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Train-the-Trainer Manual
2008K
Bringing Home Therapy Excellence
Fresenius Medical Care
2008K@home
Train-the-Trainer Manual
Train-the-Trainer Manual
Copyright 2011, Fresenius USA, Inc.All Rights Reserved
This document contains proprietary information of Fresenius USA, Inc. d/b/a Fresenius Medical Care North
America and its affiliates (Fresenius Medical Care). The contents of this document may not be disclosed to third
parties, copied, or duplicated in any form, in whole or in part, without the prior written permission of Fresenius
Medical Care.
Fresenius, Fresenius Medical Care, the triangle logo, 2008, PURISTERIL, and success@home are trademarks of
Fresenius Medical Care Holdings, Inc., and/or its affiliated companies. Hemastix is a registered trademark of
Miles, Inc. All other trademarks are the property of their respective owners.
TABLE OF CONTENTS
Section 1 Introducing the FMCNA 2008K@home Hemodialysis System ............... 3
Section 2 Home Requirements ................................................................................... 5
Section 3 Preparing for Dialysis .................................................................................. 8
Section 4 Access for Dialysis ...................................................................................... 9
Section 5 2008K@home System Overview............................................................... 10
Section 6 2008K@home Software Overview ............................................................ 17
Section 7 Getting Started .......................................................................................... 19
Section 8 Entering the Prescription ........................................................................... 21
Section 9 Machine Setup .......................................................................................... 24
Section 10 Preparing Your Dialysate......................................................................... 25
Section 11 Testing your 2008K@home Machine (Tx Setup)..................................... 27
Section 12 Setting Up the Arterial Lines: Screen 1 (Tx Setup) ................................. 28
Section 13 Arterial Lines: Screen 2 (Tx Setup) ........................................................ 30
Section 14 Venous Bloodline (Tx Setup) ................................................................... 31
Section 15 Priming Blood Side (Tx Setup) ................................................................ 32
Section 16 Prime Dialysate Side: Screen 1 (Tx Setup) ............................................ 33
Section 17 Prime Dialysate Side: Screen 2 (Tx Setup) ............................................ 34
Section 18 Entering Tx Parameters (Tx Setup) ......................................................... 35
Section 19 Starting your Treatment (Tx Connect) ..................................................... 36
1
Section 1
Introducing the
FMCNA 2008K@home Hemodialysis System
The Learning Theory Train-the-Trainer section should be used in conjunction with this training
section to introduce the trainer to learning techniques and theory that are applicable to the
successful training of 2008K@home hemodialysis system users. This section provides an
overview of the main learning concepts that must be taught to potential users of the
2008K@home hemodialysis system and should be used in conjunction with the 2008K@home
Users Guide. This Train-the-Trainer section is intended to help the trainer teach safe and
effective use of the 2008K@home hemodialysis machine in the home setting. This includes a
thorough discussion of all warnings and cautions contained in the users guide, a thorough
review of all alarms and troubleshooting procedures and recommendations for competence
demonstrations to be completed by the trainee. For each topic, we will review the main
concepts, key terms, recommended return demonstrations and critical warnings that are integral
to the training of home operators. This is supported by the Competency Check List (Appendix
G). It is recommended that each item on the competency checklist is included as a return
demonstration during the training period.
Please remember that the suggested trainer-led learning activities listed in this section are only
a guide. You will want to develop your own activities based on your experience, the information
you have learned reading the Learning Theory Train-the-Trainer, and on your trainees ability
level and learning style.
Refer to the 2008K@home Users Guide for definitions of terms and for a more complete
description of each of these topics.
Implementation Overview
Of primary importance to the success of home dialysis treatments using the 2008K@home
hemodialysis system, is the suitability of home dialysis for the patients lifestyle, environment,
and achievement of prescription goals. The patients nephrologist must certify that the patient is
a candidate for home hemodialysis training. It is recommended that each trainer assess the
patient in conjunction with the patients nephrologist to confirm their suitability for home dialysis.
In addition, trainers should complete and document (if not already in the patients chart), a
patient learning assessment to determine primary language for verbal and written
communication, level of literacy, potential visual impairment particularly color differentiation,
hearing impairment and manual dexterity. The patients training session should be adapted to
meet the learners educational needs. The main learning concepts, key terms and
recommended return demonstrations listed in this manual are guidelines for teaching strategies
which require individualization to meet specific patient requirements.
After completing the above assessments, a mutually agreed upon training schedule should be
established. In general it is anticipated that training for home hemodialysis will take
approximately 4-8 weeks. Please refer to the appropriate sections of the 2008K@home Users
Guide to review each procedure, definitions of individual terms, and warnings prior to each
training session.
Section 2
Home Requirements
Safe operation of the Fresenius 2008K@home hemodialysis machine in the home setting
requires that the home have sufficient electricity, water, water quality, water pressure and
drainage capacity (sewers) for proper machine operations. The power, water and other
environmental factors must be evaluated and certified by a qualified technician prior to the
installation of the Fresenius 2008K@home machine (see sample checklist from the users guide
below).
Table 1. Home Evaluation Checklist
Note: A qualified person from your clinic must fill out this or a similar form. He or she
should come to your home in person to check it over.
TYPE OF HOME:
House
Apartment
Mobile Home
Nursing Home
Retirement Home
Other: _______________
COMMUNITY
ENVIRONMENT:
# of occupants: ________
Room shared w/
another occupant
Urban
Rural
Local Hospital:
______________________
Approximate miles
From home to hospital: __________
Approximate miles from
Home to unit: ___________
WATER SYSTEM:
City
Well
Spring
SEWAGE SYSTEM:
City
Septic
Leach Bed
Trash Service
Other: _________________
# of bathrooms: _________
Bathroom ______ft. to bed.
Condition of shower head
ELECTRICAL:
3-Prong outlets (single phase, threeconductor type receptacle and a ground fault
interrupter at 120 Volts, 15 Amps, 60 Hz)
Outlet near bed
COOLING:
A/C: Central/Window Units
Fans: Type _____________
Duct System: Ceiling/Floor
Other: ______________
HEATING:
Electrical
Gas
Solar
Wood stove
Other: _________________
Failure to properly assess and ensure the reliable availability of electricity and water can result
in patient injury. For this reason the users guide includes the following contraindication:
Section 3
Preparing for Dialysis
Main learning concepts: Performing home hemodialysis is not only about being able to operate
the hemodialysis machine. There are a number of medical concepts that must be reviewed and
taught to home operators. These include teaching a basic understanding of simple infection
control techniques, documenting treatment data, monitoring vital signs, and calculating fluid
goal. Review common blood work that may be prescribed. Stress the significance of time,
friction and quantity of cleanser. Discuss use of hand sanitizers (alcohol based cleansers) as
needed.
Key Terms: Hand washing, Sterile and clean techniques, monitoring and documenting vital
signs and weight, Checking blood work, Approved hand cleanser, Paper towels
Recommended return demonstrations: At the end of this section the patient will be able to:
1. Contrast sterile from clean technique
2. Monitor and document vital signs and weight
3. Explain the importance of thorough hand washing and demonstrate the skill
4. Discuss preferred use of paper towels as an infection control measure
5. Restate facility established blood work protocols for blood draws, maintaining specimen
integrity and review of specimen results
Critical warnings, cautions and notes:
Warning: Failure to use sterile and clean techniques can result in severe injury or
death.
Section 4
Access for Dialysis
Vascular access cannulation and care are central to performing hemodialysis. Comfort and
success with cannulation is key to successful home hemodialysis. It is anticipated that this
subject will be stressed throughout the 4-8 week training period.
Main learning concepts: Please also refer to Appendix F, Vascular Access Care. Discuss
central venous catheters, arterio-venous (AV) fistulas, and grafts. Review the signs or
symptoms of access complications, access clotting, and access infection. Train on stepladder
and buttonhole techniques as per the policy of the facility and physician order. Review rules for
good access care and cannulation. Verbalize how to assess the dialysis access. Describe visual
assessment of access. Note possible access abnormalities such as signs of infection, bruising,
or aneurysms.
Stress importance of visual inspection and palpation of the thrill for the entire length of the
access. If the patient will utilize a catheter for dialysis, educate the patient throughout these
pathways according to the specific facility policy and procedure for catheter care.
Discuss needle removal and hemostasis including that insufficient pressure may lead to
prolonged bleeding while excessive pressure can lead to access clotting.
Key Terms: Types of access used for hemodialysis, access care and complications,
cannulation, Redness/edema/bruising, Infection/abscess Infiltration, Gauze and band aids
Sharps container, AV fistula, AV graft, dialysis catheter, Povidone iodine solution, isopropyl
alcohol, or other approved cleanser
Recommended return demonstrations: At the end of this section the patient will be able to
demonstrate appropriate care of their access and access cannulation techniques including:
1. Evaluating access thrill and bruit
2. Identifying supplies needed to clean the access
3. Identifying the parts of the fistula needle including wings, protective needle guard,
needle bevel, needle back eye, anti-stick needle protector, and tubing cap
4. Restating the steps of cannulation
5. Preparing the access for cannulation
6. Explaining the process of access monitoring during the treatment
7. Listing post treatment access steps including needle disposal and securing of access
site
8. Showing a positive commitment to self care
Critical warnings, cautions and notes:
Warning: Problems with your vascular access must be reported immediately to your
physician.
Warning: Failure to properly care for your access may result in injury or death.
Section 5
2008K@home System Overview
10
3. Restate the function of the control panel and each screen, each of the keys and the color
coding of screen buttons
4. Explain the functional sections of the main screen including the Status Box and the
Dialogue Box
5. Discuss each component in the module section including the Arterial Drip Chamber,
Blood Pump, Heparin Pump, and Level Detector
6. Recognize the importance of the venous clamp and how to properly seat the venous
blood line in the clamp
7. Discuss the dialysate circuit
8. Differentiate between the red acid connector and the blue bicarbonate connector
9. Demonstrate the use of the concentrate connectors for bicarbonate and acid concentrate
and the handling of the dialyzer quick-connectors and the shunt interlock.
