SHARED - PowerPoint PPT Presentation


Title: SHARED


1
SHARED
HAEMODIALYSIS
CARE HANDBOOK
Name
Hospital Number
Shared Haemodialysis Care Named Nurse
Date
Machine Type
Dialysis Unit
2
INTRODUCTION This handbook has been developed as
a shared care education and training guide to
help you learn how to take part in your own
haemodialysis care. Firstly you will be taught
how to do some of the simple procedures involved
in dialysis. As your confidence grows, you may
wish to learn more about the whole dialysis
procedure. This handbook is designed to help you
to pick out only the procedures that you feel you
are comfortable with, and to progress to other
procedures if and when you feel ready. You will
be taught by your own unit nurses at your own
pace. This handbook will become a record of
your progress. Every time you attend for dialysis
you can see how you are doing and what comes
next. The procedures section should be signed by
you and your nurse when you both feel that a
level of safe practice has been achieved
according to the definitions given.
Even after you have achieved a safe level of
practice in your chosen procedures, you will
always be under the supervision of a Qualified
Nurse or level 3 Support Worker who will be there
to support you and give advice. What if I decide
shared haemodialysis care isn't for me? We
realise that shared haemodialysis care doesn't
suit everyone and if you no longer want to be
involved, your treatment will continue to be
carried out by the nursing staff. You will not
be pressured into doing anything beyond your
wishes or capabilities. What if I decide I want
to haemodialyse at home? Some patients decide
they'd like to haemodialyse at home, once they've
gained confidence on the unit. If this is
something you are interested in, please see your
haemodialysis nurse for further information.
02
3
SHARED HAEMODIALYSIS CARE COMPETENCY
Patient Name
Hospital Number
SUMMARY SHEET
Please remove this Summary Sheet and place in the
patient records as soon as this handbook is
assigned to a patient.
Each time a competency is completed, please sign
and date this Summary Sheet as well as signing
the original handbook competency.

In my opinion, the following areas of practice
have been achieved by this named patient
Qualified Nurses Signature
Print Name
Date
1
Functions of the kidney principles of
haemodialysis
2
Doing my observations
3
Preparing my dialysis machine
4
Preparing my pack
5
Programming my dialysis machine
6
Preparing my fistula/graft for dialysis
7
Preparing my tunnelled line for dialysis
8
Commencing my dialysis
Discontinuing dialysis with my fistula/graft
9
Discontinuing dialysis with my tunnelled line
10
After my dialysis
11
12
Administering my medications
a) LMWH b) Erythropoietin c) Heparin
13
Problem awareness
14
Progress review sheet (photocopy as required)
4
CONTENTS
Please tick the topic/procedure
you are interested in
Section Number
COMPLETED
MAYBE
NO
YES
Topic/procedure
1
Functions of the kidney principles of
haemodialysis
2
Doing my observations
3
Preparing my dialysis machine
4
Preparing my pack
5
Programming my dialysis machine
6
Preparing my fistula/graft for dialysis
7
Preparing my tunnelled line for dialysis
You can change
8
Commencing my dialysis
or add to your
choices whenever
Discontinuing dialysis with my fistula/graft
9
you wish
10
Discontinuing dialysis with my tunnelled line
After my dialysis
11
12
Administering my medications
a) LMWH b) Erythropoietin c) Heparin
Problem awareness
13
Progress review sheet (photocopy as required)
14
03
5
Functions of the kidney principles of
haemodialysis
1
Discussion should include
Topic
Date
Date
Date
Anatomy of the kidney normal
Normal kidney function
kidney function
Filtering the blood to remove excess
waste and water.
What happens when kidneys fail?
Producing the hormone,
erythropoietin.
Principles of haemodialysis, fluid
Keeping the bones strong by
removal effect of fluid on the heart
balancing calcium and phosphate.
Keeping acid and alkaline balanced in
the blood.
Controlling blood pressure.
What happens when
kidney's fail?
Please ask your
There is no cure, so kidney function
haemodialysis nurse for
needs to be replaced by dialysis or
written information on
transplantation.
Dialysis is not as effective as working
Anatomy of the kidney

kidneys but enables many people to
Fluid removal from the body and

live a long and full life.
its effect on the heart
The principles of haemodialysis

