PURPOSE
- To disconnect the patient from CVVH machine on completion of the Hemofiltration
- To investigate malfunction in the system
POLICY
- All Nursing staff working in the Renal unit should be complete in disconnecting patients from (CVVH) Hemofiltration.
- An experienced nurse should carry out this procedure.
- A sterile aseptic technique should be maintained through out the procedure in accordance with the aseptic technique procedure
- Hand washing should be performed according to policy and procedure on hand washing.
EQUIPMENT
- Trolley washed and cleaned with 70% spirit.
- On & Off Pack.
- Surgical Mask.
- Sterile gloves.
- Disposable apron.
- Specimen container.
- Specimen bags.
- Mepore dressing 9X15 cm.
- Syringes 10mls X2.
- Syringes 2mls X2.
- Disposable (un-sterile) gloves
- 0.9% N/saline 10mls – 2ampules
- Injection Heparin 5000 I.u – I vial
- lure lock caps- 2
- B.P. Apparatus +Stethoscope
- Tegaderm dressing 9X 12cm
- CVVH record chart
- Thermometer
PROCEDURE
| SN | Nursing Action | Rationale |
| 01 | Check the time when the treatment is completed, and post medication if any. | To terminate the treatment. |
| 02 | Explain the procedure to patient, if patient is conscious, and provide privacy. | To release tears and to provide protection. |
| 03 | Both nurses wear Disposable apron and surgical Mask. | |
| 04 | Wash and dry hands according to policy and procedure on hand washing technique. | To prevent droplet infection. |
| 05 | Second Nurse will prepare the trolley appropriate, and the On & off pack on the sterile field, and open the pack gently and place all the necessary things for the termination, and pours Betadine antiseptic solution in a container. | To prevent cross infection. |
| 06 | First Nurse wear sterile gloves and sets the thing properly, including 0.9% N/saline to flush the catheter and Heparin injection to Heparinize the catheter lumens. | |
| 07 | Second Nurse will wear un sterile gloves and helps in operation the Machine. Press stop button to stop the treatment, and open the I/V set clamp and returns the arterial line blood, and closes the arterial line clamp. | |
| 08 | Again Second Nurse press the start button to return the venous line Blood. Fully line is clean, clamps the venous line after stopping the Machine. | |
| 09 | First Nurse place a sterile Drape and clamps the catheter lumens and place a Betadine socked gauze pieces between the catheter adaptor and arterio-venous tube disconnecting end 3min, then gently scrub it well and remove the Betadine gauze and wipes it again with dry gauze. and disconnects the artirio-venous line and give it to the second all the lines from the machine, and pressing the On & Off button puts off the machine . |
| SN | Nursing Action | Rationale |
| 10 | First Nurse release the (A) side of the clamps and flues it with 10mls of N/saline, then clamps (A) side clamp. Heparinizes the (A) lumen. [With 5000 iu.of Heparin].1ml , then clamps the catheter, and close the catheter adaptor with lures lock cap. | To prevent clotting, and potency of the catheter. To prevent air entry. |
| 11 | Same procedure to be done in the (V) lumen of the catheter except heparinizing the lumen with 5000 iu of Injection Heparin 1-1ml to be used. | |
| 12 | Catheter side dressing done appropriately and cover the patient well. | |
| 13 | Check vital signs and complete CVVH. Record hart and Document the procedure in the nursing notes. | Any variation infection to the physician. |