Critical warnings, cautions and notes:
11
Warning: The machines modules and internal hydraulics involve fluids. Fluid leaks
may cause excess fluid removal from the patient. Correct the problem immediately or
take the machine out of service. Spills can cause damage to carpeting and other
surfaces. To contain such spills, the machine should be on a spill-tolerant surface.
Spills can cause slips and falls; clean up spills immediately.
Caution: Do not raise the level of the drip chamber so high that the transducer protector
becomes wet. Wet transducer protectors must be replaced, as they will cause
inaccurate readings and possibly serious injury or death. See Clearing the Pressure
Monitor Line in the 2008K@home Users Guide
Note: The Power key does not interrupt electrical power to your machine. To
disconnect completely, use the main power switch on the back or pull the power cord
plug.
12
13
Machine
Section
Treatment
Section
Patient
Section
Control Panel
14
Red Acid
Connector
Concentrate
Jug Connector
Cap
Blue
Bicarbonate
Connector
Fluid
Sample
Line
Shunt
Door
Shunt
Interlock
Dialysate
Supply Line
Flow
Indicator
Dialysate Circuit
15
Dialyzer
QuickConnecters
2008K@home hemodialysis system Train-the-Trainer Manual
The 2008K@home Users Guide features a foldout map of your machine called Your K Map:
When a procedure references a location not shown, the operator can find the matching letter
and location on Your K Map (inside front page of the users guide).
16
Section 6
2008K@home Software Overview
Main learning concepts: The different types of touch screen buttons and their functions, nonclickable status of grayed-out buttons, flowchart at the top of dialysis procedure screens
Insert diagram explaining flowchart at top of screens
Key terms: In addition to reinforcing machine terminology add: grayed-out, touch (for buttons),
press (for keys), progress bar graph, flowchart
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Explain the various types of buttons and which are selectable
2. Explain how to read the progress bar graph on various screens
17
3. Explain how to read the flowchart along the top of the screen
4. Explain the alert sections of the display: Status Box and Dialogue Box
18
Section 7
Getting Started
Main learning concepts: Reinforce the benefits of home dialysis and use of the 2008K@home
machine (easy to use Control Panel keys, and simple on-screen menus). Define the role of the
trained operator, the role of the trained person who will observe the treatment, and the role of
the trainer. Identify available resources of technical support. Provide the definition of heparin
and its purpose, pharmacokinetics as it relates to dialysis and medication administration.
Discuss the contraindications to the Blood Pressure Module, identification of the 4 attention
boxes and the 7 other important machine symbols. Stress the importance of adherence to
dialysis prescription. Compare and contrast hemodialysis to the functions of the renal system,
introduce intradialytic complications, the clinics schedule for disinfecting and testing the water
treatment system, piping, inlet lines, filters, concentrate feed containers, and the dialysate lines.
Review ordering supplies provide an introduction to medical waste disposal. These overall
concepts form the basis for further learning. It is recommended that they be reviewed on
multiple occasions throughout training.
Key terms: In addition to reinforcing machine terminology add: contraindications, hypovolemia,
hypervolemia, hypertension, hypotension, hypothermia, hyperthermia, convulsions, seizures,
dialysis dementia, electrolyte, hemorrhage, acidosis, alkalosis, hemolysis, pyrogenic, chemical,
AAMI, aseptic technique, Your K Map, appendix, ultrafiltration, serum potassium, blood clotting
time.
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Discuss how fundamental hemodialysis procedures affect the body
2. Define aseptic technique
3. Describe available resources for technical and clinical support
4. Define roles and responsibilities of the registered nurse trainer, the trained operator and
trained partner
5. Explain the purpose and action of hemodialysis related medications
6. List contraindications to the Blood Pressure Module
7. Recognize the importance of adhering to the dialysis prescription
8. Restate the clinics schedule for disinfecting and testing the water treatment system,
piping, inlet lines, filters, concentrate feed containers, and the dialysate lines, ordering of
supplies
9. Discuss potential intradialytic complications and their potential resolution
10. Restate appropriate medical waste procedures relating to home hemodialysis
Critical warnings, cautions and notes:
Strict adherence to physicians orders. AAMI standards for water, Following clinics schedule for
disinfecting and testing the water treatment system, piping, inlet lines, filters, concentrate feed
containers, and the dialysate lines. Discuss Needle Dislodgement and blood loss. Discuss how
to monitor the access site, blood pressure, pulse, and general physical status so that the patient
19
can learn to quickly react to any problem with the right solution. Discuss that the patient should
not rely solely on machine alarms. Vigilance is key. Other important warnings include:
Warning: The air detector alarm is a critical safety feature that alerts the user of
potential air in the bloodline. You must properly place the venous drip chamber in its
holder and set the proper blood/saline level in the venous drip chamber. Avoid
overfilling. Failure to follow the instructions in this users guide can result in severe injury
or death. Please contact your physician if you have any questions about the proper
operation of the air detector or how to attach the venous bloodline. Repeated air
detector alarms at the beginning of treatment may indicate improper placement of the
venous drip chamber in its holder.
Warning: Repeated arterial and/or venous pressure alarms may mean poor blood flow
or access problems. If you have frequent alarms or a change in alarm patterns, you
should call your clinic. Frequent movement can trigger the alarm. Patients should
refrain from unnecessary movement during dialysis.
20
Section 8
Entering the Prescription
Main learning concepts: Restating the prescription parameters, identification of commonly used
abbreviations within the prescription setting, how to change an incorrect entry, explain
significance of 2X dialysate autoflow, mathematical addition exercises, identification of milliliters
on fluid containers, impact of improper blood pressure cuff placement and use of the BP
module, acceptable blood pressure and pulse range, and purpose of 24 hour clock (military
time) vs. regular time. Stress the importance of mastery of the entire set-up process and
procedures and emphasize the critical nature of correctly following their physicians prescription,
how to use the My Treatment Parameters card (see next page), the My Treatment Procedures
sheet, and the My Cleaning Procedures sheet.
21
22
23
Section 9
Machine Setup
Main learning concepts: Organizing and gathering supplies in a logical and consistent manner,
arranging for convenient access during setup, and checking the water system. Stress the
importance of mastery of the entire set-up process and procedures.
Key terms: Dialyzer, heparin, bloodlines, syringe, concentrate, and dialysis circuit.
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Explain the steps for water system checks
2. Identify each needed supply for the hemodialysis treatment
Critical warnings: N/A
Instructions for setup preparation:
1. Obtain all of your supplies and arrange for convenient access during setup.
2. Ensure that water system is running and has been checked according to manufacturers
specification.
3. Press Power key and check if the machine requires rinse or disinfection.
24
10
Section 10
Preparing Your Dialysate
Main learning concepts: Properly mixing concentrates, identification of appropriate acid and
bicarbonate connections, determining guidelines for sufficient concentrate throughout the
treatment, confirming concentrate prescription, and describing opportunities for potential errors.
Stress the importance of mastery of the entire set-up process and procedures and the critical
role of dialysate in hemodialysis.
Key terms: Red acid port, red acid connector, acid concentrate jug, blue bicarb port, blue
bicarbonate connector, bicarbonate jug, acetate, pH, and conductivity.
Reason
A. Powdered concentrate will displace
water so do not fill completely until
powder has been added.
B. Be sure not to spill powder anywhere
but in the jug.
C. Capping the jug prevents spillage.
D. Twisting jug back and forth provides
enough agitation to dissolve powder.
E. The package will state the total volume
in liters required to assure the proper
dilution.
25
Warning: Your jugs of acid and bicarbonate concentrates must match both your
prescription and your machine settings. Make sure they are correct before connecting.
Using the wrong concentrates may cause serious injury or death.
Warning: When your machine has stabilized, test the conductivity and approximate pH
of the dialysate with an independent device. Improper conductivity or pH may cause
serious injury or death.
Warning: Mix your bicarbonate according to your clinics instructions. Be sure the jugs
contain enough concentrate for your whole treatmentfill your concentrate jugs all the
way up to the top. If a jug runs out during treatment, a condition known as air lock may
occur, causing conductivity problems.
26
Section 11
Testing your 2008K@home Machine (Tx Setup)
11
Main learning concepts: Purpose of testing the machine and frequency, how bar graph displays
time remaining in testing, how the done button is grayed-out and not selectable during the test,
explaining steps required to retest machine after failed test, explaining how the machine
indicates a failed test, recognizing Diasafe Plus filter frequency of testing if applicable, and
distinguishing two situations when a qualified technician is needed. Stress the importance of
mastery of the entire set-up process and procedures and the critical nature of passing all safety
checks.
Key terms: Hydraulic system, Alarm system, grayed-out, test progress bar graph, and Status
Box.
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Explain testing the machine and testing frequency
2. Explain why the Done button is grayed out and how to read the test progress bar graph
3. Restate and explain the steps required to retest the machine after a failed test
4. Retell how the machine indicates a failed test
5. Distinguish two situations when a qualified technician is needed
Critical warnings, cautions and notes:
Warning: After you select and confirm the Start Test button, your machine will beep.
This is a test of the audible alarm system; make certain that the sound occurs. If your
machine fails any of these tests and the cause cannot be corrected, do not start your
treatment. Contact your clinic immediately. Have your machine checked by a qualified
technician to correct the problem.
Testing (Tx Setup) Instructions:
1. Touch Start Test and press CONFIRM to begin testing machine
2. When Status Box reads Test Complete, press RESET to clear message
3. Touch the Done button to go to the next screen
4. Explain steps required to retest machine after failed test
27
Section 12
Setting Up the Arterial Lines: Screen 1 (Tx Setup)
12
Main learning concepts: Principles of aseptic technique during arterial line connection process.