Common words used on your

Haemodialysis Unit
04
6
If you don't have access to a
computer, there are a
number of other sources, for
PATIENT INFORMATION
example patient information
If you want to find out more
leaflets and books. Please
about your kidneys, haemodialysis
ask your nurse if you require
Principles of haemodialysis
treatment please visit
further information.
www.kidneypatientguide.org.uk
Explain the blood circuit, briefly
mentioning heparin/anticoagulant to
www.kidneycare.nhs.uk
stop the blood from clotting and the
www.fistulafirst.org
air detector to prevent air in blood.
www.kidney.org.uk
(These will be elaborated on later)
www.nkrf.org.uk
Show / explain the water inlet and
waste outlet.
Please ask your haemodialysis nurse
Show / explain the dialyser (artificial
about Renal PatientView and how to
kidney), bloodlines and blood pump,
apply. You can also visit the site below
bicarbonate cartridge / dialysate fluid.
to see a demonstration of how the site
Blood is cleaned in the dialyser blood
works www.renalpatientview.org
flows through the middle of hollow
Patient information
fibres made from a semi-permeable
membrane, with the dialysate fluid
Type
flowing around the outside of the
fibres
Date
The dialysate fluid contains small
In my opinion, I have received sufficient
information and have been
amounts of the substances normally
given the opportunity to ask questions
present in the blood. The membrane
has tiny holes in it so that the excess
fluid and wastes can be removed. At
Patients Signature
Print Name
Date
no point do the blood and dialysate
fluids come into contact with each
other.
05
7
Handwashing for dialysis
1
2
3
4
RUB PALM TO PALM
BACK OF HANDS
PALMS FINGERS
BACK OF FINGERS TO PALM
8
7
6
5
USE PAPER TOWEL TO TURN
OFF TAPS AND THROW
WRISTS
FINGER TIPS
THUMBS
06
8
2
Doing my observations
Procedure
Date
Date
Date
Date
Date
Date
Date
Date
Date
Hand Hygiene
Weight
Pulse and Blood pressure
Temperature
Blood pressure (BP)
Procedure definitions
Accurately records BP unaided,
Hand hygiene
understands use of correct cuff
Washes hands in accordance
size on bare arm with loose
with Unit/Hospital Policy using
fitting short sleeves. Is aware of
attached photo guide on page 6.
his/her normal BP and
Understands the importance of
recognises and reports any
this in reducing infection risk.
abnormality.
Weight
Pulse
Accurately weighs him/herself
Accurately records pulse and
unaided and is aware of target
recognises and records any
weight.
abnormality.
Calculates required fluid loss.
Temperature
Accurately records temperature
and is aware of what
constitutes a high
temperature and the possible
reasons for this.
07
9
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
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.
Patients Signature
Print Name
Date
In my opinion, a safe level of practice has been
achieved in this section
Qualified Nurses signature
Print Name
Date
08
10
Preparing my dialysis machine
3
Connect acid concentrate
Prime blood circuit
Procedure definitions
Understands the reasons
Is aware of correct concentrate.
Hand hygiene
for priming blood circuit with
Checks dialysis prescription.
sodium chloride (saline)
Washes hands in accordance with
Connects safely and securely.
solution before dialysis.
Unit/Hospital Policy.
Connect bicarb cartridge
Carries out correct priming
Understands the importance of this
procedure.
in reducing infection risks.
Connects bicarbonate cartridge
safely and securely.
Re-circulate
Turn on machine
Attach dialyser
Understands the reason for
Switches on machine correctly
re-circulating before dialysis.
Is aware of correct dialyser.
and selects 'haemodialysis'.
Carries out correct re-
Checks dialysis prescription.
Collect equipment
circulating procedure.
Connects dialyser safely and
securely.
Collects correct equipment and is
Attach dialysate lines
aware of where to locate it.
Attach arterial venous
to dialyser
Attaches lines safely using a no
Attaches lines safely and
touch technique.
securely, following prompt
by machine.
Attach heparin syringe
Understands the action of
heparin see Section 12 Checks
dialysis prescription.
Attaches the heparin syringe
safely and securely.
09
11
Preparing my dialysis machine
3
Procedure
Date
Date
Date
Date
Date
Date
Hand Hygiene
Collect equipment
Connect acid concentrate
Connect bicarb cartridge
Attach dialyser
Attach arterial and venous blood lines
Attach heparin syringe (if applicable)
Prime blood circuit
Re-circulate
Attach dialysate lines to dialyser
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
10
12
Preparing my dialysis machine (continued)
3
Procedure
Date
Date
Date
Date
Date
Date
Hand Hygiene
Collect equipment
Connect acid concentrate
Connect bicarb cartridge
Attach dialyser
Attach arterial and venous blood lines
Attach heparin syringe (if applicable)
Prime blood circuit
Re-circulate
Attach dialysate lines to dialyser
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
11
13
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.
Patients Signature
Print Name
Date
In my opinion, a safe level of practice has been
achieved in this section
Qualified Nurses signature
Print Name
Date
12
14
Preparing my pack
4
Procedure definitions
Prepare "putting on"
pack
Hand hygiene
Sets out pack correctly using
Washes hands in accordance with
'Aseptic Technique'.
Unit/Hospital Policy.
Understands the principles of
Understands the importance of this
'Aseptic Technique'.
in reducing infection risk.
Sharps Policy
Surface hygiene
Understands what a sharp is
and how to safely handle and
Cleans work surface in accordance
dispose of sharps.
with Unit/Hospital Policy.
Understands the importance of this
in reducing infection risk.
Collect equipment
Don't forget
Is aware of what equipment is
to read and sign
needed and where to locate it.
your own units
Refers to dialysis prescription
Sharp Policy.
where appropriate.
13
15
Preparing my pack
4
Hand Hygiene
Surface hygiene
Collect equipment
Prepare putting on pack using aseptic technique
Read, understand sign
the sharps policy
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
14
16
Preparing my pack (continued)
4
Hand Hygiene
Surface hygiene
Collect equipment
Prepare putting on pack using aseptic technique
Read, understand sign
the sharps policy
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
15
17
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.
Patients Signature
Print Name
Date
In my opinion, a safe level of practice has been
achieved in this section
Qualified Nurses signature
Print Name
Date
16
18
Programming my dialysis machine
5
Procedure definitions
Heparin dose and stop time
Sodium and bicarb levels
Understands the action of heparin

