Hand Hygiene
True or False: Thousands die each year due to healthcare-associated infections. Dialysis patients are at a higher risk for infection due to a weakened immune system, the presence of catheters, frequently cannulated access sites, and multiple chronic diseases.
True
Cool, pale colored skin or hand on accesslimb
Steal Syndrome
1-04-11C Vascular Access Surveillance: Using Dynamic Venous Pressure (DVP)
What needle size can be used when performing DVP test?
Procedure updated to clarify that dynamic venous pressure monitoring can be performed with needles other than 15 gauge.
Dynamic venous pressures which exceed the threshold three (3) times in succession should be reported to the Nephrologist.
What are the components of full PPE for dialysis precaution?
Gown, gloves, Eye protection, mask
Meaning of abbreviation AKI
Acute Kidney Injury is the sudden loss of kidney function that may partially or completely reverse. It can be caused by trauma/surgery, infection/sepsis, illness, contrast agents, NSAIDs, antibiotics, etc. Caring for an AKI patient is very different from caring for an ESRD patient.
___________ can prevent 1 in 5 respiratory infections, such as COVID-19, the common cold, or the flu and 1 in 3 diarrhea-related sicknesses.
Handwashing
Signs of Stenosis
Pounding pulse or high-pitched bruit
Strong pulse-like thrill
Swollen access extremity compared to the non-access extremity
Prolonged bleeding post treatment (> 30min)
Arterial pressure exceeding recommended limit (check P&P). Never higher than negative 250
1-04-01B Post Dialysis Vascular Access Care:
When can you pull both needles at the same time?
One needle should be pulled at a time. However, if the patient requests and they are able to hold both cannulation sites, then both needles may be removed.
Pulling both needles at the same time should not be standard practice for all patients
Wall box should be cleaned with ___________ bleach as part of routine station area disinfection ________(how often)
1:100 (one to one hundred)
Between each patient (and daily for unused station)
Type of access most common in AKI patients
CVC
Wash your hands with soap and water for at least ____ or rub with alcohol based hand sanitizer until dry
20 Seconds
When prepping the site for cannulation what is the contact time (wet time) and dry time for Iodine
30 seconds wet time 2 mins dry time
B/T should be checked a minimum of every ___ minutes when a VA is in use & documented in patients chart. The access clamp should not be left on longer than ____ minutes
10
20
Donning sequence for PPE (6 Steps)
1. Hand hygiene 2. Mask 3. Gown 4. Eye protection 5. Hand hygiene 6. Gloves
The primary goals of dialysis in patients with AKI
Preservation of renal function and prevention of further renal injury. (Keep them wet, Avoid drastic swing blood pressure changes >20mmHg SBP)
What are the 2 instances when you must wash your hands instead of using alcohol based sanitizer.
When gloves are visibly soiled with blood
After coming into contact with C-diff/Any isolation patient
Rule of 6's
Depth Below Skin <0.6cm
6-8 Week post op check
Diameter of vessel >0.6cm
Access blood flow >600ml/min
1-04-02B Central Venous Catheter (CVC) with ClearGuard HD Antimicrobial EndCaps Procedure
When to perform CVC hub scrub and how long
Perform a 15 second hub scrub of the CVC during the process of connecting or disconnecting from the blood lines, including line reversal or if the patient is disconnected during treatment for any reason.
Doffing Sequence for PPE
1. Gloves 2. Hand hygiene 3. Eye protection 4. Gown 5. Mask 6. Hand hygiene
What is the max UFR per hour for AKI patients
10ml/kg/hr
What are the 5 indications for Hand hygiene
When entering and leaving the treatment floor
Before and After contract with patient
Before and after patient procedure Access care, tx initiation etc
Before and after contact with patient tx area
After potential contact with blood or bodily fluids
Describe 10 sec access check
Elevate arm
Lower arm
Check Thrill
Check Bruit
1-10-12 Seizures
Do not pry open clenched jaws once seizure has begun. Do not attempt to insert anything into the mouth. If patient becomes hypotensive, administer 100 -200 mL bolus of saline
Use _______ bleach to clean up after C. Areus and C-Diff and allow _____ contact time
1:10
10 mins (wet contact time)
What are the 2 lab orders and frequency used to monitor patients with AKI
AKI panel (weekly)
24hr urine collection (monthly)