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How to set up a Dialysis Machine part I (Hemodialysis Training)



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hello my name is magma Castaneda and I'm

a certified apology nurse and also the

owner and instructor at utopia cell

Career Center which offers a

hemodialysis program approved by bonad

and it's the best program here in

Central Florida I am here today because

I want to go through the setup of our

machine of our dialysis machine and this

would be part one from two parts that

I'm going to be explaining so the first

thing that I would like to point out is

that our machine is right now ready for

setup we've turned on the water we

connected our acid concentrate 5-card

we've tested everything is good and now

we're up to the point where we're going

to start setting up our machine okay so

we got our filter right here and by the

way I just want to know that the

supplies that I'm going to be using

today they are reused supplies that we

use here in our training school but all

of the supplies when you get them for

the first time they're going to come in

a sterile package okay

but yes for the purpose of this training

we reuse our supplies so I have my

filter and in this case we're going to

be using the f16 t in our

the way that I know what type of

supplies I'm going to use is because I

get it from my flow sheets though every

patient is going to have a flow sheet

depending on the company that you work

for or your wanting to work for they're

probably going to have a different a

flow sheet that looks a little different

but in this case I have my flow sheet

here and it's all written in it

in handwriting most likely you're going

to have something that's been out from

the computer okay so I'm looking at my

orders and part of my orders say that

I'm going to use the f16 TNR for the

patient that's coming so now that I'm

properly bound and I have my my gloves

on at this point I really I really don't

need a face shield unless there's a

policy in your unit that states that you

have to wear your face shield at this

point but for the purposes of this

training I am NOT going to wear the

print of a shield and I am going to

start setting up the arterial flight

then the venous line and then we're

going to set up the saving mind okay

it depends on where you work you're

probably going to see this in a

different order but just so you know the

end result is going to be the same

always okay so I'm going to start with

the arterial life so here I have my

arterial line the arterial line always

has a red clamp and a red clip okay

it has two ends

the end that has the big clamp this

would be the patient end and this end is

the filter or dialyzer and if we trace

it

here you see this little connector for

more luck and we use it to connect the

Saline to here some people also call it

saving T so this rounded piece that you

see right here this is called the pod or

BOE the pod has a little line that comes

out of it and this line the tip of it

gets connected to the machine this is

actually for pressure reading of the

arterial line after the pod we have this

huge segment right here and this is

called the pump segment this segment is

intended to go inside of our blood hub

so we should look something like this

but in the inside

if we keep on moving we have another

thin line here with a plant and a cap

and this would be for heparin this is

the heparin line and the other end the

rest of it this is the end that goes

death it's going to get connected to our

dialyzer okay so let's start the first

thing I want to do is that I want to get

some of the lines out of the way so I am

going to place this end which is the

patient end into the draining bucket you

don't have to pull out the draining

bucket but I wanted to pull it out so

that I can show you something this line

you are going to attach it to lead these

little slots that you see here okay so

you want to hold those lines right there

you don't want these lines to go all the

way and touch the button normally we do

rinse all these draining buckets but

they're not really disinfected so it's

preferable that the tip of the the end

of the patient line does not touch the

bottom of the draining bucket okay all

this is infection so I'm going to place

my bucket back if that was just to show

you where you're going to place that

pile

now that your patient in is in the

draining bucket now you have a little

bit more flexibility to use both of your

hands the next thing that we're going to

do is that we're going to place the

blood pump segment into the blood pump

what you want to do is is have the pot

on your left hand and you want that pot

facing forward facing you so what you're

going to do you're going to open the

little door you want to make sure that

you have enough room to slide in that

line and if you don't you can move the

pump around like so

just by pushing on this start and stop

okay so I'd like to have enough room

like that and now I am going to go ahead

and I'm going to slide in I'm gonna come

by this little handle here I'm going to

push it down push down the handle

get it in there egg and now this is got

a thread by itself you don't need to

force it or anything so just go ahead

and press the start and stop button

and it does it by itself and this other

end you want to go ahead and push it in

as well

so it should look something like that

okay how you want to go ahead and close

the door and this tip your voice you

couldn't get to the bottom of your

filter

so there you have it you have your first

line the arterial line so let's go ahead

and do the venous line we're going to

set up the venous line app or the venous

line we also have two wins so one end is

the patient end it's the one that has

the big clamp this is always the patient

end and this end would be connected to

the filter so this would be my filter in

okay so if we trace it we see this long

segment over here and we reach what is

called the drip chamber the drip chamber

we use it so that is it'll catch here

it also can catch some clots in there

nurses use it to give some medication

through this port then at the filter end

we have a venous pot okay and remember

the pots are used for pressure reading

so here we have this line again and this

line is going to be attached to my

machine for venous pressure reading so

the first thing that I want to do with

this one is try to place the drip

chamber into our air detector spot which

is this right

I'm going to go ahead and open it if you

notice there are two circle metals in

there those are our Erin and fingers

okay so this grip chamber is going to go

in there once we start with the

treatment and what we have in here is

blood these two sensors cannot see each

other okay if the level of the blood of

the blood drops then these sensors can

see each other they're going to trigger

