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Hemodialysis
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  • 1. HemodialysisHemodialysis is provided according to physician orders bycontract staff that follow their agency policy The access arm is not used as a site for arterial blood gas sampling nor is it utilized for BP’s, IV’s, or other venipunctures or tourniquet In the event that accidental venipuncture of the fistula/graft occurs, direct pressure is applied for ten minutes or until bleeding stops Continue to observe for signs of bleeding Hemodialysis catheters are used for dialysis only unless the protocol for difficult IV starts has been followed and the attending physician gives the order to utilize the line
  • 2. Hemodialysis (continued) If the Hemodialysis catheter is needed for IV infusion follow the CVC policy and physician orders for Utilization of Hemodialysis Catheters for Intermittent Intravenous Infusion Routine medications are postponed prior to dialysis and resumed following dialysis unless specifically ordered by the nephrologist Due to risk of hemorrhage, no IM medications are administered or IV initiated for three hours following dialysis If venipuncture is performed within three hours of termination of dialysis, direct pressure is applied for five minutes or until bleeding stops Apply pressure dressing for one hour to prevent further bleeding
  • 3. Hemodialysis (continued) All medications listed with the physician’s dialysis order, (for example, Epogen), are administered by the contract nursing staff in accordance with their agency policy Hemodialysis is provided in the designated dialysis treatment room; however, hemodialysis may be provided at the bedside if the patient’s condition warrants Patients that are isolated or who have Hepatitis B undergo hemodialysis in their room with appropriate precautions maintained
  • 4. Hemodialysis (continued) Nurse to nurse report occurs prior to and following hemodialysis In the event that a patient becomes unresponsive, or at the discretion of the contract dialysis nurse, becomes in need of emergent care, the dialysis nurse dials 5555 or pushes the code button and reports a “Code Blue” In addition to the administrative supervisor and the ER staff, the primary nurse reports to the treatment area In the event that the patient is a DNR, the dialysis nurse first notifies the physician, and then the primary nurse to determine the best course of action
  • 5. Hemodialysis (continued) All dialysis patients are weighed daily and have a sign posted at bedside prohibiting needle sticks and BP’s in the access arm Pertinent aspects of the patient’s condition are assessed before, during, and following hemodialysis These include, but are not limited to cardiovascular, vital signs, respiratory, pharmacological, and coagulation status Patients are observed for signs of adverse reactions, including: hypovolemia, hemorrhage, disequilibrium syndrome, electrolyte imbalance, and air embolism