DEFINITION
Priming is a process in which normal saline is rinsed and filled into the dialyser and bloodlines to expel air and expand the membranes to achieve effective surface area and to remove ETO.
PURPOSE
1. To demonstrate a safe and skilled method of priming haemodialysis blood lines and dialyser.
CONDITIONS
1. Applies to all Registered Nursing Personnel working in dialysis centres in Oman.
2. This procedure can be performed by a nurse undertaking nephrology / dialysis training programme, provided he / she is closely supervised by an experienced dialysis nurse at all times.
3. A strict aseptic technique should be maintained throughout the procedure in accordance with the policy and procedure on aseptic technique.
4. Hand washing should be performed according to policy and procedure on antiseptic hand washing.
5. The machine should be fully functional and the alarm testing system has been completed
EQUIPMENT
1. Dialyser.
2. Arterial and venous blood lines.
3. Intravenous set with luer lock.
4. Bloodlines clamp as required.
5. Three (3) 500 ml Nacl 0.9 % (2 for priming and 1 for wash back by the end of dialysis)
6. Sterile drainage bage
PROCEDURE
| SN | Nursing Action | Rationale |
| 01 | Wash and dry hands as per policy and procedure on hand washing. | To prevent cross infection. |
| SN | Nursing Action | Rationale |
| 02 | Place dialyser in holder with arterial side down Alert Please note specific requirements of the machine. | To expel air from extracorporeal circuit |
| 03 | Place one bottle of normal saline 500 ml on the Intravenous stand with primed drip set. | Intravenous normal saline should be attached and available throughout the procedure for emergency use / wash back. |
| 04 | Arterial Line Apply clamp to patient end of the arterial line with attached spike. Spike saline which is on stand. | The saline will run through the line if not clamped |
| 05 | Release clamp and prime with saline by gravity until pump segment is full of saline and re-apply the clamp as before | To expel all air from lines. |
| 06 | Place arterial line on the machine. | |
| 07 | Prime heparin line by opening the line to air and re-apply screw. | To expel air. |
| 08 | Connect arterial line to the dialyser “A” port | |
| 09 | Connect pressure transducer as required. | To monitor measure where facility is available |
| 10 | Venous line Place venous chamber in air detector. | To ensure there is continuous monitoring of air. |
| 11 | Connect venous line to dialyser “V” port. | |
| 12 | Place patient end of the venous line into sterile drainage bag and ensure venous end clamp is opened. | |
| 13 | Connect pressure transducer. | |
| 14 | Priming Hollow Fiber Dialyser Remove clamp from the arterial line. | To facilitate normal saline to flow. |
| SN | Nursing Action | Rationale |
| 15 | For first 500 mls bottle, switch on the blood pump 100 – 150 ml/minute. | To wash and remove air bubbles. |
| 16 | Make sure that extra corporeal circuit is filled with saline. | To prevent air embolism. |
| 17 | Tap gently over the dialyser to facilitate air removal. | To facilitate air removal and prevent clotting. |
| 18 | Raise fluid levels in “A” and “V” chamber as necessary (as per the specifications of the machine). | To ensure chambers remain full and prevent air entry into extracorporeal circuit. |