Hemodialysis Procedures and Emergency Protocols, Hemodialysis Infection Prevention and Complications, Water System Reference Guide for Dialysis Facilities, Reporting Patient Safety Events: A Quick Reference Guide, Complications and Management in Dial…

What is the first step in responding to a cardiopulmonary arrest in a patient on hemodialysis?

Call for help without leaving the patient.

What should be done if the patient is on hemodialysis during a cardiopulmonary arrest?

Open the saline line and administer saline, unless the equipment contributed to the arrest.

What position should the patient be placed in during a cardiopulmonary arrest?

The modified Trendelenburg position or moved to the floor with a backboard.

What should be checked for after placing the patient in the appropriate position during a cardiopulmonary arrest?

Breathing and responsiveness.

What action should be taken if the patient is unresponsive and not breathing?

Call 911 and retrieve the crash cart and AED.

How long should the carotid pulse be checked during a cardiopulmonary arrest?

No more than 10 seconds.

What should be done if no pulse is detected during a cardiopulmonary arrest?

Begin CPR by placing a backboard or moving the patient to the floor and initiate chest compressions.

What is the purpose of the AED in a cardiopulmonary arrest response?

To analyze the heart rhythm and deliver a shock if necessary.

What should be done with the patient's blood during a cardiopulmonary arrest if there are no equipment problems?

Return the patient's blood.

What should be done if there is no venous access during a cardiopulmonary arrest?

Place a peripheral IV line.

What must be done prior to cannulation of an AVFistula or AVGraft for hemodialysis?

Assess patency and signs of infection.

What is the role of the Direct Patient Care Staff in the cannulation process?

To assess and prepare the access for needle placement.

What should be used with an AVFistula during the evaluation and preparation for cannulation?

A tourniquet.

What is the maximum number of sticks a cannulator may perform per cannulation site?

Two sticks.

What should be checked to confirm patency of a fistula?

Adequate bruit and thrill.

What should be done if signs of infection are present at the cannulation site?

Do not cannulate a clotted access.

What is the purpose of performing skin disinfection before cannulation?

To prevent bacteria from entering the bloodstream.

What should patients be instructed on regarding their access between cannulation sessions?

Look, Listen and Feel.

What should be done if a patient is unable to wash their access area before treatment?

Staff or care partner should wear gloves to wash the access with soap and water.

What should be used to clean the access arm if soap and water are not available?

Hand sanitizer with 60-70% alcohol.

What personal protective equipment (PPE) should be donned by staff before accessing the patient?

Gloves, gown/apron, safety glasses and mask, or full-face shield.

What should be documented in the treatment record prior to cannulation?

Complaints of pain, numbness, tingling, coldness, tenderness, and fever.

What are some signs of complications in vascular access?

Skin discoloration, redness, bruising, lesions, hematomas, extremity swelling, new or changed aneurysm, pus, greater than expected redness or swelling, and any other unusual findings.

What should be documented in the treatment record regarding vascular access?

Any signs of complications, presence or absence of bruit, and findings from auscultation.

What is a normal bruit sound when auscultating vascular access?

A normal low-pitched bruit should be present throughout the access.

What should be done if no bruit sounds are present during auscultation?

Assume the access is thrombosed and do not attempt cannulation; communicate with the physician for referral.

What sensations should a thrill have when assessing vascular access?

A thrill should feel like a purring cat or a vibration like a cell phone, and should not pulsate.

What does strong pulsation in the thrill indicate?

It suggests a flow issue due to stenosis and requires immediate referral for further evaluation.

What is the procedure for glove changes during cannulation?

After assessing the access, perform hand hygiene and don new gloves before proceeding with the cannulation procedure.

What supplies are needed for needle placement in vascular access?

Fistula needles (2), tourniquet (AVFistula only), saline filled syringes (2), tape, underpad, gauze sponges (2), tubes for blood samples, PPE for staff, and gloves and mask for the patient.

What is the recommended method for skin disinfection before cannulation?

Use 70% isopropyl alcohol, povidone iodine, or 2% chlorhexidine with alcohol, cleaning in concentric circles for at least 30 seconds and allowing to dry.

What is the Wet Stick Method for needle placement?

