Warehouse system of hemodialysis room

1, the working system of hemodialysis room.

2, hemodialysis room personnel responsibilities at all levels.

2 1, responsibilities of doctors

2, 2, nurse responsibilities

2, 2, 1, main class nurse responsibilities.

2, 2, 2 treatment class nurse responsibilities

The responsibilities of nurses in the second, second and third nursing classes

2, 2, 4 on-site class nurse responsibilities

2, 3, 1, duties of health workers

2, 3, 2, reuse member responsibilities

3, technician job responsibilities

4. Advanced student management system

Second, medical management, specialist nursing technical operation routine

1, medical scope, mode, indications, complications, relative contraindications and emergency indications.

2, all kinds of hemodialysis machine operation procedures and nursing.

2. 1, flushing (or replacement) procedure.

2, 2, computer operation procedures.

2, 3 back to blood operation procedures

3. Blood purification procedures.

3, 1, Shan Chao.

3, 2, hemodialysis filtration (HDF)

3, 3, plasma exchange.

4. Nursing care of hemodialysis patients.

4, 1, nursing routine of hemodialysis patients.

4, 2, vascular access

4, 2, 1, internal fistula nursing

4, 2, 2, nursing of external fistula

4, 2 and 3 Establish temporary vascular access.

4, 2, 3, 1, one-time femoral V puncture

4, 2, 3, 2 deep vein indwelling catheter nursing.

5. Reused operating procedures.

Third, the disinfection and isolation system

1, hemodialysis room (including nurse station) disinfection and isolation.

2, disinfection and isolation treatment room

3. Disinfection between reuse rooms.

4, dialysis equipment (hemodialysis machine water treatment) disinfection.

5. Disinfect all kinds of articles.

The fourth is the management system.

1 management system

1, 1, consumables management

1, 2, various instruments, low-value consumables

1, 3, drug rescue vehicles, relief items

1 4, clothing and furniture

Disinfection management system of dialysis equipment

A, personal dialysis machine and pipeline:

Disinfect once a day after dialysis, the time is 1 hour, and the concentration is 5%. After entering the machine, dilute it to 1000PPM. Rinse with reverse osmosis for 30 minutes after disinfection, 30 minutes before dialysis the next day and once a week with citric acid.

Second, the centralized liquid supply system and pipeline:

Disinfect once a day after dialysis, the time is 6090 minutes, the concentration is 2.5% of the original solution, and it is diluted 35 times after entering the machine. After disinfection, rinse with reverse osmosis 1 hour, rinse for 45 minutes before dialysis the next day, and rinse with citric acid twice a week.

Three, water treatment system:

RO water is disinfected by 24-hour infrared radiation, once a month with 5% formalin, and once every other month with citric acid.

4. The barrels and containers in which liquid A and liquid B come into contact with dialysate are soaked in 1% formalin once a week for 24 hours.

Five, indoor infrared disinfection once a day, air culture once a month.

Six, indoor air disinfection (formalin 40ml/+pp powder 30%)/m3 fumigation for 24 hours.

Seven, dialysis machine and pipeline with a concentration of 5% formalin disinfection once a month.

Working requirements of dialysis consumables reuse room

1, strictly abide by the multiplexing operation procedures:

2. Keep the recycling room clean. After daily operation, clean and disinfect the pool, countertops, floors and walls in time to ensure no blood and dirt.

3, processed dialyzer, blood circuit should be neat, placed in the cabinet, should be cleaned and disinfected once a day;

4. Clean reusable barrels and trash cans once a month;

5. Clean the reuse room once a month (synchronized with the disinfection day of dialysis room);

6. Consumables for patients with hepatitis C should be reused separately and strictly isolated;

7, reuse room personnel configuration 2 people, by a formal employee is responsible for, a busboy to assist in the work.

Disinfection and isolation system in multiplex room

First of all, wear work clothes and special shoes when entering the room.

The second is to strictly implement the reuse operation procedures and keep the room clean and tidy.

Third, the room is irradiated with ultraviolet rays for 2 hours every day, which is recorded. Wipe the desktop, cabinet and floor with 250 mg/L Su Zhi disinfectant once a day.