Checks dialysis prescription for
Dialysis time
and its side effects. (See Section 12)
prescribed sodium level.

Checks dialysis prescription for

Checks dialysis prescription for
Checks dialysis prescription for
prescribed time.
prescribed heparin rate.
prescribed bicarbonate level.
Programmes in correct
Checks dialysis prescription for
Programmes correct sodium and
dialysis time.
prescribed heparin stop time.
bicarbonate levels and understands
Programmes correct heparin
the consequences if programmed incorrectly.
Fluid loss/ultrafiltration
dose and stop time.
volume
Dialysate Flow
Anticoagulant Regime
Understands concept of target /
dry weight.
Understands the action of the
Programmes correct dialysate flow.

Checks dialysis prescription for
anticoagulant and understands
prescribed target weight.
its desired effects and side effects.
Understands relevance of pre
(See section 12)
dialysis weight and BP.

Checks drug prescription chart
Understands how to calculate
for prescribed amount.
ultrafiltration (UF) volume.
Programmes correct ultrafiltration
Automated Blood Pressure
(UF) volume.
Monitor on HD machine
Identifies how much fluid is safe to
Programmes the automated
remove per hour according to the
current Renal Association Guidelines
Blood Pressure monitor as
and their individualised safe fluid loss
required.
regime as indicated in their medical
notes.
17
19
5
Programming my dialysis machine
Dialysis time
Fluid loss / ultrafiltration volume
Sodium and bicarbonate levels
Dialysate fluid flow
Heparin dose stop time or
Anticoagulant regime
Automated Blood Pressure monitor on
haemodialysis machine
(if applicable)
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
18
20
5
Programming my dialysis machine (continued)
Dialysis time
Fluid loss / ultrafiltration volume
Sodium and bicarbonate levels
Dialysate fluid flow
Heparin dose stop time or
Anticoagulant regime
Automated Blood Pressure monitor on
haemodialysis machine
(if applicable)
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
19
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Title: SHARED