Attach saline filled syringes to the ends of the fistula tubing, flush saline through to remove air, then clamp the tubing.

What should be done if drawing pre-treatment lab work from AVFistula or AVGraft?

Access must be done without saline (dry stick).

What is the purpose of using a tourniquet during the needle placement procedure?

To engorge the vein and make it easier to access, specifically for AVFistula.

What should be done if any steps in the cannulation procedure are interrupted?

Perform hand hygiene and don new gloves before continuing.

What should be observed after skin disinfection?

Observe the cannulation site for any reaction to the antimicrobial solution.

What are some topical anesthetics that can be considered before needle placement?

Benzocaine alcohol prep pads and vapor coolant sprays.

What is the importance of cleaning the stethoscope after assessing a patient?

To prevent cross-contamination and maintain hygiene.

What should be done if the direction of flow is not documented in the patient's medical record?

Compress in the middle of the access and listen to both ends to assess flow.

What is the significance of performing hand hygiene before and after the cannulation procedure?

To minimize the risk of infection and ensure patient safety.

What should be done with the gloves after assessing the access site?

Remove gloves, perform hand hygiene, and don new gloves before cannulation.

How should the disinfectant be applied to the cannulation site?

Using gentle friction, starting from the center and working outward in concentric circles.

What is the maximum time allowed for skin disinfection before cannulation?

At least 30 seconds.

What should be done if unusual findings are noted during the assessment of vascular access?

Note and report any unusual findings to the nurse in charge or home therapies staff.

What is the role of the nurse if a thrombosed access is suspected?

The nurse will communicate with the physician for a referral to the interventionalist or surgeon.

What should be done if the fistula is large and bulbous during cannulation?

A tourniquet may not be necessary, or the patient may use their non-access hand to manually compress the upper arm to create light pressure on the vessel.

What type of tourniquet is recommended for patients performing self-cannulation?

A tourniquet with a push-button release.

How should the fistula needle be held during insertion?

Grasp the wings of the fistula needle between thumb and index finger with the bevel of the needle facing up.

What should be done with the skin at the needle placement site before inserting the needle?

Pull the skin tight to prevent access from rolling, decrease pain during cannulation, and reduce infiltration risk.

What is the correct angle for inserting the needle into the vessel?

The shallowest possible angle (no less than 20 degrees) that allows the needle to be centered in the access and prevent backwall infiltration.

What should be done if resistance is felt during needle insertion?

Do not push forward; pull the needle back slightly and feel the vessel before proceeding.

What is the purpose of leaving 1/8 inch of the needle showing during cannulation?

This space helps prevent larger scab formation on patients with fragile skin.

What should be done to ensure the needle remains centered in the vessel?

Ensure that the wings stay perpendicular to the access.

What are the two taping methods for securing the fistula needle?

The 'chevron' method and the 'H' method.

What is the benefit of the 'chevron' taping method?

It minimizes movement of the needle within the vessel.

What should be placed directly over the venipuncture site after needle insertion?

A Band-Aid or other adhesive dressing, or a 2X2 Gauze pad and tape to prevent bacteria migration.

What is the purpose of using a piece of one-inch tape during taping?

To secure the bloodline to the patient's arm or leg, taking stress off the needle.

What should be avoided when taping the lines to the patient's chair?

Taping the lines to the chair increases tension on the needle, which could result in displacement, infiltration, or a hematoma.

What is the first step in the 'H' taping method after needle insertion?

Cover the puncture site with an adhesive bandage, gauze pad, and clean piece of tape.

How should the tape be applied in the 'H' method?

Place one short piece of tape lengthwise across each of the two wings on the needle and a long piece of tape over the tubing just below the wings.

What is a recommended material for covering the needle area in a home setting?

A length of nylon stocking with the foot section cut off.

What should be done after bloodlines are connected during taping?

Place another piece of tape across the wings of the needle.

What should be done with the tape around the tubing in the 'H' method?

Lightly pinch the tape together around the tubing and secure it to the skin.

What is the purpose of criss-crossing the tape in the 'chevron' method?

To anchor the fistula needle and minimize movement.

What should be done if blood pulsation stops during needle insertion?

Do not push forward; pull the needle back slightly and feel the vessel.

