Purpose:

This document is to provide guidance for the staff of the Dialysis Unit to ensure delivery of quality services to patients who require haemodialysis.

 

Before the dialysis procedure

•        A patient that has clinical or biochemical indications for dialysis (after review by the nephrologist), must carry out the following investigations before dialysis:

1. Packed cell volume (PCV)

2. E/U/Cr

3. HIV screening

4. Hepatitis B surface antigen (HBsAg)

5. Anti-Hepatitis C virus antibody (Anti-HCV antibody)

•        If PCV < 21 %, patient requires blood transfusion pre- or intra-dialysis as determined by the physician (Exception: Patients with Haemoglobin SS genotype can have haemodialysis if PCV > 18% without blood transfusion)

•       HIV, HBsAg and Anti-HCV results must be negative. Tests to be repeated every six months for patients on maintenance haemodialysis.

•        If above results are satisfactory, patient's relatives to go to the dialysis centre as directed by the attending physician.

•        Results above to be confirmed by the Nurse. If results are satisfactory, the invoice for payment to be issued to the patient/ relatives.

•        Payment to be confirmed prior to commencement of haemodialysis.

•        The machine is disinfected for use between patients

•       The patient is called from the waiting area (in the case of out-patients) or from the ward (in the case of in-patients) when the dialysis machine and station have been prepared.

 

Dialysis procedure

        •         All staff in the dialysis room must wear dedicated shoes with caps and         masks. Patients will also be asked to wear dedicated shoes and gowns.

        •       The following must be checked prior to commencement of dialysis:

1.     Weight (checked pre- and post- dialysis)

 

2.        Pulse rate

3.        Blood pressure

4.        Temperature

5.        Blood glucose (for diabetic patients)

6.        Oxygen saturation (for unconscious patients and patients in respiratory distress)

•        Patients with oxygen saturation (Sp02) 94% should receive supplemental oxygen during the procedure.

    •        Record of previous dialysis session is reviewed (if any). The Doctor on     duty examines the patient and documents the indications for dialysis,     investigation results and physical examination findings. The dialysis     prescription is also outlined.

    •       Strict aseptic techniques must be followed.

    •       Patients without a vascular access will have a temporary access created     by the doctor on duty (femoral catheter) assisted by the Nurse on duty.

    •       The Nurse connects the patient to the machine which has been adequately     prepared by the technician on duty. The dialysis procedure commences.

    •       The duration of dialysis is 3 hours for new patients except otherwise stated     by the nephrologist and 4 hours for old patients.

    •        Vital signs must be measured every 30 minutes during the procedure After     the dialysis procedure

    •        Check vital signs

    •        Weigh patient

    •        Check blood glucose (for diabetic patients)

    •        In-patients are handed over to the ward Nurse; who then transfers to the     ward

    •        Out-patients handed over to relative(s)