i now feel safe and confident to do all of the above without direct supervision. i understand that...
TRANSCRIPT
I now feel safe and confident to do all of the above without direct supervision.I understand that by signing this, I take responsibility for following the procedure definitions.
Patient’s Signature Print Name Date
In my opinion, a safe level of practice has been achieved in this section:
Qualified Nurse’s signature Print Name Date
40
After my Dialysis11
Procedure definitions:
Strip machine and dispose of all equipment:
Rinse and disinfect machine:
Clean machine externally:
• Removes lines and dialyser from machine and understands how to safely dispose of all equipment including sharps according to Unit/Hospital Policy.
• Wears appropriate protective wear according to Unit Policy.
• Rinses and disinfects machine according to unit protocol.
• Understands the importance of cleaning machine externally in reducing risk of cross infection.
• Cleans machine in accordance with Unit policy.
Record weight, BP and pulse:
Record Temperature:
Hand hygiene:
• Accurately records weight and BP and pulse and understands the significance of these readings.
• Accurately records temperature and is aware of what constitutes a high temperature and the possible reasons for this.
• Washes hands according to Unit/Hospital Policy.
• Understands the importance of hand hygiene before and after these procedures in reducing infection risk.
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Strip machine and dispose
of all equipment
Rinse and disinfect machine
Clean machine externally
Record weight, Blood Pressure and pulse
Record temperature
Hand hygiene
KEYX S P C
= Demonstrated by qualified nurse or level 3 support worker= Supervised closely by qualified nurse or level 3 support worker= Practising to become competent under distant supervision= Agreed as competent by qualified nurse
Procedure Date: Date: Date: Date: Date: Date:
After my Dialysis11
42
KEYX S P C
= Demonstrated by qualified nurse or level 3 support worker= Supervised closely by qualified nurse or level 3 support worker= Practising to become competent under distant supervision= Agreed as competent by qualified nurse
Strip machine and dispose
of all equipment
Rinse and disinfect machine
Clean machine externally
Record weight, Blood Pressure and pulse
Record temperature
Hand hygiene
Procedure Date: Date: Date: Date: Date: Date:
After my Dialysis (…continued)11
43
I now feel safe and confident to do all of the above without direct supervision.I understand that by signing this, I take responsibility for following the procedure definitions.
Patient’s Signature Print Name Date
In my opinion, a safe level of practice has been achieved in this section:
Qualified Nurse’s signature Print Name Date
44
A. Administering my Low Molecular Weight Heparin (LMWH)12
Procedure definitions:
Hand hygiene:
Checks correct dose:
Clean arterial injection port:
Give LMWH:
• Washes hands before & after procedure in accordance with Unit/Hospital Policy.
• Understands the importance of this in reducing infection risk.
• Correctly identifies prescribed dose.• Is aware of actions & side effects
of LMWH.•
• Identifies correct port. • Cleans port using Unit approved
agent.
• Gives LMWH once venous line has been connected & pressures checked at 200mls/min.
Checks drug prescription chart for prescribed amount.
Dispose of syringe:
Check condition of bubbletrap & dialyser:
Check time for stop bleeding:
• Demonstrate safe disposal of syringe according to Unit sharps policy.
• Checks PBE pre & post dialysis. • Identifies reason for these checks.
• Checks for clots & streaks post washback.
• Identifies reasons for these checks.
• Identifies time taken for needle sites to stop bleeding & recognises any changes.
Check pressure beforeentry (PBE):
45
Hand hygiene
Check correct dose
Clean arterial injection port
Give LMWH
Dispose of used syringe
Check PBE at start of dialysis
Check PBE at end of dialysis
Check condition of bubble trap &
dialyser post washback
Check time for stop bleeding
KEYX S P C
= Demonstrated by qualified nurse or level 3 support worker= Supervised closely by qualified nurse or level 3 support worker= Practising to become competent under distant supervision= Agreed as competent by qualified nurse
12
Procedure Date: Date: Date: Date: Date: Date:
46
A. Administering my Low Molecular Weight Heparin (LMWH)
KEYX S P C
= Demonstrated by qualified nurse or level 3 support worker= Supervised closely by qualified nurse or level 3 support worker= Practising to become competent under distant supervision= Agreed as competent by qualified nurse
Hand hygiene
Check correct dose
Clean arterial injection port
Give LMWH
Dispose of used syringe
Check PBE at start of dialysis
Check PBE at end of dialysis
Check condition of bubble trap &
dialyser post washback
Check time for stop bleeding
12
Procedure Date: Date: Date: Date: Date: Date:
A. Administering my Low Molecular Weight Heparin (LMWH) (…continued)
47
I now feel safe and confident to do all of the above without direct supervision.I understand that by signing this, I take responsibility for following the procedure definitions.
