This document outlines the steps for terminating a dialysis treatment session through either saline or air rinse. It describes disconnecting the patient from the dialysis machine by using saline or a saline-air mixture to displace the remaining blood in the extracorporeal circuit and return it to the patient. It notes that air rinse increases the risk of air embolism so must be carefully supervised. The document also provides instructions for caring for vascular access sites after treatment and in emergency situations.

1. Closing of HD
(Termination)
By,
DARSHAN S

2. Steps for Dialysis Termination
The blood in the extracorporeal circuit can be
returned using either saline or air.
 If saline is used, the patient usually receives
100–300 mL of this fluid during the rinse-back
procedure
nullifying the corresponding amount of fluid
removed by ultrafiltration
If the patient’s blood pressure is low at the end
of dialysis, the saline bolus will help to raise the
blood pressure quickly.

3. When air is used, the blood pump is first
shut off, and the arterial blood line is
clamped close to the patient.
The arterial blood line is then
disconnected just distal to the clamp
opening it to air.
The blood pump is restarted at a
reduced rate (100–150 mL/min), and the
air is allowed to displace the blood in the
dialyzer.

4. When the air reaches the venous air trap, or
when air bubbles are first seen in the venous
blood line, the venous line is clamped, the
blood pump shut off, and the return procedure
terminated.
Use of air to return the blood increases the
risk of air embolism
and the termination procedure should be
extremely carefully supervised when air return
is employed.

5. Termination of dialysis
1. Saline rinse:
⦿ The blood is returned by pumping sterile normal saline into the
arterial side until the blood is displaced.
⦿ After the bubble trap, the fluid should be very pale pink in color
( to assure that the patient has lost the least of red cell)
2. Saline air rinse:
⦿ The blood is forced by pumping a small amount of saline into
the arterial line, then the line is opened to allow air into the
circuit to push the saline and blood.
⦿ Again the fluid entering the patient should be very pale pink in
color.

6. Terminating of permanent access
1. Get ready the gauze roll with betadine ointment
required for placing on the access
2. Remove the AVF needle carefully and slowly
simultaneously place the Gauze roll above the exact
cannulated site with pressure
3. Do the same for both of the venous and artery
needles
4. Then tie the access site with the torniquet tightly so it
wont loose and bleed.

7. Termination of temporary access
1. Get ready the heparin with saline i.e. 1.5ml of heparin and
1.1ml of saline for non cuffed catheters and 5ml for perm
catheter.
2. First flush the both artery and venous line with 10ml of saline
in each port
3. So the remaining blood present in the catheter will be
cleared, if not done it will form colt in the catheter
4. Then flush the ports with the heparin solution and close the
ports with clamp
5. Then wipe the catheter with disinfectant and pack with the
gauze roll completely

8. Termination in emergencies
In emergencies like hypotension, cardiac arrest, decreased
saturation or high temperature:
We should not remove the catheters or cannulated AVF needles
We should just flush the saline for needle or catheter and wait
until patient comes to normal condition
If hypotension- give 200ml of saline from the access line and
wait for recovery
If cardiac arrest- activate the emergency response immediately
If high temperature give IV medication through access if
necessary
If decreased saturation give 100% oxygen with the help of
oxygen mask

9. Post HD care:
1.Needle site care
2.Monitoring of post HD vitals
 Blood pressure
 Pulse
 Saturation
 Temperature
3.Collection of sample for post HD investigations

10. 4)Administration of medication such as
Inj.Espogen, inj.Renorise, etc.
5)Measurement of weight is must and should
6)Educating the patient about the access site care
in home
7)Diet education & fixing of next appointment

11. THANK YOU