Explain components of the bloodline set and the functionality, explain importance of removing
numbered tape only when instructed, explain the risk of kinked lines, arterial line, arterial
access, arterial line clamp. Stress the importance of mastery of the entire set-up process and
procedures.
Key terms: Arterial drip chamber, blood pump, pump housing, transducer, transducer protector,
aseptic technique, arterial pressure port, sterile, bracket, tape, and bloodline set.
28
29
Section 13
Arterial Lines: Screen 2 (Tx Setup)
13
Main learning concepts: Stress the importance of mastery of the entire set-up process and
procedures. Explain functionality of transducer protectors, and explain why wet transducers
must be replaced.
Key terms: Drain bag, transducer protector, red and blue recirc connector
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Show how to tighten the red and blue recirc connectors
2. Demonstrate opening and closing clamps
3. Manipulate saline bags as needed
4. Change a wet transducer protector
5. Restate aseptic technique
Critical warnings, cautions and notes:
Warning: Use a sterile transducer protector between your machine and each pressure
monitor line so the transducers do not get wet. Wet transducer protectors must be
replaced, as they will cause inaccurate pressure readings.
Arterial Line Screen 2 setup instructions:
1. Connect patient end of arterial line to drain bag
2. Connect transducer protector to arterial pressure port and explain functionality of
transducer protectors. Show procedure to change wet TP.
3. Tighten the red and blue recirc connector
4. Close saline clamp
5. Hang saline bag
6. Remove Tape 3 and connect saline bag
7. Touch the Done button to go to the next screen
30
Section 14
Venous Bloodline (Tx Setup)
14
Main learning concepts: Principles of aseptic technique during venous line connection. Stress
the importance of mastery of the entire set-up process and procedures.
Key terms: Venous chamber, sensor heads, Venous Clamp Optical Detector, tubing guides,
medication clamps, and venous pressure port.
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Discuss and review the blood circuit, venous blood lines, hemodialysis access and
preventing kinks in the bloodlines
2. Restate aseptic technique
3. Complete all venous line connections follow venous line setup instructions
4. Explain functionality of optical detector
5. Explain the functionality of transducer protectors and explain why wet transducers must
be replaced.
Critical warnings, cautions and notes:
Warning: If the drip chamber contains a filter, make certain the filter is below the sensor
heads.
Warning: The level detector must be calibrated for the venous line model being used.
Failure to do so may cause serious injury or death.
Warning: The tubing beneath the venous drip chamber must be inserted into the venous
line clamp and the optical detector.
Venous Line setup instructions:
1. Roll venous chamber into holder; make sure the filter is below the sensor heads.
2. Insert line into Venous Clamp and Optical Detector. Explain functionality of both
components again.
3. Connect patient end of venous line to drain bag.
4. Remove Tape 4 and connect venous line to dialyzer.
5. Insert line into tubing guides.
6. Connect transducer protector to venous pressure port.
7. Close both medication clamps.
8. Touch Done button to go to the next screen.
31
Section 15
Priming Blood Side (Tx Setup)
15
Main learning concepts: Utilizing my treatment procedures sheet to determine drip chamber
level. How to set drip chamber level. How the Done button is grayed-out and not selectable
during the priming process, How bar graph displays time remaining in priming process. Stress
the importance of mastery of the entire set-up process and procedures.
Key terms: Gravity prime, prime, heparin, heparin line clamp, and recirculated saline.
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Demonstrate proper use and function of the level detector.
2. Review air detector alarms.
3. Stress the importance and function of the air detector and transducers protector.
Critical warnings, cautions and notes:
Review wet transducer procedure.
Warning: The Level Adjust on the Blood Pump module can only be used to raise the
level in the arterial chamber. Do not press the Level Adjust key so long that the
pressure transducer becomes wet. Wet transducer protectors must be replaced to avoid
false pressure readings.
Warning: Only use syringes prescribed by your doctor in the Heparin Pump module.
Make sure that there is enough heparin for your entire treatment. Do not load the
syringe beyond your prescribed amount.
Warning: The heparin pump is to be used only under positive pressure conditions.
Under negative pressure conditions, too much heparin may be infused.
Caution: The syringe must be properly loaded for your machine to add heparin during
treatment.
Prime Blood Side Instructions:
1. Prime heparin line, close heparin clamp, and insert your selected syringe.
2. Open saline line clamp.
3. Gravity prime arterial patient line to drain bag.
4. Close arterial patient line clamp.
5. Turn on the blood pump.
6. Set arterial drip chamber level using the arterial Level Up key on the Blood Pump.
7. Touch the Prime button and press CONFIRM twice to begin priming.
8. Touch Done button to go to the next screen.
32
Section 16
Prime Dialysate Side: Screen 1 (Tx Setup)
16
Main learning concepts: Importance of testing dialysate for proper pH and conductivity, explain
why it is necessary to use an independent meter to test the dialysate, explain what is residual
disinfectant and why it is necessary to test for it.
Key terms: Dialysate, conductivity, pH, independent device or meter, residual disinfectant
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Demonstrate how to take a dialysate sample for testing
2. Test the dialysate for conductivity using an independent meter
3. Enter the values displayed on the meter into the 2008K@home parameter-buttons on
the screen
Critical warnings, cautions and notes:
Warning: After testing the dialysate through independent means (e.g., using a
conductivity meter and pH paper or meter), verify that the conductivity is reasonably
close to the theoretical value (TCD) and the pH is between 6.9 and 7.6. The machine
must also be free of residual disinfectant. If these conditions are not met, do not initiate
dialysis.
Note: If your conductivity or pH values are out of range, the Dialogue Box will alert you.
Make sure that the value you entered matches your test reading. If the value is still out
of range, take a new dialysate sample to test.
Dialysate Testing Instructions:
1. Verify the following:
a. Dialysate lines on shunt
b. Conductivity and temperature stabilized
c. Independent meter is properly calibrated
d. Patient has a clean, non-foam container for collection
2. Open shunt door and unsnap blue dialysate line
3. Rinse container and collect sample
4. Close shunt door
5. Open shunt door and snap blue dialysate line back on shunt.
6. Test dialysate with an independent device
7. Enter conductivity
8. Enter pH
9. Press the CONFIRM key
10. Touch the Done button to continue
33
Section 17
Prime Dialysate Side: Screen 2 (Tx Setup)
17
Main learning concepts: Restate why dialyzer is rotated, purpose of recirculation, how to clear
air from the dialyzer, how the done button is grayed-out and not selectable during the test and
recirc, and emphasize the importance of clearing all air from the dialyzer and lines by priming to
the end of the lines, how to read the test and recirc progress bar graph
Key terms: Venous side of dialyzer, arterial side of dialyzer, shunt door, and shunt interlock.
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Demonstrate tight connections
2. Demonstrate priming the tubing and dialyzer
3. State purpose of rotating the dialyzer
4. Identify correct connections and sequence of connections
Critical warnings, cautions and notes:
Warning: All quick-connectors must be tightly connected to prevent air from entering
the dialysate circuit or dialysate leaks.
Note: If all the air has not been cleared from your dialyzer, turn your dialyzer upside
down and right side up again.
Note: Make sure the saline has reached the end of the bloodline when priming.
Prime Dialysate Side Instructions:
1. Rotate dialyzer.
2. Connect blue dialysate line to venous side of dialyzer and red dialysate line to arterial
side of dialyzer.
3. Close drain bag clamp
4. Open arterial patient line clamp.
5. Touch Recirc Saline and press CONFIRM to begin recirculation.
6. When recirculation is complete, touch Done button to go to the next screen.
34
Section 18
Entering Tx Parameters (Tx Setup)
18
35
Section 19
Starting your Treatment (Tx Connect)
19
dialysate lines must be checked for leaks after the treatment has started. Access sites must be
uncovered and monitored. Improper bloodline connections or needle dislodgements can result
in excessive blood loss, serious injury and death. Check all bloodlines for kinking as improper
blood flow may cause hemolysis. Do not raise blood level so high in the arterial drip chamber
that the transducer becomes wet. Keep fingers clear of the blood pump rotor when it is running.
Serious injury may occur.
Warning: If any of the conditions listed above have not been met, you must correct
them before continuing with your treatment preparation. Failure to do so may cause
serious injury or death.
Warning: You must test the conductivity and approximate pH of the dialysate with an
independent device before connecting for treatment. Improper conductivity or pH may
cause serious injury or death.
37
Section 20
Flush Saline (Tx Connect)
20
Main learning concepts: The purpose of performing a saline flush before the start of the
treatment. How to properly flush the lines with saline. Explain how to verify the patient ends of
the bloodlines have been flushed properly. Stress the importance of mastery of the entire setup process and procedures.
Key terms: Blood pump, gravity flush, arterial line, drain bag, saline bag, saline, level detector,
level adjust, drip chamber, and venous clamp, recirculated saline.
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Restate how to perform a saline flush and why it is done
2. Retell and stress what to do in the case of an air detector alarm and how to prevent
them
Flush saline instructions:
1. Explain why saline is flushed before start of treatment.
2. Press the Start/Stop key on the Blood Pump module to stop blood pump.
3. Change saline bag.
4. Open drain bag clamp and gravity flush arterial line to drain bag.
5. Close clamp on patient end of arterial bloodline.
6. Start blood pump.
7. 300 ml saline into drain bag.
8. Stop blood pump.
9. Close saline, drain bag, and venous clamps.
10. Verify that line is flushed and set toggle-button to Yes, then CONFIRM.
11. Touch the Done button to go to the next screen.
Critical warnings, cautions and notes:
Ensure that the level detector system has been tested before treatment is started.
Make certain that there is enough saline in the bag for the entire treatment.
Pay close attention to the saline bag level until 300 ml has been disposed into the drain bag.