Patient’s Signature Print Name Date
In my opinion, a safe level of practice has been achieved in this section:
Qualified Nurse’s signature Print Name Date
48
B. Administering my Erythropoietin (EPO/Neorecormon/Aranesp) 12
Procedure definitions:Hand hygiene:
Measure/aware of BloodPressure post dialysis:
• Washes hands before & after procedure in accordance with Unit/Hospital Policy.
• Understands the importance of this in reducing infection risk.
• Identifies acceptable & unacceptable blood pressure measurements in accordance with current local Anaemia Management Policy.
• Understands reasons for not giving erythropoietin.
Check syringe:• Correctly identifies prescribed
dose, expiry date and that fluid is clear of contaminates. • Is aware of colour coding in identifying correct dose.
• Is aware of storage advice.•
• Is aware of latest haemoglobin level
• Is aware of signs & symptoms of anaemia.
• Is aware of actions & side effects of Erythropoietin changes.
Check drug prescription chart for prescribed amount.
Identify correct injection Site & give injection:
Dispose of syringe:
• Does not expel air from syringe.• Injects subcutaneously e.g.
arm/abdomen or inject via haemodialysis circuit.
• Demonstrates safe disposal of syringe according to Unit/hospital sharps policy.
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Hand hygiene
Measure/aware of Blood Pressure post dialysis
Check syringe
Identify correct injection site & give injection
Dispose of used syringe
KEYX S P C
= Demonstrated by qualified nurse or level 3 support worker= Supervised closely by qualified nurse or level 3 support worker= Practising to become competent under distant supervision= Agreed as competent by qualified nurse
12
Procedure Date: Date: Date: Date: Date: Date:
50
B. Administering my Erythropoietin (EPO/Neorecormon/Aranesp)
KEYX S P C
= Demonstrated by qualified nurse or level 3 support worker= Supervised closely by qualified nurse or level 3 support worker= Practising to become competent under distant supervision= Agreed as competent by qualified nurse
Hand hygiene
Measure/aware of Blood Pressure post dialysis
Check syringe
Identify correct injection site & give injection
Dispose of used syringe
B. Administering my Erythropoietin (EPO/Neorecormon/Aranesp) (…continued) 12
Procedure Date: Date: Date: Date: Date: Date:
51
I now feel safe and confident to do all of the above without direct supervision.I understand that by signing this, I take responsibility for following the procedure definitions.
Patient’s Signature Print Name Date
In my opinion, a safe level of practice has been achieved in this section:
Qualified Nurse’s signature Print Name Date
52
C. Administering my Heparin
Procedure definitions:
Hand hygiene:
Check correct dose:
Attach to arterialdialysis line & secure to machine:
• Washes hands before & after procedure in accordance with Unit/Hospital Policy.
• Understands the importance of this in reducing infection risk.
• Correctly identifies prescribed dose.
• Is aware of actions & side effects of Heparin.
•
• Attaches Heparin syringe to correct part on the machine.
Checks drug prescription chart for prescribed amount.
Enter correct Heparin dose into machine parameters:
Dispose of sharps
Check PBE (pressure beforeentry) into the dialyser
Check condition of bubbletrap & dialyser
Check time for stop bleeding
• Check dialysis prescription for prescribed Heparin.
• Sets Heparin correctly on the machine.
• Demonstrates safe disposal of sharps according to Unit sharps policy.
• Checks PBE (pressure before entry) pre & post dialysis.
• Identifies reason for these checks.
• Checks for clots & streaks post washback.
• Identifies reasons for these checks.
• Identifies time taken for needle sites to stop bleeding & recognises any changes.