Four, reuse dialyzer, pipeline, dedicated, dedicated box, fixed place, giant cleaning at any time. Storage cabinets should be cleaned and disinfected once a month.

Five, patients used dialyzer, pipeline, with peracetic acid disinfection twice, for later use. Disinfection is valid for 7 days.

Six, patients used dialyzer, pipeline, no longer use with 500MG/L JianZhiSu disinfectant disinfection 10 minutes before putting it into medical waste for centralized treatment.

Seven, every month indoor with formalin 40 ml/m3+potassium permanganate 30 g/m3, fumigation and disinfection, air culture.

Note: This system is supervised and implemented by reuse personnel in the reuse room.

Disinfection and isolation system of treatment room

A, into the treatment room to clean clothes, masks, wash your hands, normal operation.

Two, ultraviolet disinfection 2 hours a day, and special registration time, ultraviolet lamp irradiation twice a week.

Three, indoor clean areas and sterile areas are clearly marked.

4. Sterile articles and non-sterile articles should be placed separately and fixed in place, and the disinfection date and validity period should be marked (winter10-May 1- summer 14- summer1-June 7-1).

5. Replace the tweezers jar, disinfectant, iodine and alcohol every Tuesday and Friday. All sterile items are marked with the date of disinfectant.

Six, deal with the endless clean areas of vehicles, and the lower layer is the polluted area. After using the goods, the car and license plate should be clean and tidy.

Seven, medicine box drugs are placed in an orderly manner, internal medicine and external medicine boxes are placed neatly, and the labels are obvious.

Eight, disposable syringes and other supplies after use, with 500MG/L health disinfectant immersion 10 minutes, open the syringe needle plug, make the needle tube filled with disinfectant, disinfectant liquid level more than the syringe liquid level. After use, open the dialysis needle, fill the tube with disinfectant, and soak it in 500MG/L health disinfectant for 10 minute. Sterilized disposable articles are put into medical garbage bags, which are sealed and transported to the supply room for centralized treatment by health workers every day.

Nine, a tourniquet, after use, soak in 125MG/L Jianzhisu disinfectant 10 minutes, clean and dry for later use.

Ten, the domestic waste and medical waste are strictly separated, and the medical waste is packed in black plastic bags and sent to the incinerator for incineration.

Eleven, indoor formalin 40ml/M+ potassium permanganate 30G/M, fumigation once a month to do air culture once a month.

Note: this system is supervised and implemented by the staff of each treatment class.

Disinfection and isolation system of nurse station

First of all, you should wear special clothes when entering the room.

Second, keep the room clean and tidy at all times, put things in order, and put them back after use.

Third, try to wipe the desktop floor twice a day, with special towels and mops.

Fourth, the laboratory test sheet in the dryer is double-eliminated, fumigated and disinfected with formalin and pasted on the medical record.

Five, put medicine in the refrigerator, can't store personal belongings.

Six, the wheelchair with 250MG/L health essence disinfectant disinfection once a week.

Note: This system is supervised and implemented by nurses in delivery class.

Disinfection and isolation system of hemodialysis room

First, enter the room with work clothes and special shoes.

Second, the operation should wear masks, hats, strict aseptic operation.

3. Air disinfection method: after dialysis is finished every day, ultraviolet rays are irradiated for 2 hours, and windows are opened for ventilation before dialysis in the morning 1 hour; Steam once a month; Formalin 40ml/M+ potassium permanganate 30G/M, respectively placed in the four corners of the room and the center of the room, steamed for 24 hours, and then opened the doors and windows for ventilation.

Four, the ground clean twice a day, mopping the floor, regular disinfection. Disinfection method: soak in 250MG/L Jianzhishu disinfectant for 10 minute every Thursday, then clean and dry.

Five, dialysis machine, bed table at the end of the daily dialysis with 250MG/L JianJing disinfectant to wipe it again, towel is special.

Six, patients with daily dialysis at the end of the towel with 250MG/L JianZhiSu disinfectant immersion 10 minutes after cleaning for later use, do one towel.