Ensure that the clamps are closed after 300 ml of saline has been drained.
Warning: You must test the Level Detector system before treatment. To test your
machine: Press the Down Level Adjust key to lower the fluid level in the venous drip
chamber. Remove your machine from service if the blood pump does not stop and the
Venous Clamp does not close. Press the Up Level Adjust key to raise the venous drip
chamber level again.
38
Section 21
Connect Bloodlines (Tx Connect)
21
Main learning concepts: Connection of the correct line segments to the correct section of the
vascular access (arterial line to arterial access and venous line to venous access), and proper
administration of heparin bolus, if prescribed.
Key terms: Arterial line, arterial access, venous line, venous access, drain bag, heparin line, and
heparin bolus
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Restate and demonstrate how to disconnect the arterial line from drain bag and connect
to it to the arterial access and then disconnect the venous line from the drain bag and
connect it to the venous access
2. Verbalize the purpose of heparin and administer the heparin bolus if prescribed by their
physician.
Critical warnings, cautions and notes:
Warning: Check all bloodlines and dialysate lines for leaks after your treatment has
started. Keep access sites uncovered and monitored. Improper bloodline connections
or needle dislodgements can result in excessive blood loss, serious injury and death.
Machine alarms may not occur in every blood loss situation.
Warning: Check all bloodlines for kinking. Improper blood flow may cause hemolysis of
the blood.
Warning: Infusing recirculated saline is not recommended. Use fresh, sterile saline, if
required.
Flush saline instructions:
1. Remove Tape 5
2. Disconnect arterial line from Drain Bag and connect to arterial access
3. Remove Tape 6
4. Disconnect venous line from Drain Bag and connect to venous access
5. Open bloodline clamps at the patient ends of the arterial and venous bloodlines and
open both access line clamps
6. Open heparin line clamp
7. Infuse bolus if prescribed
8. Touch the Done button to go to the next screen.
39
Section 22
Start Treatment (Tx Connect)
22
Main learning concepts: Initiating prescribed blood flow rate while monitoring tolerance of the
vascular access, acceptable machine pressures (arterial, venous, and TMP) and any blood
alarms. Initiating treatment. Calculating TMP using UF Rate displayed on Home screen and
Dialyzer Coefficient or KUF from dialyzer instruction sheet.
Key terms: Blood pump, Pump Speed, Tx Paused, Tx Running, Arterial Pressure, Venous
Pressure, Transmembrane Pressure (TMP), KUF, dialyzer ultrafiltration coefficient.
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Demonstrate how to begin their treatment by setting the blood pump speed and then
starting the Blood Pump and slowly raising the speed to the prescribed blood flow rate
2. Turn on the Tx Clock (Tx Running)
3. Restate how to adjust the level of the arterial drip chamber
4. Explain importance of arterial, venous, and TMP pressure and associated alarm
windows
5. Explain importance of having enough concentrate for the entire treatment
6. Calculate approximate expected TMP using the following equation:
UF Rate
Dialyzer Coefficient or KUF
Approximate
Expected TMP
40
Warning: Dialysate leaks in the dialyzer will add to your ultrafiltration rate. Watch the
system for fluid leaks. Stop your treatment if you cannot correct any fluid leak quickly.
Failure to do so may cause serious injury or death.
Warning: When blood flow is established, check the bloodlines for air. Air must not
enter your access lines.
Warning: The pressure changes from an access line separation or needle
dislodgement may be too small for your machine to detect. All access sites and
connections must be uncovered, properly, secured and checked regularly. Failure to do
so may cause serious injury or death.
Warning: After starting dialysis, calculate to see if the TMP corresponds to the
dialyzers ultrafiltration coefficient (KUF). TMP must be closely monitored with the alarm
limits. The TMP may not change substantially during UF errors when high permeable
dialyzers are in use. A fluctuating TMP may indicate a leak in the dialysate side of the
system. Some, but not all, UF errors can be checked by measuring the volumetric
accuracy of the UF pump via the fluid sample port using a graduated cylinder. If the
cause cannot be corrected quickly, discontinue treatment.
Warning: After starting dialysis, calculate to see if the TMP corresponds to the
dialyzers ultrafiltration coefficient (KUF). TMP must be closely monitored with the alarm
limits. The TMP may not change substantially during UF errors when high permeable
dialyzers are in use. A fluctuating TMP may indicate a leak in the dialysate side of the
system. Some, but not all, UF errors can be checked by measuring the volumetric
accuracy of the UF pump via the fluid sample port using a graduated cylinder. If the
cause cannot be corrected quickly, discontinue treatment.
41
Section 23
Monitoring the Treatment (Home Screen)
23
Main learning concepts: Monitoring arterial, venous, and TMP pressures, monitor Dialogue Box
for most recent blood pressure and heart rate, and use of Screen Sleep button to darken screen
like a screen saver.
Key terms: Arterial Pressure, Venous Pressure, Transmembrane Pressure (TMP), Dialogue
Box, and Screen Sleep buttonMethod to darken the display.
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Identify important readings on the Dialysis Home Screen, including the transmembrane
pressure (TMP), arterial and venous pressures, the blood pressure and the heart rate
2. Demonstrate how to darken the dialysis Home screen
Critical warnings, cautions and notes:
Warning: The values shown here are for example only. You must use the values
prescribed by your doctor. If you use the wrong values, it may cause serious injury or
death.
Warning: Your dialysate flow must be monitored. The flow must be set to your
prescribed flow rate. Without proper dialysate flow, your machine cannot remove
enough waste from your blood. This may cause injury.
Monitoring the Treatment Instructions:
1. Explain how parameters can be adjusted on the Home screen, if required
2. Monitor the bloodline connections, arterial, venous, and TMP pressures; DO NOT allow
concentrates to run out during treatment
3. Measure and document patients vital signs according to home program protocol
4. Address Alarm and Warning messages without delay
42
Section 24
Ending the Treatment
24
43
25
Section 25
Check Saline (Tx End)
44
Section 26
Return Blood (Tx End)
26
1.
2.
3.
4.
46
27
Section 27
Disconnect (Tx End)
Main learning concepts: Adherence to procedures. Use aseptic technique when disconnecting
from access and performing access care.
Key terms: Venous patient line, venous access line, access site, and infection
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Restate and demonstrate how to disconnect the bloodlines from the blood access.
Critical warnings, cautions and notes:
Warning: You must wait until the blood pump is stopped before completing the
disconnect (Tx End) steps.
Disconnect instructions:
1. After blood pump has stopped, close clamp on saline line
2. Close clamp on Arterial bloodline
3. Disconnect patient end of the venous line from the venous access line
4. Disconnect from access
5. When these steps are completed, touch the Done button to go to the next screen.
47
28
Section 28
Emptying (Tx End)
Main learning concepts: Adherence to procedures.
Key terms: Priming set, red and blue recirc connector, venous line, rotate dialyzer, shunt, and
shunt interlock
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Restate and demonstrate the steps to complete the end of treatment procedures.
Emptying instructions:
1. Disconnect the saline line and bag from the bloodlines.
2. Connect the arterial and venous lines together with the red and blue recirc connector.
3. Open the arterial and venous line clamps.
4. Rotate the dialyzer so the venous line is on top.
5. Open the shunt door, take the blue dialysate line off the dialyzer and connect the blue
dialysate connector to the shunt interlock.
6. Close the shunt door.
7. When the dialysate compartment is empty, touch the Done button to go to the next
screen.
Critical warnings, cautions and notes:
Caution: Do not forcefully pull the lines from your machine. Damage to your machine
or its sensors may result. Open the pump door and press the Start/Stop key on the
Blood Pump module (see Your K Map: D) to re-align the rotor so you can remove the
bloodline more easily. Rotate the Optical Detector door open before taking the line from
the Venous Clamp.
Warning: Keep fingers clear of the blood pump rotor when it is running. Serious injury
may occur.
48
29
Section 29
Cleansing (Tx End)
Acid Clean and Heat Disinfect; Acid Clean, Chemical Disinfect and Rinse
Main learning concepts: Difference between rinsing, cleaning and disinfecting the dialysis
machine, difference between cleaning and disinfecting schedule, appropriate cleaning and
disinfecting agents, preparation of dilute (1:100) bleach solutions, cleaning of the machines
exterior, cleaning of the blood pressure cuff, transducer contamination policy, disinfection of the
concentrate containers, explaining Put connectors in chem, explaining Put Connectors to
ports, testing for negative bleach residual according to unit policy, explaining purpose of
rinsing, cleaning and disinfecting.
Key terms: Cleaning, disinfecting, acid clean, heat disinfection, rinsing, vinegar, rinse cycle,
chemical disinfectant jug, rinse port, corrosive, and rotor
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Verbalize their understanding of the importance of cleaning their machine according to
the procedures recommended by their clinic
2. Restate the types of cleaners that should and should not be used in and on their
machine
3. Demonstrate how to return the connectors to the ports and put the red dialysate
connector into the shunt, all with tight connections.
4. Restate and demonstrate how to clean the outside of the machine and the blood
pressure cuff
5. Demonstrate an acid cleaning procedure and a heat disinfection procedure
6. Explains the importance of the bleach test strip being negative after a chemical
disinfection
7. Explain why the cleaning and disinfection screen prompt (pop-up) on the Select
Program screen would be displayed and how to clear the message.
Critical warnings, cautions and notes:
Warning: Your clinic must decide your cleaning procedures. Failure to follow your
clinics procedures could lead to serious injury or death. Thoroughly cleaning the exterior
of your 2008K@home machine after every treatment is critical to prevent the spread of
bacteria and viruses like Hepatitis. Use surface cleaners in small amounts to avoid
excess cleaner from getting into your machine. Rinse off cleaning solutions with a
water-dampened cloth, especially if a corrosive cleaner such as bleach is used.