What is the importance of the correct needle angle during cannulation?

It minimizes the risk of infiltration and injury to the AVF lining or graft wall material.

What should be considered when selecting a taping method for patients?

Patient and/or care partner comfort level with the taping method and their ability to secure the needle safely.

What is the consequence of improper taping of the lines to the chair?

It could lead to increased tension on the needle, causing infiltration or hematoma.

What is the first step in establishing patency with a dry stick?

Slightly loosen the protective plastic cap on the end of the needle tubing to allow it to fill with blood.

What should you check after inserting the needle for a dry stick?

Check the needle placement by pulling back and forth on the tubing/syringe 2-3 times for resistance.

What action should be taken if swelling occurs during blood return?

Immediately stop returning the blood and clamp the needle line, indicating infiltration.

What is the purpose of gently aspirating blood with a wet stick?

To ensure the needle is in the correct position before instilling normal saline.

What should be done if signs of infiltration occur during a wet stick?

Stop flushing the needle and clamp the line.

What are the initial steps in machine setup before starting dialysis?

Connect the water supply line, insert the drain line, plug in the power cord, and turn on the heater and power switches.

What should be verified before starting the dialysis machine?

The date of the last disinfection.

What is the first step in the acid cleaning process of the dialysis machine?

Gather supplies and don PPE.

What should be done after connecting the bicarbonate line to the machine?

Select Start Up and press Acid Heat Clean, then confirm to start.

What is the purpose of the weekly machine disinfection?

To acid clean the machine, rinse the lines, chemically disinfect, and test for remaining disinfectant.

How is the dialyzer primed?

Gravity fill the patient end of the arterial bloodline, clamp it, and push the Prime button on the machine.

What should be done after the entire system is primed?

Stop the blood pump and close main line clamps on the arterial and venous bloodlines.

What is the procedure for post-treatment emptying of the dialysis machine?

Verify the patient is not connected, close clamps, remove the blood pump segment, and rotate the dialyzer to venous end up.

What is the order of draw for lab samples starting with the gold SST top?

Gold SST Top (5.0 mL Monthly, 3.5 ml Weekly), Red Top - No Gel (6.0 mL), Royal Blue Top/Clear Top (6.0 mL), Light Blue Top (2.7 mL), Lavender Top (2.0 mL), Purple Top (4.0 mL), Green Top PST Post (3.0 mL, 4.5 mL).

What should be done with the venous blood line after treatment?

Remove it from the venous line clamp and the venous drip chamber from the level detector.

What is the significance of the optical detector door in the priming process?

It must be closed after placing the venous blood line in the occluding clamp.

What is the purpose of the heparin line during dialysis?

To prime the heparin syringe and prepare for heparin infusion if ordered.

What should be done with the dialyzer port cap after removing the blue dialyzer connector?

Place it on the dialyzer outlet where the blue connector was removed and ensure it is tight.

What is the volume of blood for the Light Blue Top lab sample?

2.7 mL.

What is the volume of blood for the Lavender Top lab sample?

2.0 mL.

What is the volume of blood for the Green Top PST Post lab sample?

3.0 mL and 4.5 mL.

What should be done after the acid cleaning step is completed?

Document the disinfection of the machine in TMS.

What is the role of the dialyzer supply line in machine setup?

It connects the dialyzer to the machine shunt.

What is the significance of clamping the needle line during the wet stick procedure?

It prevents backflow and ensures proper flushing of the needle.

What should be done if there is redness at the catheter insertion site?

Immediately report any redness or signs of infection to the RN.

What are the consequences of compromised aseptic technique during catheter-related procedures?

It can lead to infections and complications.

What is the first step to take if a patient shows symptoms of an air embolism?

Stop the pump and clamp the line.

What position should a patient be placed in if an air embolism is suspected?

Trendelenburg position on their left side.

What should be reported to the RN in the case of an air embolism?

The patient's position (Trendelenburg, left side) and symptoms.

What complication can occur if the CVC catheter cuff is outside the insertion site?

CVC catheter dislodgement.

What should be done if a CVC catheter dislodges?

Stop the pump, call the RN, do not return the catheter, and put the patient on their left side.

What is a possible complication of line separation during hemodialysis?

Infection.