Seven, sphygmomanometer cuff cleaning once a week; After weekly cleaning, use paraffin oil to wipe the infusion basket. Hemostatic forceps should be cleaned once a week, and cleaned at any time if there are blood stains. Humidify the oxygen bottle, soak it with 250MG/L Jianzhisu disinfectant every week for 10 minute, then clean and dry it for later use; One oxygen tube per person shall not be mixed; The thermometer was disinfected by soaking in 75% alcohol; Disinfectant should be changed twice a week.

Eight, air culture once a month and make records.

Nine, sheets, quilts and pillowcases should be replaced once a week. In case of special circumstances, it should be replaced at any time. The sickbed should be wiped once a week with 250 mg/L of Jianzhisu disinfectant.

Note: This system is implemented under the supervision of the staff of each nursing class.

The duties of the main class nurse

1, responsible for dialysis operation, patient condition observation, data recording, and keeping equipment and bed units clean and tidy.

2, responsible for the deployment of nurses in the region and the patient's bed arrangement. Responsible for arranging and checking the work of nurses, health workers and reuse workers.

3, the patient is responsible for checking the temperature, concentration, blood flow, dehydration, heparin and so on and so forth of the dialysis machine in this area.

4, to participate in the rescue work of critically ill patients, responsible for personnel distribution, observation, treatment, records, to ensure the smooth progress of the rescue work.

5. Responsible for the ideological work of patients in this region, timely reflect the ideological trends of patients to the director and doctors, actively organize nurses in this region to improve the service quality and try their best to meet the needs of patients.

6, responsible for the registration of patients with dialysis costs on the same day, in a timely manner to the accounting. Participate in the collection of arrears.

7, undertake the guidance of holistic nursing care of dialysis patients.

Responsibilities of nurses in treatment class

1, responsible for preparing the dosage of heparin for dialysis that day.

2, prepare dialysis supplies (puncture needle, dialysis box, disinfection items, etc. ), after cleaning and disinfection.

3, responsible for handling the car clean and tidy, to ensure that the goods are fully equipped.

4, undertake the patient hemodialysis operation, observe the condition and be responsible for measuring body temperature, heart rate, blood pressure and breathing. After returning blood, clean the dialysis machine and arrange the bed unit.

5, to participate in the rescue work, responsible for the supply of rescue items, the replacement of disinfection items and the disposal of disposable consumables.

6. Disinfect articles and indoor air every Tuesday and Friday.

7. Responsible for blood transfusion, infusion and various treatments during dialysis.

8. Improve service quality and service attitude, do a good job in the overall care of dialysis patients, and strengthen psychological care and health education.

Check the therapeutic instruments and medicines on Monday, and ask the warehouse manager for them in time.

Disinfect every Tuesday, Tuesday and Friday.

On Wednesday, check the deadline of disinfection items and update them in time.

Responsibilities of nurses in nursing class

1, responsible for dialysis treatment, condition observation, vital signs observation and dialysis form registration.

2, keep the dialysis equipment and bed unit clean and tidy.

3, to participate in the rescue work of critically ill patients.

4, responsible for the overall care of dialysis patients. Understand the patients' physical condition, diet and living habits, psychological status, social relations and dialysis effect, and improve the service level. Actively carry out health education.

5. Assist each class to manage hemodialysis and prepare for dialysis.

Key work:

Clean and disinfect hand towels daily, and clean and wash dialysis machine towels.

Tuesday, change sheets and quilts.

On Wednesday, sterilize the thermometer.

Clean the cuff of sphygmomanometer, hemostatic forceps and infusion basket on Friday and Saturday.

Duties of field nurses

1, responsible for all foreign affairs liaison and coordinating contact with relevant departments.

2, responsible for exchanging disinfection items, testing drugs, transporting patients, etc.

3, responsible for the management of health workers, and guide them to keep the environment clean and tidy at any time. Maintain the order of dialysis room and discourage family members from accompanying.

4, responsible for dialysis patients' life service, do a good job in diet management, ask patients at any time.

Main coal planting industry

On Monday and Friday, check the change of work clothes and bedding.

On Tuesday, supervise and guide the work of health workers.

On Saturday, check the cycle of disinfection items.

Responsibilities of medical staff in blood purification center

1, working under the leadership of head nurses and the guidance of nurses.

2. Be responsible for all indoor and environmental sanitation of the center and keep it clean and tidy.

3. Responsible for the disposal of polluted garbage and ordinary domestic garbage.

4. Supply and management of drinking water.

5, responsible for the replacement of contaminated clothes and clothing.

Responsibilities of technicians

1, responsible for the management, maintenance, debugging, maintenance and disinfection of all instruments and equipment in the center, and report any problems found in time.

2, each shift in dialysis to patrol the equipment running status 3-4 times, found that the fault handled in time, and make records.

3, strictly implement the rules and regulations and technical operation procedures, accurate, timely and standardized to complete the technical operation.

4, responsible for testing the quality of each batch of dialysate. Check the quality of dialysate with the doctor on the same day to prevent mistakes and accidents.

5. Assist nurses in various technical operations and give technical guidance.

6, responsible for purchasing equipment spare parts plan, take good care of equipment spare parts and maintenance tools.

7, to participate in emergency, overtime, on duty. Pay attention to economy and strengthen fire prevention and theft prevention measures.

8. Responsible for the training and guidance of advanced students and interns.

Operating procedure of NCS ――200C centralized liquid supply device

First, turn on the main power switch.

Press the {protection} and {dialysis} switches at the same time, and the machine will start working.

Secondly, after dialysis is completed, press the {protection} and {end} switches.

3. Press the {protection} and {post-cleaning} switches to start the post-cleaning procedure.

Four, after the cleaning, the instrument into the standby state.

Early the next morning, the machine automatically went into pre-cleaning and waited for dialysis.

Responsibilities of the person in charge of disinfection and isolation

First, supervise and inspect the implementation of disinfection and isolation system.

Second, the last week of each month is responsible for the disinfection of hemodialysis room, treatment room and reuse room.

Three, every month after the room disinfection, responsible for contact with the relevant personnel of the clinical laboratory, indoor air culture and centralized liquid supply, anti-seepage single machine export bacteria culture and save the inspection list.

Four, responsible for preaching to employees about disinfection and isolation, hospital infection rules and regulations and all kinds of knowledge.

Disinfection arrangement of public articles in hemodialysis room:

Person-in-charge's disinfection method, time, concentration of disinfectant and disinfection time

Weekly medical record clip 250 mg/l/wipe each nursing class.

On Tuesday, hemostatic forceps and the basket were soaked in 250 mg/L 10 in each nursing class.

On Wednesday, each nursing class was soaked in oxygen cylinders of 250mg/l 10 minutes.

Friday plastic bucket 250mg/l10min brush reuser

Every nursing class has a bed of 250 mg/liter/scrub on Saturday.

Saturday Wheelchair 250 mg/L/Wipe Test Paramedics

Continuing education system

Purification center is the base for learning blood purification technology; It is the display window of the development trend of imported dialysis machines and dialysis consumables; This is a course to learn to repair and maintain dialysis equipment. Those who volunteer to study are welcome. I hope we can learn from each other and improve together.

First of all, anyone who goes to the "center" for further study must submit an application form and go through the formalities for further study after the consent of the leaders of the "center".

Two, to the "center" personnel must meet the following conditions:

1. Nurses and technicians: have a secondary nursing school education, have been engaged in clinical work for more than three years, and have certain clinical experience. Technicians should have certain knowledge of electronics and electricians.

2. Physician: with a bachelor's degree in medicine, engaged in clinical work for more than three years and rich experience in clinical experiments.

3. Work actively, be willing to learn, and be enthusiastic about serving patients.

4. Respect teachers and abide by the rules and regulations of hemodialysis room.

Three, the nurse learning content arrangement (not less than three months).

A, technical operation:

Study for three months:

1, be familiar with the environment and learn to flush the pipeline.

2, learn to install pipes, replacement flushing.

3, learning computer, blood transfusion, blood vessel puncture and other technologies.

4, dialysis equipment daily maintenance, maintenance methods.

Study for six months:

1, on the basis of mastering the above technologies, learn how to deal with special situations.