Caution: Do not use foaming type cleansers or disinfectants containing quaternary
ammonium compounds like N-alkyl (C12 C18) dimethyl benzyl ammonium chloride.
These chemicals attack the polycarbonate plastics used in your machine. Read the
product labels and follow the instructions. Call Technical Services or your clinic if you
have questions.
49
Warning: Bent or loose tubing guide posts can damage bloodlines. Replace rotor if
necessary.
Warning: Disinfect your machine immediately after your treatment if a blood leak alarm
occurs.
Warning: When chemicals are used inside your machine, it must be thoroughly rinsed
and tested for remaining disinfectant before your next treatment. Your machine must be
labeled with the chemical used and instructions to rinse and test for remaining
chemicals. Rinsing your machine does not disinfect your machine. Acid cleaning does
not disinfect the machine. Test your machine for remaining disinfectant before starting
your treatment after a chemical disinfection.
Warning: Do not come into contact with the steam from your machines vent during
heat disinfection. Steam and machine parts affected by heat disinfection will be hot and
can cause burns.
Note: Your machine must be connected to an approved water source, the drain line
connected to a drain, the dialysate supply lines on the shunt interlock with the shunt door
closed, and the concentrate connectors tightly seated in their rinse ports to run these
programs.
Caution: Do not use chlorine solutions or high-temperature steam-cleaners on the
blood pressure cuff. If using a chemical soak, test a small area of the cuff for possible
staining. Rinse well to remove any remaining disinfectant. When machine washing, be
sure that the hook and loop fasteners are connected so the hooks do not collect lint or
other fibers. The fasteners can melt at temperatures above 132C (325F), when being
ironed or pressed. Follow the manufacturers instructions.
50
3. Put connectors in chem message will appear. Connect acid concentrate connector to
acid and bicarb connector to vinegar.
4. Press CONFIRM to start.
5. When completed, the message Put Connectors to ports will appear. Put acid and
bicarb connectors into respective ports and CONFIRM to exit.
6. Touch the Chemical/Rinse button.
7. Put Red wand in chem. message will appear. Connect acid concentrate connector to
disinfectant container (yellow connector bottle) and press CONFIRM.
8. When completed, the message Return Connector in port will appear. Return Acid
concentrate connector to machine port and machine will initiate a 15 minute mandatory
rinse.
9. Test for negative bleach residual according to unit policy. DO NOT interrupt the
mandatory rinse cycle. This MUST be completed. Press and hold POWER key to turn off
machine once test for bleach is negative.
51
Section 30
Troubleshooting Alarms
30
Introduction: Your 2008K@home machine has an advanced system of features that work for
your safety. Electronic sensors and diagnostic software constantly monitor your machines
operation. When problems or possible problems are detected, your machine warns you with
Status Box messages and, in some cases, audible alarms. Audible alarms are deactivated
when dialyzer supply lines are on the shunt interlock and/or the Tx Clock is running, unless
blood is sensed. Your 2008K@home machine may be set to silence all audible alarms until
blood is sensed in the venous line. When selected, the audible alarms occur only if the
dialysate lines are off the shunt interlock and the optical sensor in the level detector module
senses blood. This option is set in Service Mode by a qualified technician and is selected by
your clinic. Otherwise, alarms are always audible when dialysate lines are off the shunt
interlock.
During an alarm, the Status Box background turns bright red and an audible alarm sounds. The
Help screen-button in the lower right corner of the display may flash if additional information on
troubleshooting the problem is available. For alarm procedures, use the troubleshooting section
of this manual and as listed in the users guide.
Main learning concepts: Prioritizing alarms, what alarms indicate, correct order of response
steps, troubleshooting alarms
Key terms: Status Box, Dialogue Box, Blood Alarms, Dialysate Alarms, Other Alarms,
Troubleshooting, Reset, Override, Mute, Help screen-button, alarm, alarm window, warning
Recommended return demonstrations: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Verbalize what to check and do in the event of a blood alarm, demonstrating how to
reset the alarm and adjust the alarm limits
2. Troubleshoot potential causes of the alarm and solutions by referring to the alarms
troubleshooting section of the 2008K@home Users Guide and/or using your machines
built-in Help screen.
3. Verbalize understanding of the importance of promptly addressing the alarm and the
potential consequences of not addressing it
Critical warnings, cautions and notes:
All alarms need your immediate attention. Failure to do so may cause serious injury or death.
Your machine may not alarm with all blood loss situations. Your access site must be uncovered,
properly secured, and checked regularly throughout the dialysis treatment. Failure to do so may
lead to excessive blood loss which can cause serious injury or death. You must correct the
condition causing a blood alarm before clearing the alarm.
Reacting to Alarms
The Mute and Reset keys on the 2008K@home control panel are used in the course of
handling most alarms:
52
Mute: Press the Mute key to silence an alarm for two minutes or until another alarm event
occurs. The red light above the key illuminates when an alarm is muted.
Reset: Press the Reset key to reset the machine after an alarm. Press and hold the Reset
key for two seconds to spread the alarm window by 300 mm Hg for arterial and venous
pressures and fully open the transmembrane (TMP) pressure window for 30 seconds. The
light above the Reset key will not be on when the alarm window has been spread.
Types of Alarms
There are three categories of alarms:
1. Blood Related Alarms
Blood alarm events have the highest priority. When a blood alarm occurs:
The blood pump stops.
The venous clamp on the level detector occludes.
The UF pump stops.
RTD stops
During a blood leak alarm, press and hold the RESET key for three seconds to override the
alarm and keep the blood pump running for three minutes. The light above the RESET key will
be on during an override.
2. Dialysate Related Alarms
During a dialysate alarm (temperature or conductivity), the blood system continues to operate,
but the dialysate is run through the machine instead of the dialyzer. This is called bypass and
can be observed by watching the float in the dialyzer supply line. During bypass, the float will
remain still at the bottom of the flow indicator. Contrarily, a high or low flow error will not cause
the machine to go into bypass. Dialysate alarms are self-resetting when the alarm condition is
corrected. Temperature and conductivity alarms do not occur during the pure UF mode of
sequential dialysis when there is no dialysate flow.
3. Other Alarms
Other alarms may relate to machine parts like the heparin pump or UF pump, BPM, BVM, BTM,
etc.
Troubleshooting
The 2008K@home Users Guide contains a table of all alarms the machines software can
detect. Your 2008K@home machine is also equipped with a 9-Volt battery that sounds an alarm
if the power fails. The power failure procedure is contained in the Alarms and Troubleshooting
section of the 2008K@home Users Guide. Other potentially hazardous situations that may go
undetected such as fluid spills/leaks or damage to the machine must be observed by the
operator. Be sure to resolve all problems quickly.
53
Section 31
Troubleshooting Specific Blood Alarms
and Dialysate Alarms
31
54
2. Troubleshoot potential causes of the alarm and solutions by referring to the alarms
troubleshooting section of the 2008K@home Users Guide
3. Verbalizes understanding of the importance of promptly addressing the alarm and the
potential consequences of not addressing it
Critical warnings, cautions and notes:
A sustained blood pump stoppage can contribute to a clotted extracorporeal system
3. Arterial Pressure Alarm - LOW
Main learning concepts: the pressure inside the arterial drip chamber is below the set alarm
limits indicating kinking, clotting or line obstruction, access spasms, occlusions at the tip of the
needle caused by patient movement.
Key Terms: Arterial drip chamber, access, blood pump, transducer protector, RESET key
Recommended return demonstration: Demonstrate the listed steps in the corresponding section
of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Verbalize what to check and do in the event of a low arterial pressure alarm,
demonstrating how to reset the alarm and adjust the alarm limits
2. Troubleshoot potential causes of the alarm and solutions by referring to the alarms
troubleshooting section of the 2008K@home Users Guide
3. Verbalizes understanding of the importance of promptly addressing the alarm and the
potential consequences of not addressing it
Critical warnings, cautions and notes:
Inadequate dialysis will result with decreased blood flow.
4. Arterial Pressure Alarm - HIGH
Main learning concepts: The pressure inside the arterial drip chamber is above the set alarm
limits indicating a potential problem with the access being able to deliver the blood flow as set
on the blood pump or there may be kinking or clotting within the extracorporeal system
Key Terms: Arterial drip chamber, access, blood pump, transducer protector, RESET key
Recommended return demonstration: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Verbalize what to check and do in the event of a high arterial pressure alarm,
demonstrating how to reset the alarm and adjust the alarm limits
2. Troubleshoot potential causes of the alarm and solutions by referring to the alarms
troubleshooting section of the 2008K@home Users Guide
3. Verbalizes understanding of the importance of promptly addressing the alarm and the
potential consequences of not addressing it
Critical warnings, cautions and notes:
Hemolysis can occur when the arterial pressure is indicating that the access cannot supply the
blood required by the blood pump.
55
56
Key terms: TMP, ultrafiltration coefficient (KUF), dialysate pressure, Ultrafiltration rate, blood
flow rate, dialysate flow rate, dialysate line filter screen, UF Goal
Recommended return demonstration: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Verbalize what to check and do in the event of a low TMP alarm, demonstrating how to
reset the alarm and adjust the alarm limits
2. Troubleshoot potential causes of the alarm and solutions by referring to the alarms
troubleshooting section of the 2008K@home Users Guide
3. Verbalizes understanding of the importance of promptly addressing the alarm and the
potential consequences of not addressing it
Critical warnings, cautions and notes:
To keep dialysate from moving into the bloodstream, blood compartment pressure must be
equal to or greater than dialysate compartment pressure
Warning: Verify that that the TMP corresponds to the ultrafiltration coefficient (KUF) of
the dialyzer. TMP must be closely monitored with the alarm limits. The TMP may not
change substantially during UF errors when high permeable dialyzers are in use. A
fluctuating TMP may indicate a malfunction in the balancing system and could result in
UF errors and/or serious injury. If unable to reset alarm, discontinue treatment and notify
home training nurse and/or a qualified technician.
