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  1. 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. 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. 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. 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. 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