2, simple machine troubleshooting.

3. Learn the operation methods of hemofiltration, plasma exchange and CAVH.

Study for one year:

1, understand the basic knowledge of blood purification and the basic principle of HD.

2. Basic knowledge of water treatment.

3. Indications and contraindications of dialysis.

4. Treatment of dialysis complications.

5. Nursing care of patients with uremia and rejection after renal transplantation.

Fourth, the technician learning arrangements

1, familiar with the environment, understand the daily work arrangement of technicians.

2, familiar with the basic operation of the equipment.

3, familiar with the preparation method of dialysate.

4, understand the working principle of water processor and dialysis machine.

5, learn common instrument troubleshooting.

Five, the doctor's study arrangement

1, understand the basic knowledge of blood purification and the basic principle of HD.

2. Basic knowledge of water treatment.

3. Indications and contraindications of dialysis.

4. Anticoagulation therapy in dialysis.

5. Treatment of acute and chronic complications in hemodialysis.

6. Learn ultrafiltration, sequential dialysis, high and low sodium sequential dialysis, low humidity dialysis, heparin-free dialysis, hemofiltration, hemofiltration dialysis, hemoperfusion, pediatric dialysis, CAVII, plasma exchange and immunoadsorption.

7, the establishment of vascular access:

Temporary: jugular vein intubation and femoral vein puncture.

Permanent: internal fistula.

Arrange counterpart teachers with dialysis clinical experience to be responsible for teaching, and hire experts above attending doctors to give theoretical lectures and counseling.

Medical management

First, the scope of medical treatment.

Can be used for treating acute and chronic renal failure, acute pulmonary edema, organic carbon drug poisoning, alcoholism, immune system diseases such as familial lupus erythematosus, nervous system diseases such as Guillain-Barre disease, myasthenia gravis, multiple myeloma, hyperlipidemia, etc.

Second, medical treatment.

Gradually carry out: bicarbonate hemodialysis, hemodialysis filtration, plasma exchange, hemoperfusion, simple ultrafiltration and other blood purification therapies.

Third, the indications of hemodialysis

1, acute functional failure

1) Hypercatabolism (BUN increases by more than 25 per day).

2) People who have no urine (less than 100 ml/day) or have less urine (less than 400 ml/day) for more than 48 hours will gain 20 kg/day.

3) BUN of urea nitrogen 80 mg/dl.

4) Serum muscle SCR》8 mg/dl

5) Blood Potassium 6.5 meq/L.

6) Nitrogen dioxide binding rate CO2CP? 15 meq/l

7) Those with obvious edema, pulmonary edema, nausea, vomiting, lethargy, dryness and disturbance of consciousness.

2. Chronic renal failure

1) endogenous muscle clearance CCR is less than or equal to 10ML/MIN (less than or equal to 15ML/MIN for diabetic patients).

2) Serum muscle SCR is greater than or equal to 8- 10 mg/dl.

3) Urea nitrogen is greater than or equal to 80- 100 mg/dl.

Four, hemodialysis contraindications

1 relative contraindication

1) elderly high-risk patients and infants who do not cooperate with treatment.

2) Severe bleeding or anemia.

3) Severe hypotension and shock.

4) Heart failure and pulmonary edema caused by severe heart disease.

5) Renal failure caused by advanced systemic diseases such as tumors.

6) Persons who are mentally abnormal and unable to cooperate.

Five, hemodialysis complications

Medical complications of dialysis treatment:

Hypotension, hypertension, arrhythmia, imbalance syndrome, fever, headache, nausea, vomiting, muscle spasm, acute hemolysis, dyspnea, unconsciousness, general spasm, mental disorder, rash and itching.

Six, emergency dialysis indications

1, hyperkalemia: serum potassium 70 mmol/L, anuria.

2, severe left heart failure: dyspnea can not lie flat, need oxygen, cough pink foam-like sputum;

3, severe acidosis: COCP《20 mmho, pH "7.2, serious electrolyte disorder, which can not be corrected by conservative treatment.