8. TMP Alarm - High (Toward 500)
Main learning concepts: Transmembrane Pressure (TMP) is the difference in pressure between
the filtrate and permeate sides of the dialyzer membrane. TMP = Dialysate Pressure Venous
Pressure and are dependent on the Ultrafiltration rate, ultrafiltration coefficient (KUF) of the
dialyzer, and the blood and dialysate flow rate.
Key Terms: TMP, ultrafiltration coefficient (KUF) dialysate pressure, ultrafiltration rate, blood
flow rate, dialysate flow rate, dialysate line filter screen, UF Goal
Recommended return demonstration: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Verbalize what to check and do in the event of a high TMP alarm, demonstrating how to
reset the alarm and adjust the alarm limits
2. Troubleshoot potential causes of the alarm and solutions by referring to the alarms
troubleshooting section of the 2008K@home Users Guide
3. Verbalizes understanding of the importance of promptly addressing the alarm and the
potential consequences of not addressing it
Critical warnings, cautions and notes:
To keep dialysate from moving into the bloodstream, blood compartment pressure must be
equal to or greater than dialysate compartment pressure
Warning: Verify that that the TMP corresponds to the ultrafiltration coefficient (KUF) of
the dialyzer. TMP must be closely monitored with the alarm limits. The TMP may not
change substantially during UF errors when high permeable dialyzers are in use. A
fluctuating TMP may indicate a malfunction in the balancing system and could result in
57
UF errors and/or serious injury. If unable to reset alarm, discontinue treatment and notify
home training nurse and/or a qualified technician.
All alarms need your immediate attention. Failure to do so may result in serious injury or
death.
59
Recommended return demonstration: Demonstrate the listed steps in the corresponding section
of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Verbalize what to check and do in the event of a high conductivity alarm, demonstrating
how to reset the alarm
2. Troubleshoot potential causes of the alarm and solutions by referring to the alarms
troubleshooting section of the 2008K@home Users Guide
3. Verbalizes understanding of the importance of promptly addressing the alarm and the
potential consequences of not addressing it
Critical warnings, cautions and notes:
Warning: The conductivity alarm is an important safety feature of your dialysis
treatment. You must fill your concentrate jugs to the top at the beginning of each
treatment. During treatment you must keep your jugs full enough so you do not run low
on concentrate. Failure to change your jugs when they run low will prevent you from
receiving your prescribed dialysis and may lead to serious injury or death
Warning: Check conductivity and approximate pH of the dialysate with an independent
device prior to initiating treatment. Verify that the machine is set for the correct type of
concentrates used. Improper dialysate composition could result in serious injury or
death. Verify that the machine goes into bypass when this alarm occurs. See Alarms and
Troubleshooting Section of the 2008K@home Users Guide. If unable to reset alarm,
discontinue treatment and notify home training nurse and/or a qualified technician.
13. Temperature Alarm - High
Main learning concepts: A temperature alarm indicates that the dialysate temperature is too
high or too low. Dialysate that is too hot can cause hemolysis,
Key terms: Hemolysis
Recommended return demonstration: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Verbalize what to check and do in the event of a high temperature alarm, demonstrating
how to reset the alarm
2. Troubleshoot potential causes of the alarm and solutions by referring to the alarms
troubleshooting section of the 2008K@home Users Guide
3. Verbalizes understanding of the importance of promptly addressing the alarm and the
potential consequences of not addressing it
Critical warnings, cautions and notes:
Hemolysis of the blood in the dialyzer may occur if the dialysate temperature goes higher than
42 C. Dialysate temperatures must be maintained below this level, do not return hemolyzed
blood.
Warning: High dialysate temperature could result in patient discomfort, hypotension
and/or hemolysis. Verify that the machine goes into bypass. Check that the machine is
set to the prescribed temperature. Discontinue treatment if unable to maintain prescribed
temperature and notify home training nurse and/or a qualified technician.
60
61
holder, a piston and an electric motor used to continuously deliver precise amounts of heparin
during dialysis.
Key terms: Heparin, anticoagulant, extracorporeal circuit, syringe, piston
Recommended return demonstration: Demonstrate the listed steps in the corresponding section
of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Verbalize what to check and do in the event of a heparin pump alarm, demonstrating
how to reset the alarm
2. Troubleshoot potential causes of the alarm and solutions by referring to the alarms
troubleshooting section of the 2008K@home Users Guide
3. Verbalizes understanding of the importance of promptly addressing the alarm and the
potential consequences of not addressing it
Critical warnings, cautions and notes:
Warning: Only use syringes prescribed by your doctor in the Heparin Pump module.
Make sure that there is enough heparin for your entire treatment. Do not load the
syringe beyond your prescribed amount.
Warning: The heparin pump is to be used only under positive pressure conditions.
Under negative pressure conditions, too much heparin may be infused.
Warning: You must select your prescribed syringe to accurately add heparin during the
treatment.
Caution: The syringe must be properly loaded for your machine to add heparin during
treatment.
Warning: If you do not enter a Stop Heparin value, the heparin pump will run at the
selected rate until the syringe is empty or your treatment is over. The heparin pump
should be monitored to make sure of proper heparin infusion.
17. Online PHT Failed Alarm
Main learning concepts: The online Pressure Holding Test (PHT) automatically checks the
2008K@home machines dialysate balancing system. The PHT runs only during dialysis when
the dialyzer is connected.
The online PHT runs about every 12 minutes regardless of other alarm conditions. During the
test, the Status Box displays the message: Running Online PHT. The UF light above the UF
on/off key also flashes. The test will run for about seven seconds as the balancing chamber
runs through two cycles. During the test, your machine is in bypass mode and the TMP alarm
limits are spread.
If your machine fails an online PHT (pressure holding test), the Status Box displays the alarm
message: Online PHT Failed. This alarm does not stop the blood pump.
Key terms: online Pressure Holding Test, PHT, UF on/off key, balancing chambers, dialyzer,
cycle
Recommended return demonstration: Demonstrate the listed steps in the corresponding section
of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
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1. Verbalize what to check and do in the event of an Online PHT Failed alarm,
demonstrating how to reset the alarm
2. Troubleshoot potential causes of the alarm and solutions by referring to Chapter 6:
Emergencies and Alarms and the alarms troubleshooting section of the 2008K@home
Users Guide
3. Verbalizes understanding of the importance of promptly addressing the alarm and the
potential consequences of not addressing it
Critical warnings, cautions and notes:
Warning: If an online PHT failure recurs, you must stop your treatment and have a
qualified technician test the hydraulics.
Note: The online pressure holding test is not a substitute for the self-test. Do not begin
dialysis until the self-test has been run.
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Section 32
Potential Problems During Dialysis
32
Main learning concepts: This section is to provide a general guide to some treatment
complications. Identifying and reporting clinical signs, symptoms or other problems is a
crucial portion of training. This must be emphasized and stressed repeatedly. Review
and discuss the signs, symptoms and response to potential treatment problems including chest
pain and shortness of breath. Stress the importance of reporting any problems to the patients
physician and home RN. Please refer to Appendix D for further information on complications of
hemodialysis.
Key terms: Hypotension, leg cramps, arrhythmias, seizure, air embolism, hemolysis, crenation,
infiltration, blood loss, allergic reaction, steal syndrome, edema
Recommended return demonstration: Demonstrate the listed steps in the corresponding
section of the 2008K@home Competency Checklist (Appendix G).
At the end of this section the patient will be able to:
1. Describe signs and symptoms associated with common intradialytic complications and
when these should be reported to the home dialysis nurse
2. Explain how to check for edema
3. Describe what to do to manage potential complications as described in Appendix D
Critical warnings, cautions and notes:
Warning: Failure to report potential problems or complications promptly to your
physician can result in severe injury or death.
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Section 33
Returning the Blood Manually Handcranking
33
Main learning concepts: During a power failure the blood pump stops and the venous clamp
closes. The dialysate flow pump, heater, blood leak detector and level detector are nonfunctional. All machine lights go out and a steady, audible alarm will sound for seven minutes.
The alarm cannot be silenced with the Mute key. The blood pump can be manually operated to
immediately return the blood to the patient, or, if power is expected to return soon, to keep the
blood in circulation.
It is imperative that the learner familiarizes himself with the steps necessary to immediately
return the blood manually or, if power is expected to return soon, to keep the blood in
circulation. Reference the procedure noted in the users guide.
Key terms: Arterial access bloodline, arterial line, arterial line clamp, blood leak detector, blood
pump, blood pump door, crank handle, detachable handle, dialysate flow pump, emergency
hand crank, hand crank spindle, handle knob, heater, latch door, level detector, recirc
65
connector, rotor, rotor latch, rotor latch slot, saline bag, venous bloodline, venous chamber,
venous clamp.
Recommended return demonstration: Locating emergency hand crank on back of machine,
ensuring sufficient saline is available for rinseback of blood (equal to at least the priming
volume), removing venous line from venous clamp (otherwise the line will remain clamped),
closing arterial clamps, disconnecting arterial access bloodline, connecting arterial line to saline
bag and opening clamps, opening latch door and flipping rotor latch outward, lining up hand
crank with rotor, sliding hand crank into place, rotating hand crank six to ten revolutions per
minute, disconnecting venous line when blood has returned.
Critical warnings, cautions and notes:
Caution: Do not forcefully pull the lines from the machine. Damage to machine or
sensors may result.
Note: As a precaution, the handle knob will detach from the crank if you attempt to turn
the rotor in the wrong direction. An arrow stamped on the blood pump module, above
the rotor, points in the correct clockwise direction of rotation.
Warning: Carefully watch the venous chamber and bloodline for air intakes. Be sure no
air enters the patient access/circulation.