1
SHARED
HAEMODIALYSIS
CARE HANDBOOK
Name
Hospital Number
Shared Haemodialysis Care Named Nurse
Date
Machine Type
Dialysis Unit
2
INTRODUCTION This handbook has been developed as
a shared care education and training guide to
help you learn how to take part in your own
haemodialysis care. Firstly you will be taught
how to do some of the simple procedures involved
in dialysis. As your confidence grows, you may
wish to learn more about the whole dialysis
procedure. This handbook is designed to help you
to pick out only the procedures that you feel you
are comfortable with, and to progress to other
procedures if and when you feel ready. You will
be taught by your own unit nurses at your own
pace. This handbook will become a record of
your progress. Every time you attend for dialysis
you can see how you are doing and what comes
next. The procedures section should be signed by
you and your nurse when you both feel that a
level of safe practice has been achieved
according to the definitions given.
Even after you have achieved a safe level of
practice in your chosen procedures, you will
always be under the supervision of a Qualified
Nurse or level 3 Support Worker who will be there
to support you and give advice. What if I decide
shared haemodialysis care isn't for me? We
realise that shared haemodialysis care doesn't
suit everyone and if you no longer want to be
involved, your treatment will continue to be
carried out by the nursing staff. You will not
be pressured into doing anything beyond your
wishes or capabilities. What if I decide I want
to haemodialyse at home? Some patients decide
they'd like to haemodialyse at home, once they've
gained confidence on the unit. If this is
something you are interested in, please see your
haemodialysis nurse for further information.
02
3
SHARED HAEMODIALYSIS CARE COMPETENCY
Patient Name
Hospital Number
SUMMARY SHEET
Please remove this Summary Sheet and place in the
patient records as soon as this handbook is
assigned to a patient.
Each time a competency is completed, please sign
and date this Summary Sheet as well as signing
the original handbook competency.

In my opinion, the following areas of practice
have been achieved by this named patient
Qualified Nurses Signature
Print Name
Date
1
Functions of the kidney principles of
haemodialysis
2
Doing my observations
3
Preparing my dialysis machine
4
Preparing my pack
5
Programming my dialysis machine
6
Preparing my fistula/graft for dialysis
7
Preparing my tunnelled line for dialysis
8
Commencing my dialysis
Discontinuing dialysis with my fistula/graft
9
Discontinuing dialysis with my tunnelled line
10
After my dialysis
11
12
Administering my medications
a) LMWH b) Erythropoietin c) Heparin
13
Problem awareness
14
Progress review sheet (photocopy as required)
4
CONTENTS
Please tick the topic/procedure
you are interested in
Section Number
COMPLETED
MAYBE
NO
YES
Topic/procedure
1
Functions of the kidney principles of
haemodialysis
2
Doing my observations
3
Preparing my dialysis machine
4
Preparing my pack
5
Programming my dialysis machine
6
Preparing my fistula/graft for dialysis
7
Preparing my tunnelled line for dialysis
You can change
8
Commencing my dialysis
or add to your
choices whenever
Discontinuing dialysis with my fistula/graft
9
you wish
10
Discontinuing dialysis with my tunnelled line
After my dialysis
11
12
Administering my medications
a) LMWH b) Erythropoietin c) Heparin
Problem awareness
13
Progress review sheet (photocopy as required)
14
03
5
Functions of the kidney principles of
haemodialysis
1
Discussion should include
Topic
Date
Date
Date
Anatomy of the kidney normal
Normal kidney function
kidney function
Filtering the blood to remove excess
waste and water.
What happens when kidneys fail?
Producing the hormone,
erythropoietin.
Principles of haemodialysis, fluid
Keeping the bones strong by
removal effect of fluid on the heart
balancing calcium and phosphate.
Keeping acid and alkaline balanced in
the blood.
Controlling blood pressure.
What happens when
kidney's fail?
Please ask your
There is no cure, so kidney function
haemodialysis nurse for
needs to be replaced by dialysis or
written information on
transplantation.
Dialysis is not as effective as working
Anatomy of the kidney

kidneys but enables many people to
Fluid removal from the body and

live a long and full life.
its effect on the heart
The principles of haemodialysis

