PURPOSE
- To remove large molecular weight substances.
- Facilitate intravenous feeding. (T.P.N) Total parenteral Nutrition
- To Administer Medication and fluids (Intravenous)
POLICY
- This procedure is performed
- when Haemodialysis is contraindicated
- for patients who are Hyper catabolic
- for patients who need large amount of fluid to be remove
- This procedure should be performed by tow (2) nurses, one of whom is an experience senior nurse
- A sterile Aseptic technique should be maintained through out the procedure in accordance with the policy and procedure of aseptic technique.
- Hand washing should be preformed according to policy and procedure of hand washing technique.
EQUIPMENT
- Trolley washed will soap and water and wipe with spirit 70%
- On & Off Pack
- Betadine antiseptic solution
- Sterile gloves
- Surgical Mask
- Disposable apron
- Specimen containers
- Specimen bags
- BP. Apparatus & Sterile
- Culture swab sterile stick
- Thermometers
- Lab investigation forms
- Mepore dressing 9X15 cms
- Tegaderm 10X12cm
- CVVH record chart
- Syringes 10X 3mls .
PROCEDURE
| SN | Nursing Action | Rationale |
| 01 | Check the physician order print to –CVVH. Procedure. | To perform the correct treatment |
| 02 | Explain the procedure to patient, if patient is conscious and provide privacy. | To release tears and to provide protection |
| 03 | Check and record vital signs. | If any variation inform to the physician before performing the procedure. |
| 04 | Both nurses wear disposable apron and surgical Mask. | To prevent droplet infection. |
| 05 | Wash and dry hands as per policy and procedure on hand washing technique. | To prevent cross infection. |
| 06 | Prepare trolley appropriate, and palace On & Off pack on the sterile fluid, open the pack gently, and place all the necessary thing including antiseptic Betadine solution in a container. | To avoid damage to the catheter. |
| 07 | Second Nurse Remove the catheter site dressing as well as the plaster. (Do not use SCISSORS). | |
| 08 | First Nurse wear sterile gloves and place sterile Drape under the catheter, and with forceps she remove inner dressing of the catheter site. | |
| 09 | Inspect the catheter site for any unwanted leakage or infection and take swab if appropriate. | To detect early signs of infection. |
| 10 | First Nurse will clean the catheter site, and surrounding area with Betadine solution socked swabs, and wipes it with dry swab then applies sterile dressing. | To prevent infection. |
| SN | Nursing Action | Rationale |
| 11 | Warp the catheter both lumens with a piece of gauze soacked with antiseptic Betadine solution for 3 minutes, then gently scrub the catheter lumens and remove the Betadine swab, and dry the catheter lumens with plain sterile gauze. | |
| 12 | Change gloves and place another sterile drape under the catheter. Remove luer lock cap from (A) lumens and clean the catheter adopter with Betadine swab then dry swab and attach 10ml syringe and release the clamp, aspirate 2ml instilled heparin and fluid it in a gauze piece after clamping the (A) lumen. Check any Blood clot. Check the flow also. | To check the patency of the catheter. |
| 13 | Same procedure to be done in (V) lumens of the catheter and flush the venous lumens with 10mls of N/S 0.9% and administer loading dose of Heparin in (V) lumens. | To Heparinize the Blood |
| 14 | Second Nurse will give (A) line to 1st nurse- 1st nurse will connects it to the catheter adopter of (A) lumens and release the (A) lumens clamp. | |
| 15 | Second Nurse release the clamp of (A) line and closes the start button on the CVVH Machine, and select Blood flow rate ml /min and enter it. | |
| 16 | Blood bleeds via catheter to the extra corporal circuit on machine, when blood reaches to the venous end she stops the machine by pressing stop button and gives it to the 1st nurse . | |
| 17 | First Nurse connect the venous line to the catheter adopter nicely and release all clamps. | |
| 18 | Second Nurse will display the machine and enters the data as per Doctors order. Then press the START button Now CVVH or CVVH is in progress. |
| SN | Nursing Action | Rationale |
| 19 | First Nurse will secure all the connection properly and covers the patient well. | To prevent accidental disconnection |
| 20 | Check vital signs at this point hourly and maintain it or more frequent check depending on patient condition . | |
| 21 | Maintain the CVVH record chart hourly. | Any variation Inform to nurse in-charge and physician. |
| 22 | Document the procedure in the nursing notes. |