1.

GENERAL POLICY STATEMENT:

1.1 GMC renal dialysis unit provides accurate and up to date hemodialysis procedure to
all renal patients both acute and chronic in nature. The unit follows a strict standard
from the beginning of the process up to the end of the procedure.

2. DEFINITION OF TERMS:
2.1 Hemodialysis – is a process that uses a man-made membrane (dialyzer) to: Remove
wastes, such as urea, from the blood. Restore the proper balance of electrolytes in
the blood. Eliminate extra fluid from the body.
2.2 Dialyzer – an apparatus in which dialysis is carried out consisting essentially of one
or more containers for liquids separated into compartments by membranes.
2.3 Ultrafiltration – membrane filtration in which hydrostatic pressure forces a liquid
against a semipermeable membrane.
2.4 Blood Flow Rate – the amount of blood propelled through the dialyzer in a given time
by a roller pump during routine hemodialysis.
2.5 Hemodialysis Machine – a machine used in dialysis that filters a patient’s
dysfunctional, or missing. It can be thought of as an artificial kidney.

3. POLICY:
3.1 All renal dialysis unit staff nurse shall be trained according to Hospital standard when
starting and ending hemodialysis therapy.
3.2 All renal staff nurses shall be equipped in cannulation and operation of other types of
access site.
3.3 The hemodialysis nurse/technician shall ready HD machine in terms of operation and
disinfection prior to use.
3.4 Bloodlines shall only be used once and are disposable. Dialyzers can be reused 8-10
times (8x for Low flux; 10x for high flux) unless the dialyzer fails the function test
done by trained personnel.
3.5 Dialyzer size shall be identified through a doctor’s order including the blood flow rate
and the amount of Ultrafiltration needed.
3.6 All patients who shall undergo hemodialysis therapy are assessed well and must be
cleared by their doctor prior to starting the hemodialysis therapy, unless a standing
order is made for the patient.
3.7 For patients who comes in for regular dialysis with untoward signs and symptoms of
encephalopathy, hypotension, difficulty of breathing and more, the patient shall be
seen and cleared by attending nephrologist or the resident on duty prior to dialysis
therapy.
3.8 All patients who are identified to be blood borne infectious shall be isolated, and
hemodialysis therapy is done in the separate machine that is also isolated and used
only for infectious patients.
3.9 All patients with temporary access sites must be handled in strict aseptic technique
to avoid contamination and infection of access site.
4. PROCEDURE:
4.1 PREPARATION OF THE HEMODIALYSIS MACHINE BEFORE HEMODIALYSIS
4.1.1 The RDU nurse/technician will set up the machine by:
4.1.1.1 Switch on Dialog machine by pressing the master switch at the top left on
the rear side of the unit.
4.1.1.2 Select Disinfection then click “Rinse” (16 minutes rinsing time).
4.1.2 T1 Test
4.1.2.1 Connect acid and bicarbonate suction tube to the acid and bicarbonate
canister.
4.1.2.2 After placing the acid and bicarbonate suction tube, click “Test” then let
the machine perform the test.
4.1.2.3 During the T1 test if the alarm occurs, click “Test” again until the alarm is
resolved. If the alarm is not resolve then call the Technician/Engineer.

4.2 PRIMING AND SETTING-UP

4.2.1 Priming and setting-up of dialyzer and bloodlines shall be done
simultaneously with the preparation of the hemodialysis machine.
4.2.2 Prepare all materials needed.
4.2.2.1 Dialyzer
4.2.2.2 Bloodlines
4.2.2.3 NSS (Normal Saline Solution) 1 liter (2 bottles)
4.2.2.4 Working gloves
4.2.2.5 Syringe 20cc
4.2.2.6 Heparin
4.2.2.7 Acid and Bicarbonate
4.2.3 The RDU nurse/technician should check and identify the patient’s dialyzer.
4.2.4 Check for Peracetic Acid of dialyzer prior for priming
4.2.5 Unwrap the bloodline. Inspect for integrity and expiry date. Check protective
caps and close all small clamps.
4.2.6 Place safely the bloodlines into the machine. Open the cover of the blood
pump and safely secure the blood pump segment of the arterial bloodline to
the arterial blood pump of the machine by turning the roller pump clockwise
then close blood pump cover.
4.2.7 Connect the end of arterial and venous bloodline to the arterial and venous
blood port of the dialyzer, respectively, using aseptic technique.
4.2.8 Connect the end of IV line to arterial bloodline connector and attach the
connector of the venous bloodline to a drainage bag.
4.2.9 Screw on tightly the transducers to the pressure port.
4.2.10 Once the nurse/technician done placing the bloodlines, he/she can start
priming. Click “Prime” then prime 1 liter of Normal Saline Solution and
increase blood pump at 300 ml/minute.
4.2.11 Invert arterial and venous chamber to remove all bubbles or air.
4.2.12 Ensure that all bubbles or air is removed from the dialyzer by gently roll the
dialyzer.