Warning: Keep fingers clear of the blood pump rotor when it is turning as serious injury
may occur.
Note: During power failure, the machine safety systems are inactive. All machine lights
go out and a steady audible alarm will sound for seven minutes.
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Section 34
Potential Problems During Dialysis
34
Main learning concepts: Testing of the Diasafe Plus Filter, how to perform the Pressure Holding
Test (PHT), what to do if PHT fails.
Key terms: Pressure Holding Test (PHT), Diasafe Test
Recommended return demonstrations: The patient must demonstrate how to perform the
Pressure Holding Test and verbalize troubleshooting for failed PHT test.
Critical warnings, cautions and notes:
Warning: If your machine fails any of the tests and the cause cannot be corrected, or if
it fails later tests, it should not be used for treatment. Have your machine checked by a
qualified technician to correct the problem.
Warning: After replacing the Diasafe Plus filter, run a Heat Disinfect to disinfect your
machine.
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Section 35
Replacing the Diasafe Plus Filter
35
Main learning concepts: Identification and purpose of the Diasafe Plus Filter, how and when to
replace the filter.
Key terms: Diasafe Plus Filter, ultra-pure dialysate
Recommended return demonstrations: The patient must demonstrate the location of the
Diasafe Plus Filter on the hemodialysis machine; demonstrate the removal of the old filter and
subsequent replacement with a new filter.
Critical warnings, cautions and notes:
Warning: You must still routinely monitor the chemical and bacterial water quality.
Caution: Before inserting the new filter in your machine, remove the plastic tabs on the
Diasafe Plus filter inlet and outlet. The Diasafe Plus filter can only be used in Fresenius
hemodialysis machines fitted with Diasafe Plus Diafix lock system kits.
Instructions for replacing the Diasafe plus filter:
1. Lift lock levers on the left side of the filter mount
2. Slide the old Diasafe Plus filter up and out
3. Fit the new Diasafe filter into the groove in the top of the mount. Slide the filter down until
it snaps into place
4. Push the lock levers down to lock the filter into the mount.
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Section 36
Overview of Warnings and Cautions
36
It is important that home operators are understand the warnings in the 2008K@home Users
Guide. These should be reviewed individually by the home training nurse. Failure to
appropriately follow the warnings may result in patient injury or death. Some key warnings in the
2008K@home Users Guide are listed below. A complete list of general warnings is included in
the beginning of the users guide. Please refer to the users guide and review these warnings
with patients as part of their training.
1. Machine Set-up:
a. Warning: Make sure your machine is working correctly before beginning
your treatment. If you fail to respond to alarms, it may lead to serious injury
or death.
b. Warning: You must properly match your concentrate type to your machines
setup. Failure to do so may cause serious injury or death. Many different
concentrate types are available for use in your machine. Concentrates
contain various amounts of dextrose, potassium, calcium, sodium, chloride,
magnesium, and bicarbonate.
c. Warning: Make sure your machine is working correctly before beginning your
treatment. If you fail to respond to alarms, it may lead to serious injury or
death.
d. Warning: Use of an acid concentrate intended for a 1:44 mix ratio in any
1:34 proportioning dialysate delivery machine may result in a dialysate
solution with normal conductivity but without a physiological buffer (low pH).
There will be no alarms in this event. Use of improper dialysate solutions
may cause injury or death.
e. Warning: Your dialysate concentrate jugs must match the concentrate listed
in the Set up screens. If you use the wrong dialysate solutions, it may
cause serious injury or death. Fresenius Medical Care recommends using
the concentrate containers provided with your machine to avoid mismatching
containers.
f. Warning: Test the conductivity and approximate pH of the dialysate with an
independent device before beginning treatment. Test it also when you
change concentrates during your treatment. The wrong conductivity or pH
may cause serious injury or death.
g. Warning: You must properly disinfect your machine and test for remaining
disinfectant before every treatment day.
h. Warning: You must follow all local regulations covering the separation of
devices in the water supply. In case of drain back up; you must maintain an
air gap between your machines drain line and its drain.
i. Warning: Your machines Level Detector module must be calibrated for the
venous line being used, your machine is compatible with a number of venous
lines. Follow the instructions for adjusting the level in the venous drip
chamber. Also, visually check that the Venous Clamp is capable of fully
closing the model of bloodline you are using. Failure to do so may cause
serious injury or death.
69
j.
f.
71
when they run low will prevent you from receiving your prescribed dialysis
and may lead to serious injury or death.
h. Warning: Frequent temperature or water flow alarms may indicate a problem
with the water supply. Call a qualified technician if you have these problems.
5. Machine maintenance
a. Warning: Only qualified people from your clinic may use Service Mode. Do
not make any changes to your machine with Service Mode. If you enter the
wrong options or values, you may cause serious injury or death.
b. Warning: The water used for hemodialysis must be periodically tested to
demonstrate that it meets AAMI standards. Your water must meet all
standards to keep dialysate quality. Monitor the water source regularly to
detect changes in quality. These changes could have an unfavorable effect
on you or your machine. Regularly check for chemicals such as chlorine and
chloramines. These chemicals can harm dialysis patients.
c. Warning: Do not use the 2008K@home machine in your home if you do not
have a constant water supply with good pressure. Your water pressure must
be at least 20 psi and no more than 105 psi.
d. Warning: Never perform maintenance when a patient is connected to your
machine. If possible, remove your machine from the treatment area when it
is being serviced. Label your machine to make sure that it is not accidentally
returned to use before the service work is completed. Disinfect and test your
machine when service is done. Test the dialysate for acceptable conductivity
and pH values before use.
e. Warning: Do not install the 9-Volt battery backwards in your machine, it will
damage your No Power alarm.
f. Warning: Shock hazard. Do not remove machine covers. Refer servicing to
qualified personnel. The electrical source must be single phase, threeconductor type provided with a hospital grade receptacle and a ground fault
interrupter at 120 Volts, 15 Amps, 60 Hz. The proper polarity and ground
integrity must be initially checked and maintained. Plug your machine directly
into the electrical outlet; do not use extension cords or power strips.
g. Caution: Only qualified people authorized by your clinics medical director or
by Fresenius Medical Care may assemble, install, adjust, or repair your
machine.
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Section 37
Servicing the Fresenius 2008K@home Machine
37
The Fresenius 2008K@home machine must be serviced only by authorized and trained
personnel. It must be emphasized that patients are not authorized to repair the machine and
must contact an authorized person. Failure to follow these instructions can result in patient
injury. Patients should be instructed on the availability of support services and provided with
instructions both verbally and in writing regarding how to access and use these resources. The
2008K@home Users Guide includes the following information for contacting technical services:
73
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Arterial Drip Chamber Chamber within the extracorporeal circuit were arterial
pressure is monitored. A bubble trap inside the drip chamber collects any air that enters
the blood tubing.
Arterial Drip Chamber Holder Semicircular piece on the module that secures the
arterial drip chamber in place
Arterial Inflow the flow of arterial blood into a fistula.
Arterial Line Part of the extracorporeal circuit that is involved with transporting the
patients blood to the dialyzer.
Arterial Line Clamp Clamp positioned on the arterial blood line.
Arterial Pressure Port The pressure port houses a pressure transducer that monitors
arterial tubing pressure.
Arterial Side of Dialyzer The end of the dialyzer where the patients blood enters to
be dialyzed.
Aseptic Technique Series of steps necessary to prevent microbial contamination of
patient or environment.
Auto Flow Rate A ratio of dialysate flow to blood flow based on the dialysis
prescription, for example 2x dialysate auto flow with a blood flow of 400ml/min would be
800 ml/min.
Back Pain Pain located in the posterior regions of the trunk, including the thoracic,
lumbar, sacral, or adjacent regions.
Balancing Chambers The hydraulic chambers inside your machine that control the
volume of dialysate. The chambers make sure that the amount of fresh dialysate
entering the dialysate flow is equal to the amount of used dialysate being drained.
Base Na+ The prescribed sodium level for the dialysate. The default Na+ value is
carried over from the value displayed in the Na+ parameter-button in the Rx
Parameter screen.
Bicarbonate A buffer used by the body to neutralize acids that form when the body
breaks down protein and other foods.
Bicarbonate Jug Container used for storing bicarbonate.
Biofilm Biological residue from treatment that collects on machine drain lines.
Bleeding Escape of blood from a vessel.
Blood Circuit Component of the dialysis system that is enclosed within the arterial
blood line, dialyzer fibers and the venous blood line. It is also referred to as the
extracorporeal circuit.
Blood Clotting Time the time is takes for blood to clot.
Blood Flow Rate See blood pump speed.
Blood Leak Detector An alarm system that monitors used dialysate for blood or air
that would indicate a leak in the dialyzer membrane.
Blood Line Set Part of the extracorporeal circuit that carries blood from the patients
vascular access through the arterial needle or catheter port, to the dialyzer, and back to
the patient through the venous needles or catheter port. There are two segments of
75
blood tubing: arterial (red connector colored) and the venous (blue connector colored).
Other components of the blood tubing include patient connectors, dialyzer connectors,
arterial and venous drip chambers, blood pump segment, heparin and saline infusion
lines.
Blood Pump Part of the hemodialysis delivery system that moves the patients blood
through the extracorporeal circuit at a fixed rate of speed when the blood pump
segment is threaded between the pump head and the rollers.
Blood Pump Door Cover of the blood pump.
Blood Pump Housing Component that holds the blood pump rotor and tubing
guides.
Blood Pump Speed Prescribed rate of blood programmed on the blood pump.
Blood Sensed The venous line runs through an Optical Detector above the Venous
Clamp. When the clear bloodline tubing is opaque, your machine uses this Blood
Sensed information for a number of alarms, informational messages, or warnings.
Blue Bicarbonate Connector Device used to connect to the bicarbonate jug.