12
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Hand hygiene
Check correct dose
Attach to arterial dialysis line
& secure to machine
Enter correct Heparin dose into machine
parameters
Dispose of sharps according to local unit
sharps policy
Check PBE pre & post dialysis
Check condition of bubble trap & dialyser
post washback
Check time for stop bleeding
KEYX S P C
= Demonstrated by qualified nurse or level 3 support worker= Supervised closely by qualified nurse or level 3 support worker= Practising to become competent under distant supervision= Agreed as competent by qualified nurse
C. Administering my Heparin 12
Procedure Date: Date: Date: Date: Date: Date:
54
KEYX S P C
= Demonstrated by qualified nurse or level 3 support worker= Supervised closely by qualified nurse or level 3 support worker= Practising to become competent under distant supervision= Agreed as competent by qualified nurse
C. Administering my Heparin (…continued) 12
Hand hygiene
Check correct dose
Attach to arterial dialysis line
& secure to machine
Enter correct Heparin dose into machine
parameters
Dispose of sharps according to local unit
sharps policy
Check PBE pre & post dialysis
Check condition of bubble trap & dialyser
post washback
Check time for stop bleeding
Procedure Date: Date: Date: Date: Date: Date:
55
I now feel safe and confident to do all of the above without direct supervision.I understand that by signing this, I take responsibility for following the procedure definitions.
Patient’s Signature Print Name Date
In my opinion, a safe level of practice has been achieved in this section:
Qualified Nurse’s signature Print Name Date
56
Problem Awareness
Procedure definitions:
Hypotension (low BP) on dialysis:
Air detector alarm
Causes:• Removing too much fluid (usually
too quickly) causing BP to drop.
Symptoms:• Feeling faint, dizzy, nauseous,
cramp, hot.
Actions:• Ask for help.• Stop fluid removal, lay flat
and elevate feet.• Check BP.• Re-assess target weight.
This is a potentially serious alarm. Call for nursing assistance.
Common causes:• Blood lines not connected securely.• Low arterial pressure (if pump
restarted without dealing with problem).
Actions:• Ask for nursing assistance.• Check blood lines for evidence
of air bubbles.• Check all connections are secure.• If air is visible, you may need to
re-circulate (ask for help). • If no visible air, re-set air detector.
Common causes:• Clamps left on arterial or venous lines.• Needle needs repositioning.• Clotting.• Needle 'bumped/blown' (see 'bumped/blown needle).
Actions:• Check for clamps or kinks in lines.• Reduce blood pump speed.• Check needles and reposition if
necessary (ask for help).• Check lines and dialyser for signs of
clotting (ask for help).• Rectify problem and slowly increase
blood pump speed.
Arterial and venous pressure alarms
Conductivity alarm
'Bumped/Blown' needle
Common causes:• Machine not picking up correct amount of acid dialysate or bicarbonate due to delivery problems e.g. water problems, empty bicarb cartridge, empty acid bottle or acid supply problem.
Action:• Check connections/probes.• Request new bicarb cartridge/
acetate bottle.• Ask for help.
Recognised by arterial or venous pressure alarm, pain at needle site and swelling at needle site.Causes:• Needle passing through the
other side of the vein allowing blood to flow into the surrounding tissues.
Actions• Insert a new needle (ask for
help).
13
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Blood leak alarm
Common causes:• False blood leak: air in dialysate
pathway.• True blood leak: leak in dialyser
membrane.
Actions:• False blood leak
- Check no air in dialysate pathway.• True blood leak
- Look for visual signs of blood in outflow dialysate line.
- Test with Haemastix if no blood visible.
- Ask for help to deal with the problem according to unit protocol.
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Hypotension
(low Blood Pressure)
on dialysis.
• causes
• symptoms
• actions
Air detector alarm
• causes
• actions
Venous pressure alarm
• causes
• actions
Arterial pressure alarm
• causes
• actions
Conductivity alarm
• causes
• actions
‘Bumped/blown’ needle
• causes
• actions
Blood leak alarm
• causes
• action
Procedure Date Date Date(Discussed, real or simulated?) (Discussed, real or simulated?) (Discussed, real or simulated?)
59
Problem Awareness13
Patient’s Signature Print Name Date
In my opinion, a safe level of practice has been achieved in this section:
Qualified Nurse’s signature Print Name Date
Qualified nurse / level 3 support worker to sign each box when discussed or demonstrated and record detail in progress sheet.
NOTE
I have been made aware of the problems listed in this section through discussion, real-life situations or simulations.
60
My Progress14
Progress Review Sheet (Photocopy As Required)
Time & Date Signature of patient & staff
61
Progress Review Sheet (Photocopy As Required)
Time & Date Signature of patient & staff
62
Content adapted from material developed by staff at Guys and St Thomas Hospitals as part of a Modernisation Initiative on Self Care Dialysis.
Intellectual Copyright of the Yorkshire and The Humber Sharing Haemodialysis Care Programme.
For further information on the Patient Handbook please contact the Yorkshire and Humber Shared Haemodialysis Care Nurse Educators: