What are the PPE requirements?
- gowns
- gloves
- face shield
- face mask to patient if they have a CVC
What is the order of lab draws?
- dark blue
- red (plain)
- light blue
- gold
- lavender
- green (post-treatment)
What will cause for a lab draw to be rejected?
handwritten or double labels
What are the steps for processing labs?
- clotting time (follow requisition label)
- rules for spinning samples (follow requisition)/ must balance centrifuge
- When to refrigerate: culturettes/swabs/occult stool - follow directions
- training requirements for shipping - IATA
What is the goal for Single Pool (spKt/V) for 3x/week frequency of dialysis treatments?
greater than or equal to 1.2
What is the K in Kt/V
clearance of urea
What treatment factors decrease K? (5)
- inadequate coagulation
- decreased BFR
- poor priming
- not following P&P
- patient not staying on treatment has prescribed
What treatment factors increase K? (4)
- Increased BFR
- Correct DFR (dialyzer flow rate)
- correct dialyzer
- correct target weight/amputation factor
What is the goal for the urea reduction ratio (URR) lab result?
greater than or equal to 65%
What is “t” in Kt/V?
time of dialysis session
What factors influence “t”? (3)
- running prescribed treatment time
- following physician orders
- getting off treatment early impacts time
What is “V” in Kt/V?
volume of urea distribution/volume of patient’s body water in which urea is distributed
What factors influence “V”? (5)
- amputation
- height
- sex
-age
-type of access
What are the steps in the procedure for Post BUN lab draw? (5)
- verify that dialysis has been initiated for about 30 minutes with BFR set as prescribed
- turn off UFR or decrease it to 50 mL/hr
- decrease DFR to 300 or put it in bypass
- decrease BFR to 100 mL/min
- wait 15 seconds for all access types and draw post.
What are some lab draw mistakes that would falsely increase Kt/V? (3)
- BFR not reduced
- waiting only 5 seconds
- Drawing post BUN from venous line
What are some lab draw mistakes that would falsely decrease Kt/V? (2)
- Accidently diluting pre-treatment arterial BUN blood with saline
- waiting longer than 15 seconds to draw blood sample
What 2 steps are performed to replace fluid removed and prevent clotting during recirculation of blood in the extracorporeal circuit when there has been a treatment interruption?
- Saline infusion line is opened and if patient is receiving an intradialytic heparin infusion via the dialysis machine, heparin pump remains on.
Once the heparin loading dose is administered, when can the hemodialysis treatment be initiated?
after waiting 3-5 minutes