Common words used on your

Haemodialysis Unit
04
6
If you don't have access to a
computer, there are a
number of other sources, for
PATIENT INFORMATION
example patient information
If you want to find out more
leaflets and books. Please
about your kidneys, haemodialysis
ask your nurse if you require
Principles of haemodialysis
treatment please visit
further information.
www.kidneypatientguide.org.uk
Explain the blood circuit, briefly
mentioning heparin/anticoagulant to
www.kidneycare.nhs.uk
stop the blood from clotting and the
www.fistulafirst.org
air detector to prevent air in blood.
www.kidney.org.uk
(These will be elaborated on later)
www.nkrf.org.uk
Show / explain the water inlet and
waste outlet.
Please ask your haemodialysis nurse
Show / explain the dialyser (artificial
about Renal PatientView and how to
kidney), bloodlines and blood pump,
apply. You can also visit the site below
bicarbonate cartridge / dialysate fluid.
to see a demonstration of how the site
Blood is cleaned in the dialyser blood
works www.renalpatientview.org
flows through the middle of hollow
Patient information
fibres made from a semi-permeable
membrane, with the dialysate fluid
Type
flowing around the outside of the
fibres
Date
The dialysate fluid contains small
In my opinion, I have received sufficient
information and have been
amounts of the substances normally
given the opportunity to ask questions
present in the blood. The membrane
has tiny holes in it so that the excess
fluid and wastes can be removed. At
Patients Signature
Print Name
Date
no point do the blood and dialysate
fluids come into contact with each
other.
05
7
Handwashing for dialysis
1
2
3
4
RUB PALM TO PALM
BACK OF HANDS
PALMS FINGERS
BACK OF FINGERS TO PALM
8
7
6
5
USE PAPER TOWEL TO TURN
OFF TAPS AND THROW
WRISTS
FINGER TIPS
THUMBS
06
8
2
Doing my observations
Procedure
Date
Date
Date
Date
Date
Date
Date
Date
Date
Hand Hygiene
Weight
Pulse and Blood pressure
Temperature
Blood pressure (BP)
Procedure definitions
Accurately records BP unaided,
Hand hygiene
understands use of correct cuff
Washes hands in accordance
size on bare arm with loose
with Unit/Hospital Policy using
fitting short sleeves. Is aware of
attached photo guide on page 6.
his/her normal BP and
Understands the importance of
recognises and reports any
this in reducing infection risk.
abnormality.
Weight
Pulse
Accurately weighs him/herself
Accurately records pulse and
unaided and is aware of target
recognises and records any
weight.
abnormality.
Calculates required fluid loss.
Temperature
Accurately records temperature
and is aware of what
constitutes a high
temperature and the possible
reasons for this.
07
9
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
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.
Patients Signature
Print Name
Date
In my opinion, a safe level of practice has been
achieved in this section
Qualified Nurses signature
Print Name
Date
08
10
Preparing my dialysis machine
3
Connect acid concentrate
Prime blood circuit
Procedure definitions
Understands the reasons
Is aware of correct concentrate.
Hand hygiene
for priming blood circuit with
Checks dialysis prescription.
sodium chloride (saline)
Washes hands in accordance with
Connects safely and securely.
solution before dialysis.
Unit/Hospital Policy.
Connect bicarb cartridge
Carries out correct priming
Understands the importance of this
procedure.
in reducing infection risks.
Connects bicarbonate cartridge
safely and securely.
Re-circulate
Turn on machine
Attach dialyser
Understands the reason for
Switches on machine correctly
re-circulating before dialysis.
Is aware of correct dialyser.
and selects 'haemodialysis'.
Carries out correct re-
Checks dialysis prescription.
Collect equipment
circulating procedure.
Connects dialyser safely and
securely.
Collects correct equipment and is
Attach dialysate lines
aware of where to locate it.
Attach arterial venous
to dialyser
Attaches lines safely using a no
Attaches lines safely and
touch technique.
securely, following prompt
by machine.
Attach heparin syringe
Understands the action of
heparin see Section 12 Checks
dialysis prescription.
Attaches the heparin syringe
safely and securely.
09
11
Preparing my dialysis machine
3
Procedure
Date
Date
Date
Date
Date
Date
Hand Hygiene
Collect equipment
Connect acid concentrate
Connect bicarb cartridge
Attach dialyser
Attach arterial and venous blood lines
Attach heparin syringe (if applicable)
Prime blood circuit
Re-circulate
Attach dialysate lines to dialyser
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
10
12
Preparing my dialysis machine (continued)
3
Procedure
Date
Date
Date
Date
Date
Date
Hand Hygiene
Collect equipment
Connect acid concentrate
Connect bicarb cartridge
Attach dialyser
Attach arterial and venous blood lines
Attach heparin syringe (if applicable)
Prime blood circuit
Re-circulate
Attach dialysate lines to dialyser
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
11
13
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.
Patients Signature
Print Name
Date
In my opinion, a safe level of practice has been
achieved in this section
Qualified Nurses signature
Print Name
Date
12
14
Preparing my pack
4
Procedure definitions
Prepare "putting on"
pack
Hand hygiene
Sets out pack correctly using
Washes hands in accordance with
'Aseptic Technique'.
Unit/Hospital Policy.
Understands the principles of
Understands the importance of this
'Aseptic Technique'.
in reducing infection risk.
Sharps Policy
Surface hygiene
Understands what a sharp is
and how to safely handle and
Cleans work surface in accordance
dispose of sharps.
with Unit/Hospital Policy.
Understands the importance of this
in reducing infection risk.
Collect equipment
Don't forget
Is aware of what equipment is
to read and sign
needed and where to locate it.
your own units
Refers to dialysis prescription
Sharp Policy.
where appropriate.
13
15
Preparing my pack
4
Hand Hygiene
Surface hygiene
Collect equipment
Prepare putting on pack using aseptic technique
Read, understand sign
the sharps policy
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
14
16
Preparing my pack (continued)
4
Hand Hygiene
Surface hygiene
Collect equipment
Prepare putting on pack using aseptic technique
Read, understand sign
the sharps policy
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
15
17
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.
Patients Signature
Print Name
Date
In my opinion, a safe level of practice has been
achieved in this section
Qualified Nurses signature
Print Name
Date
16
18
Programming my dialysis machine
5
Procedure definitions
Heparin dose and stop time
Sodium and bicarb levels
Understands the action of heparin