an alarm and the alarm is going to tell

us that we probably have some air in the

system so the first place that we want

to look is here and it's probably just a

matter of rising the level of the blood

inside of our drip chamber okay but I'll

tell you how to rise the level of the

book or saline inside of the drip

chamber in a minute let's place it in

first

a lot of my students were asking me this

Magda but it's very difficult to place

that drink drink chamber inside of the

air detector slot and one thing that you

can do is just squeeze it a little bit

in order to get it in there now

don't squeeze it too hard because I'm

going to pull it out for a minute in the

bottom of this in the bottom of the drip

chamber you see a little piece sticking

out it looks like a strain well it is

the stream and you don't want to go

ahead and break that out because then if

we have any claws or something in there

they could pass through okay so I'm

going to place it back in so you want to

make sure that the that lip it has like

a limp in the top it's about leveled

with the edge of the air detector spot

okay so now you want to take the patient

end and you want to place it inside of

your draining button

and then you want to go ahead and you

want to connect your filter end on to

your filter

I'd like to kind of twist it

counterclockwise so that I when I

connected it connects good and it's

straight

so now after I do that I want to make

sure that the small clamps are closed at

this point so this is closed this one is

closed

also let me recheck the arterial lines

clamps this one is closed at this point

only the smaller clamps should be closed

but the big plans that are on your on

your draining bucket dolls should be

open see those should be open okay so up

to this point we have the arterial life

we have our filter and we have our

venous line now we want to go ahead and

connect our Saline our sailing and the

Saline night

so here I have my saline line okay my

saline ein has two clamps one and two so

what basically is for safety and the

other one is on for backup okay at this

point all you need to close is what you

don't need to close both of them just

close one but when you start your

patients treatment you want to go ahead

and have them both closed so once you

close one of your clamps just go ahead

and spite your saline bag

okay at this point you don't have to

Prime or anything this line because you

are going to prime it when it's

connected to the arterial line so go

ahead and remove the cap of your saline

line and this is going to go connect it

to our warlock or saline teeth that I

showed you before

now by the way is important that you use

the best a septic technique possible and

you want to avoid touching the tips of

the lines and any tip that you open you

want to avoid touching it also when you

are doing this process of connecting the

lines and saline

you don't want to be talking as well

because any bacteria that we have in our

mouth can just slide into one of these

tubing and remember we're dealing with

patients blood and we don't want any of

our patients to get infected with any

bacteria okay so let's go ahead and move

on to our next step

so our next step is to prime the

arterial end and I'm going to go ahead

and pull out the arterial line from the

draining bucket just so that you know

what's going to happen so what we're

going to do now is that we are going to

prime this portion of the arterial line

or remove all the air and we do it by

opening the saving line right here and

you see this connection of line it's

going to prime this the same thing is

going to pipe this in all the way to the

patient end now there's no need to open

this cap just keep it closed because the

Saline is going to go through anyways

just kind of pass through anyways okay

so I am going to get this remember this

would be inside of your draining bucket

but I'm going to leave it here so that

you see what happens

there you go

so all you need to drain out is a little

bit just to make the air go out of this

segment and then your this actually

normally is never pulled out of the

draining bucket but I'm just going to

put it back okay so now we want to prime

the rest of our line and our filter and

for that we're going to have to turn on

our blood pump because the prior segment

we're using gravity for that but now we

can't use gravity because the lines are

going up so in this case we're going to

have to use our pump so that we can move

that see me

so we want to make sure first that our

blood speed is at 150 if the number is

flashing that means that the blood pump

is off I'm just going to go ahead and

turn it on that's on and now I'm going

to go ahead and click prime prime is

right there so what's happening now is

that the blood pump is helping me move

sailing through the lines and it's going

to prime about 300 ml of saving so I'm

just going to wait until that process

happens it takes the Bell probably like

2 minutes or so if you were in the

dialysis center all you need to do is

let this one prime and move on to your

next machine

so once our prime light goes off then

we're done we're done with the priming

process now what we want to do we want

to go ahead and close the flow clamp

from the venous line and we're gonna cup

we're going to connect those two lines

together

so at this point at this point both of

your patient end lines are closed and

what you want to do is that you want to

connect them together to do that

you have to remove one of the camps and

then connect it to the other and you

want to do this with your best a septic

technique and while you do this please

do not talk

once you have your connection go ahead

and open your clamps and now you can get

go ahead and place this on your IV pole

you want to make sure that there's no

kids on those lines so that when you do

the testing and the recirculation

process it won't give you any other

alarms so I told you before that I was

going to show you how to rise the level

of the fluid inside of a drip chamber

let's go ahead and do that now so if you

notice in there you can see that the

saving that the saving level is too low

so we're going to go ahead and write it

and the way that we use it is that you

are going to open the plan this little

clamp the port clamp and then you you're

going to move the cap careful you do not

want your remove it completely you are

only just going to lose it it and you

will see the level right so go ahead and

pay attention to this

open the plan and live a little

by loosening the polygamy

then you want to make sure that you are

tightening the cap and closing your

clamps closing the flap once you raise

the level then what you want to do is

that you want to place the be design

into the middle class and closing the

door so this is it this is the end of

part 1 of setting your machine I hope

that helped