hands (surgical washing) before transporting the patient.
Disinfecting the site of the venous and arterial connection in the patient’s hand with betadine.
The nursing staff, in the presence of the doctor, places two Festula catheters in the patient's arm. After ensuring that the catheter is fixed in the patient's arm, the nursing staff connects 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-cock intravenous line to the end of the closed intravenous needle.
Open the blood pump slowly with all closed valves open.
Ensure that the blood level in the air barrier rises and speed up the blood pump gradually.
Wrap the extensions around the patient's hand securely and secure them.
The nursing staff fills out the follow-up paper information during the session for each patient.
The excess weight, blood pump speed, vital signs, medications and solutions are recorded during the session, and any signs of low blood pressure are noted.
Give the heparin dose at the specified times.
Observe and monitor blood pressure every hour during the session.
Note any changes that occur in the patient during the hemodialysis session.
Responsible for implementation:
Unit nursing staff, doctors
The Reviewer:
Proposed specifications for the dialysis unit.
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Patient complications policy during dialysis session
(low blood pressure)
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Politics:
Dealing with low blood pressure during a dialysis session according to the standards of specialized medical centers and the standards of international quality organizations.
The Purpose:
Providing treatment services at a distinguished level according to the standards of specialized medical centers and the standards of international quality organizations to all our clients in order to satisfy them while preserving the environment according to the standards and objectives of environmental protection institutions and followers of occupational health and safety policies and infection control standards.
Procedures:
Stop drawing until we restore balance to the patient.
Position the patient (head down and feet up whenever possible).
0.9% natural salt solution gradually, starting from 100 cm3, and according to the doctor’s order, quickly and not by drip.
Reduce the washing machine temperature to 36.5 degrees Celsius.
Avoid using 2.7 trisalt solution to avoid the patient feeling thirsty and consuming large amounts of fluids that will lead to weight gain.
Reconsider the assessment of the patient's dry weight, and accordingly, the withdrawal rate and withdrawal rate must be adjusted by the specialist physician.
Important Notes:
Reducing the speed of the blood pump does not lead to improving the pressure, but rather reduces the efficiency of washing, and increasing its speed does not cause a drop in pressure.
Be careful in weighing the patient only with the knowledge of the nurses, not the attendants, workers, or the patient himself before and after the session, and write that down on the patient’s sheet.
Prepare an intravenous device and a bottle of 0.9% salt for rapid intervention when the pressure drops and to avoid dismissing the patient from the session.
Patients who suffer from significant weight gain between sessions, it is preferable to use the (Isolated UF) or ISO program, or what is called external traction bypass, according to the doctor’s order.
Ineffectiveness of using dexamethasone ampoules during hypotension.
Responsible for implementation:
◾ Doctors and nurses in the unit.
The Reviewer:
◾ Proposed specifications for the dialysis unit.
◾ National Infection Control Guide.
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Policy for terminating a hemodialysis session
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Politics:
Ending the hemodialysis session in the artificial kidney unit according to the standards of specialized medical centers and the standards of international quality organizations.
The Purpose:
Providing treatment services at a distinguished level according to the standards of specialized medical centers and the standards of international quality organizations to all our clients in order to satisfy them while preserving the environment according to the standards and objectives of environmental protection institutions and following occupational health and safety policies and infection control standards.
Procedures:
◾ Prepare the necessary supplies (plaster + sterile gauze).
◾ Wear protective clothing (apron - gloves).
◾ Measure blood pressure before ending the session.
◾ Close the blood pump and close the artery valve and 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 the nursing staff gently presses it.
◾ After ensuring that there is no blood in the place of the vestula, disinfect the site of the vestula with betadine, sterile gauze and plaster.
◾ Dispose of the connections, filter, and all consumables related to the patient, and sterilize the machine from the outside with chlorine and alcohol.
◾ Weigh the patient and record this in the papers.
◾ Measure blood pressure before allowing the patient to leave the unit.
◾ Recording all supplies and medications and signing the department’s nursing staff.
◾ The patient signs the session and confirms the date of the next session.
◾ Allow the patient to leave the unit by the worker.
Responsible for implementation:
◾ Nursing staff members in the unit.
The Reviewer:
◾ Proposed specifications for the dialysis unit
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