4.3 RE-CIRCULATION
 4.3.1 Begin re-circulation. Close the roller clamp of the IV line and clamp the
arterial and venous bloodlines.
4.3.2 Disconnect IV line from the arterial bloodline connector and connect the same
to the IV port (short tubing before the pump).
4.3.3 Disconnect the venous bloodline from the connector attached to the drainage
bag then connect to the arterial bloodline using the connector.
4.3.4 Open the IV line roller clamp and the IV port clamp. Unclamp the arterial and
venous bloodlines and unclamp the small clamp in arterial and venous in
between transducer.
4.3.5 Open the coupling and connect it to the dialyzer.
4.3.6 Once all set up, set UF to 300ml and set time to 6 minutes then start blood
pump and turn UF on.
4.3.7 After pre-circulation is done, test it with residual strips before starting the HD.

4.4 CONNECTING PATIENT TO HEMODIALYSIS MACHINE

4.4.1 The nurse/technician set-up the machine before starting the HD:
4.4.1.1 UF
4.4.1.2 Time of Dialysis
4.4.1.3 Dry weight
4.4.1.4 Height
4.4.1.5 Age
4.4.1.6 Gender
4.4.1.7 OCM (should be ON)
4.4.1.8 Kt/v Goal (Standard:1.4/1.6)
4.4.2 After setting the machine, disinfect the end of the arterial bloodline with
Chlorhexidine then connect to the arterial bloodline (if with temporary access)
or the arterial fistula needle (if with permanent access).
4.4.3 Open the catheter or fistula needle arterial clamp and the clamp of the arterial
bloodline. Unclamp the venous bloodline and drainage bag then start the
blood pump (dumping).
4.4.4 Run the extracorporeal circuit with patient’s blood with blood flow rate set
initially at 150 ml/minute and should be gradually increased to a desired level
of 200-300 ml/minute or higher.
4.4.5 After dumping, the machine blood pump automatically stops once blood
reaches the venous chamber. Disconnect the venous bloodline to the
drainage bag and disinfect the venous blood with Chlorhexidine.
4.4.6 Connect venous bloodline to the venous lumen of the catheter or venous
fistula needle and open the clamps. Ensure the bubbles are removed. Start
the blood pump again.
4.4.7 Secure properly the bloodlines and dialyzer to avoid leakage.

4.5 TERMINATION OF HEMODIALYSIS

4.5.1 Put on clean gloves. Press “Alarm Limits Menu” and click “+” or “-“to begin the
Reinfusion.
4.5.2 Disconnect IV line and connect to arterial bloodline.
4.5.3 Open the clamp of arterial bloodline and open the ruler of IV line then click start
to start the reinfusion. Allow the Normal Saline Solution (NSS) to return the blood back
to the patient. Blood pump should be at 150 ml/minute. Note: Blood pump automatically
stops upon completion of the process.
 4.5.4 Clamp the venous fistula needle and venous bloodline, then disconnect.
4.5.5 Remove the bloodlines in the machine and dispose it properly to the provided
bin.

1. GENERAL POLICY STATEMENT:

1.1.1 Gensan Medical Center ensures quality in rendering hemodialysis to its
patients by providing the best practices in dialyzer reprocessing following
a strict AAMI and hospital standard

2. DEFINITION OF TERMS/PROCESS DESCRIPTION:

a. Dialyzer – also referred to as the artificial kidney, which aids in the removal of
excess fluids and wastes products in the patient’s blood during dialysis
treatment.
b. Reprocessing – procedure that involves cleaning, testing, filling the dialyzer with
a sterilant (Renalin Cold Sterilant), inspecting, labaling, storing and rinsing the
dialyzer before it is reuse for the next treatment. This can be done manually or
through a reprocessing machine.
c. Manual Reprocessing – reprocessing done by hand by a hemodialysis
personnel.
d. Viability test/Pressure Test – a test to the dialyzer to ensure that the dialyzer is
safe from broken fibers and leaks.
e. Total Cell Volume (TCV) Test – is the measurement of the fluid volume of the
blood compartment of the dialyzer – A TCV test is performed to ensure that the
fibers are not clotted.