Checks dialysis prescription for
Dialysis time
and its side effects. (See Section 12)
prescribed sodium level.

Checks dialysis prescription for

Checks dialysis prescription for
Checks dialysis prescription for
prescribed time.
prescribed heparin rate.
prescribed bicarbonate level.
Programmes in correct
Checks dialysis prescription for
Programmes correct sodium and
dialysis time.
prescribed heparin stop time.
bicarbonate levels and understands
Programmes correct heparin
the consequences if programmed incorrectly.
Fluid loss/ultrafiltration
dose and stop time.
volume
Dialysate Flow
Anticoagulant Regime
Understands concept of target /
dry weight.
Understands the action of the
Programmes correct dialysate flow.

Checks dialysis prescription for
anticoagulant and understands
prescribed target weight.
its desired effects and side effects.
Understands relevance of pre
(See section 12)
dialysis weight and BP.

Checks drug prescription chart
Understands how to calculate
for prescribed amount.
ultrafiltration (UF) volume.
Programmes correct ultrafiltration
Automated Blood Pressure
(UF) volume.
Monitor on HD machine
Identifies how much fluid is safe to
Programmes the automated
remove per hour according to the
current Renal Association Guidelines
Blood Pressure monitor as
and their individualised safe fluid loss
required.
regime as indicated in their medical
notes.
17
19
5
Programming my dialysis machine
Dialysis time
Fluid loss / ultrafiltration volume
Sodium and bicarbonate levels
Dialysate fluid flow
Heparin dose stop time or
Anticoagulant regime
Automated Blood Pressure monitor on
haemodialysis machine
(if applicable)
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
18
20
5
Programming my dialysis machine (continued)
Dialysis time
Fluid loss / ultrafiltration volume
Sodium and bicarbonate levels
Dialysate fluid flow
Heparin dose stop time or
Anticoagulant regime
Automated Blood Pressure monitor on
haemodialysis machine
(if applicable)
X
Demonstrated by qualified nurse or level 3
support worker
S
Supervised closely by qualified nurse or level
3 support worker
KEY
P
Practising to become competent under distant
supervision
C
Agreed as competent by qualified nurse
19
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