4, drug poisoning coma, and has been in the emergency gastric lavage, catheter;

5. Those who meet the above conditions should pay attention to the following matters:

1) The emergency dialysis cost is about 1000-2000 yuan (including brand-new dialyzer and pipeline);

2) The cost of hemoperfusion is about 2000-3000 yuan (including carbon kidney and pipeline).

3) Before dialysis, please test: hemoglobin (5.5g%), platelet, clotting time and blood type;

4) emergency dialysis time is generally not more than 3 hours, except for hyperkalemia;

5) Outpatients must go through the emergency room;

6) The patient's blood pressure is stable, with high pressure above 100-90 mmGH and low pressure above 70MMGH.

Operating procedure of hemodialysis device

1. Turn on the main power switch, connect the dialysate straw with dialysate barrels A and B, and press the button of dialysis blood matching syringe;

2. Install the dialyzer and blood circuit on the dialyzer.

3. Pre-flush the branch end of blood circuit, heparin tube, arterial jug, dialyzer and venous jug with 500ml of 0.9% normal saline for injection, and exhaust;

4. When the "Ready for Bypass" button stops flashing, press the Bypass button. The connecting pin is connected to the outlet and the inlet of the dialysate chamber. Press the exhaust button to exhaust the air in the liquid chamber, and then close the bypass;

5. According to the doctor's advice, set the target dehydration amount, dehydration speed, nutrient maintenance amount, machine temperature between 36-37 degrees Celsius, knob bubble monitoring and arterial negative pressure monitoring at the working position;

6. Puncture the internal fistula artery under aseptic operation. After seeing the blood backflow, exhaust the air, and connect and fix the nozzle of the arterial puncture needle with the arterial port of the blood circuit. Start the blood pump at the speed of 80 ml/min. When the blood rises to the heparin tube, quickly inject the first dose of heparin and determine the maintenance amount of heparin.

7. Puncture the internal fistula vein and exhaust. When blood flows to the venous jug, turn off the blood pump. Disinfect the nozzle at the venous end of the blood circuit, exhaust and clamp the hemostatic forceps. Exhaust air, and connect the nozzle of the venous puncture needle with the venous port of the blood circuit. Check whether the whole road is clear and fixed firmly.

8. Start the blood pump from 200ml/min to 300ml/min, press the start button, and set the alarm limit for monitoring venous pressure and hydraulic pressure. The regulator adjusts the arterial end of the dialyzer upwards;

9. Check all the settings again. There was no bleeding at the puncture site. The fixing method is correct and there is no entanglement. The blood circulation is unimpeded. Tighten all connectors and check the tightest part of hemostatic forceps. After being examined by a second person, it is confirmed to start dialysis;

10. Measure the patient's blood pressure and pulse without abnormality, and record it on the dialysis record paper;

1 1. Monitor blood pressure every hour during dialysis, report to the doctor immediately if any abnormality is found, and handle symptoms at any time. Troubleshooting in time. Ensure the dialysis goes smoothly and the water is discharged accurately.

Blood transfusion operation procedure

First, the total amount of water removed is up to standard. When the time is up, the target amount of water to be removed will be prompted. If there is no special treatment, blood can be returned. Press the Stop, Prepare and Reset buttons at the peak to reset the heparin pump to zero. Clamp the heparin tube, adjust the blood flow to about 80 ml- 100/min, and start blood transfusion;

Step 2, turn off the blood pump, clamp the front tube of the blood pump, so that the bypass saline slowly flows into the arterial side, and clamp the puncture needle tube after washing the blood in the tube. Open the front clamp of the pump and the blood pump, and the blood flow is about 100ML/NIN. Wash the arterial jug, dialyzer and venous jug with 0.9% normal saline, and clamp the venous puncture needle tube after washing the blood. Stick a bandage on the puncture point, press it with a paper roll, and pull out the needle to fix it;

Third, press the bypass and drainage keys to drain the fluid in the fluid chamber of the dialyzer, disconnect the vein and artery chain and reset. Dialysis key;

Fourth, dismantle the blood circuit and dialyzer, and turn off the power switch;

5. Unplug the dialysate straw and insert it back into ports A and B on the dialysis device. Start the automatic flushing and disinfection of the dialysis device.