PURPOSE
1. To provide guidelines regarding exchanging machine during dialysis.
2. To complete dialysis session without any complication.
3. To demonstrate safe and skilled technique of handling dialysis.
CONDITIONS
1. Two (2) nurses, of whom one should be an experienced nurse should carry out this procedure.
2. A spare machine should be kept ready at all time for use in case of emergency, if available.
3. All Registered Nurses working in renal unit must be aware of nursing responsibility in case of machine breakdown during dialysis.
4. The functional test in the machine must be completed prior to start each dialysis session.
5. This procedure should be carried out within 15-20 minutes to prevent complications.
PROCEDURE
| SN | Nursing Action | Rationale |
| 01 | As soon as the machine breakdown, the nurse should call for help from another nurse/ technician. | |
| 02 | Switch OFF the machine after writing down the parameters on the machine including time. | |
| 03 | Release “V” air detecor clamp. | |
| 04 | Rotate the blood pump manually. Alert All nurses need to be very vigilant because there are no machine alarms. | |
| 05 | Explain the procedure to the patient and re-assure him/her. | To allay fears and gain patient’s confidence and cooperation. |
| SN | Nursing Action | Rationale |
| 06 | If no spare machine return the blood manually . | |
| 07 | Bring the spare machine to the bedside and switch on (same company). | |
| 08 | Disconnect water inflow and drain connection from the other machine and connect to spare machine. Put concentrate stick in the dialysate fluid and start functional test. | |
| 09 | Once the spare machine is ready, clamp the arterial and venous pressure monitors, patient lines, and heparin line. | |
| 10 | Disconnect dialysate lines from the dialyzer and replace them in lock. | |
| 11 | With the assistance of the other nurse, remove gently the dialyser and tubing from the faulty machine and connect to the spare machine. Alert Ensure that the catheter / fistula needles are in sites and the tubing are not pulled while transferring. | To recommence safe dialysis. |
| 12 | Attach dialysate lines to the dialyser. | |
| 13 | Fix arterial and venous lines and release all clamps. | |
| 14 | Reset all alarms. Alert Always check the system for air / blood clot. | |
| 15 | Check all dialysis parameters. | |
| 16 | Start haemodialysis and adjust the remaining dialysis time. | To complete the required hours of dialysis. |
| 17 | Take and record vital sings | To monitor the condition of the patient. |
| SN | Nursing Action | Rationale |
| 18 | Document the incident including the time, when the machine breakdown, time taken when transferring, time restarted, and presence / absence of blood clot in the system. |