3. POLICY:
a. A trained reprocessor shall do the reprocessing of the dialyzer
b. Adequate reprocessing shall be performed in order to remove excess blood or
blood clot in the dialyzer membrane.
c. Dialyzer reprocessing also prepares the membrane for disinfection and storage.
d. Infectious dialyzers for reprocessing follow a strict infection control and have a
separate protocol as to the regular reprocessing of non-infectious dialyzers.
e. The reprocessing unit of the dialysis station is designed according to DOH
standard following infection control and staff safety since corrosive chemicals are
used in the reprocessing process.
f. Dialyzers should be cleaned one at a time. The technician must finish one
dialyzer before proceeding to the next.
g. The technician may pre rinse other dialyzers to prevent clotting in the fibers.
h. Dialyzers are only re-used maximum of 8-10 times depending on type of the
dialyzer as long as it passes the viability test done by the reprocessor. In an
instance that the dialyzer does not pass the viability test, it will be discarded and
new set shall be used.
i. Only dialyzers that passed the viability testing will be stored.
j. Patients will be informed ahead of time, before their dialysis schedule if their
dialyzer is non-viable already or have failed the pressure test.
 k. Minimum contact time for Renalin disinfection should be 11 hours. Patients on
Stat hemodialysis with previously soaked dialyzers that did not reach 11 hours
soaking period must use a new dialyzer.
l. The level of sterilant inside the dialyzer must be adequate prior to storage.
Headers must at least be 2/3rds full.
m. Personal Protective equipment must be used in reprocessing of dialyzers.
n. There is an adequate storage area for the reprocessed dialyzers with accurate
labelling following a strict standard. Labeling includes the following:
i. Patient’s name
ii. Date of first use and succeeding re-use
iii. Percentage of Viability of the Dialyzer
iv. Name of Reprocessor
v. Date and time of storage
o. Standard acceptable disinfectant for reprocessing shall be Renalin. The
reprocessor shall adhere to strict standard precaution in reprocessing of
dialyzers.
p. Storage of dialyzers shall be within the AAMI standard unit. In Renalin cold
sterilant should be stored at 32º-75ºF.

4. PROCEDURE:
4.1Materials needed:
i. Dialyzer
ii. Goggles
iii. Apron (Disposable)
iv. Facemask
v. Gloves
b. Prepare all materials needed.
c. The nurse will follow the steps:
4.3.1 The RDU nurse/technician will carefully handle the dialyzer to the reprocessing
room.
4.3.2 Remove the bloodlines from the dialyzer. Place the bloodline to the provided
bin.
4.3.3 Open the header of the dialyzer to remove the clot.
4.3.4 Place the dialyzer in the dialyzer holder at the sink.
4.3.5 Connect the modified Hansen to the dialyzer allowing the RO water to flow
freely through the blood side of the dialyzer until the excess blood and clots
are removed.
4.3.6 Let the dialyzer be pressurized for minimum of 10-15 minutes depending on
viscosity of the blood. The 15 minutes will ensure that maximum cleaning has
been achieved.
4.3.7 After pressurized, soak the dialyzer with Renalin for at least 30 minutes.
Dilution of Renalin is 35:1000
4.3.8 After soaking, if the dialyzer is still clotted, repeat the procedure until the clot
is not visible.
4.3.9 After soaking, connect modified hansen for at least 5 minutes to flush out the
disinfectant.
4.3.10 Check the dialyzers if there is no blood visible then soak it with Renalin and
place it to the Dialyzer rack.
5. VIABILITY TESTING
a. After cleaning the dialyzer with clots and blood residues, connect the leak tester
to the venous port and start pumping enough air into the dialyzer.
i. There should be no leaks if the pump does not reinflate after introduction
of air in both venous and arterial ports, this indicates viability in leaks.
b. Check the consistency of the fibers inside the dialyzer. The fibers should be
symmetrical and there should be no material degradation.
c. Check the physical integrity of the dialyzer including the O-ring. It should be in
the right place and there should be no cracks or dents.