Blue Recirc Connector Part of the extracorporeal circuit used when returning venous
blood to the patient.
Bolus A relatively large, single dose.
Bruit The buzzing or swooshing sound caused by the high-pressure flow of blood
through a patients fistula or graft.
Button Certain identified sites on the Touch Screen that, when touched, will cause a
specific action by the software.
Bypass Mode Bypass mode occurs when the dialysate conductivity or temperature
goes outside alarm limits. In bypass mode, valves inside your machine redirect the flow
of dialysate to bypass the dialyzer internally until temperature and conductivity are back
within acceptable limits.
Cannulation to insert fistula needles into a fistula or graft for dialysis.
Caution Statement that identifies conditions or actions that could result in damage to
the machine.
Chemical Rinse The Chemical/Rinse program disinfects your machine by rinsing it
with water, chemical disinfectant, and water again. You should run a Chemical/Rinse
weekly.
Chemical Disinfect Jug Container for bleach during the chemical rinse.
Chest Pain Pressure, burning, discomfort, or numbness in the chest.
Clean Technique Series of steps necessary to prevent contamination of patient or
environment. It includes, but is not limited to, using clean gloves and hand washing.
Clearance The rate at which waste products in the blood are removed by dialysis.
Coefficient A numerical measure of a physical or chemical property that is constant
for a system under specified conditions.
Conc. Abbreviation for concentrate.
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Concentrate One of two salt solutions (acid and bicarbonate) that are mixed together
with purified water to form dialysate.
Concentrate Connectors Color-coded plastic connectors located on the front panel
to connect acid and bicarbonate concentrates. The red connector is for acid concentrate
and blue connector for bicarbonate concentrate.
Conductivity The ability of a fluid to transfer electrical charge as a measurement of
ions in a solution.
Conductivity Meter Measures the electrolyte composition of dialysate to ensure it is
within safe limits for use.
Contraindication Symptom, condition or circumstance that renders the use or a
remedy or procedure inadvisable, usually because of a risk.
Control Panel Top front portion of the machine consisting of a touch screen, various
keys and data entry keypads used to operate the 2008K@home machine.
Convulsion Violent involuntary contraction or series of contractions of voluntary
muscles. Also known as seizure.
Corrosive Slow disintegration or wearing away of something by a destructive agent.
Cramping A sudden, involuntary, spasmodic muscular contraction causing severe
pain, often occurring in the leg or shoulder. Painful muscle cramps often in the hands
and feet may result from removal of too much fluid, changes in blood chemistry,
especially sodium, low potassium levels and hypotension.
Crenation Conversion of normally round red blood cells into shriveled, irregularly
shaped forms that occurs if the blood is exposed to a solution that is more concentrated
than blood.
Delivered Dose of Dialysis The amount of clearance of urea expected to be
completed following the dialysis prescription.
Dialogue Box Text box in the top right corner of the screen that shows patient
information and instructs the operator for certain actions.
Dialysate Solution used to diffuse and clear waste from your bloodstream through the
dialyzer. It consists of the acid and bicarbonate concentrates mixed together with
purified water.
Dialysate Circuit Component of the dialysis system that is enclosed within the
hydraulic system and the dialysate compartment (outside the fibers) of the dialyzer.
Dialysate Flow Rate A prescribed ml/min flow of the dialysate through the dialyzer.
Dialysate Line Filter Screen A small screen inside the dialysate connector to filter
concentrate
Dialysate Pressure Pressure or force within the dialysate side of the dialysis system.
It is used in conjunction with venous pressure to measure TMP (Transmembrane
Pressure).
Dialysis The passage of a solute through a membrane.
Dialysis Dementia Deteriorative mental state that may occur during dialysis. Dialysis
dementia can be caused by chronic exposure to aluminum salts.
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Dialyzer The device used to filter and diffuse waste from your bloodstream using
semi-permeable membranes.
Dialyzer Clotting related to sustained blood pump alarms or less that required
anticoagulation that caused the blood to clot in the dialyzer.
Dialyzer Quick Connectors Color-coded metal pieces to securely attach the dialyzer
to the dialysate lines. The blue connector delivers fresh dialysate and is attached to the
venous end of the dialyzer. The red connector sends spent dialysate to the rest of the
hydraulic system and is attached to the arterial end of the dialyzer.
Dialyzer Reaction can be caused by a reaction to ethylene oxide or other chemicals
in the system with symptoms occurring in the first 15 30 minutes of treatment that
include itching, chest and or back pain, shortness of breath, hypotension, nausea and
general discomfort.
Dialyzer Ultrafiltration Coefficient Ultrafiltration constant. The fixed amount of fluid
a dialyzer will remove from the patients blood per hour at a specified pressure. A
dialyzers ultrafiltration coefficient is included with its instructions. See also KUF.
Diasafe Plus A filter for your dialysis machine that filters the dialysate solution further,
removing even the smallest bacteria and pyrogen to deliver ultra pure dialysate.
Diasafe Test A test to verify integrity of the Diasafe Plus filter. This is automatically
performed after chemical disinfectant rinse.
Diastolic Pressure The lower blood pressure number of the two, it describes the
bloods pressure just before the next heartbeat.
Diffusion The movement of dissolved particles across a semi-permeable membrane
from an area of higher solute concentration to an area of lower solute concentration.
This process continues until the concentration of solutes on both sides of the membrane
are equal. In dialysis, the diffusion process removes wastes from the blood.
Dim button Method to darken the display screen like a screen saver.
Disequilibrium Syndrome can occur when the BUN is removed much faster from the
blood than from the brain, when disequilibrium occurs and the fluid moves into the brain
cells causing swelling. The symptoms are headache, nausea, hypertension,
restlessness, confusion, blurred vision and seizures.
Disinfection The process that destroys or slows the growth of harmful microbes.
Display Screen A viewing screen located in the middle of the control panel.
Drain Bag Device used when priming the dialyzer to collect saline.
Drip Chamber Used to collect air in the arterial and venous chambers.
Dry Weight Patients weight without excess fluid.
Edema Accumulation of an excessive amount of fluid in or around tissues or cells.
Electrolytes Ions or electrically charged molecules in the bloodstream that are
needed for various functions in the body, including nerve cell transfer signals. Healthy
kidneys maintain constant, healthy levels despite changes in exercise and diet.
Electrolyte (Imbalance) Disturbance is an abnormal change in the levels of
electrolytes in the body, usually constituting a medical emergency. Severe or prolonged
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Hemodialysis The procedure carried out by your machine that separates the waste
products and excess water artificially from your blood by diffusion and ultrafiltration.
Hemolysis Rupture of red blood cells. This may be caused by hyponatremia (low
blood sodium), dialysate that is too hot or too dilute (hypotonic), chloramines, copper, or
nitrates in dialysate water, bleach in the dialysate, low dialysate conductivity, too-high
arterial pressure or kinked blood tubing.
Hemorrhage Abnormal bleeding, either internal or external.
Heparin A chemical naturally found in the liver that prevents blood from clotting.
Heparin Line Clamp Clamp positioned on the heparin line.
Heparin Pump A component of the dialysis delivery system that delivers heparin at a
prescribed rate.
Hydraulic System The lower third of the dialysis machine that houses the
water/dialysate circuit and controls ultrafiltration.
Hyperparathroidism Primary hyperparathyroidism is a disorder of the parathyroid
glands, also called parathyroids. "Primary" means this disorder originates in the
parathyroids: One or more enlarged, overactive parathyroid glands secretes too much
parathyroid hormone (PTH). In secondary hyperparathyroidism, a problem such as
kidney failure causes the parathyroids to be overactive.
Hypertension Is high blood pressure, readings > 140 mm Hg systolic and 90 mm Hg
diastolic pressure are considered high blood pressure. Can be related to fluid overload,
patients missing their blood pressure medication, anxiety or disequilibrium syndrome.
Hyperthermia Abnormally high body temperature.
Hypervolemia Abnormally increased volume of circulating blood in the body.
Hypotension Is low blood pressure and occurs most often when too much fluid is
removed during dialysis. Symptoms include sever muscle cramps, headache, feeling
warm, restless, dizzy, faint or nauseated.
Hypothermia Abnormally low body temperature.
Hypovolemia Abnormally decreased volume of circulating blood in the body.
Hypoxia Clinical manifestation of respiratory distress consisting of a relatively
complete absence of oxygen.
Infection Invasion and multiplication of microorganisms in body tissues, which may
be clinically unapparent or result in local cellular injury.
Infiltration In dialysis, this is refers to the dislodgment of the fistula needle from the
patients access and blood being injected into the surrounding tissues.
Inflation Pressure The amount of pressure in the blood pressure cuff when taking a
blood pressure reading.
Keys Located on the Control Panel and on various modules, keys are used to enter
numbers, confirm selections on the Touch Screen, and activate certain machine
functions.
Kilogram Measure of weight, 2.2 lbs = 1 kg (kilogram).
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KUF Ultrafiltration constant. The fixed amount of fluid a dialyzer will remove from the
patients blood per hour at a specified pressure. A dialyzers KUF is included with its
instructions. See also Dialyzer Ultrafiltration Coefficient
Level Adjust Ability to raise the level within either the venous chamber or the arterial
chamber.
Level Detector Module Component of the dialysis delivery systems that holds the
venous drip chamber in place and utilizes an ultrasonic sensor to detect a deficiency in
the fluid level within the venous drip chamber.
Long Power Down Turning off your machine for longer than two minutes. Certain
information stored in machine memory is lost after two minutes and some treatment
parameters are reset to their default settings. Power failures are not the same as long
power downs, where treatment information is saved. See also Short Power Down and
Power Failure Recovery.
MAP (Mean Arterial Pressure) The average pressure your blood vessels experience
as your heart beats.
Maximum UF Volume Value set in service mode with the maximum value of 4000
ml/hour for fluid removal.
Medication Clamps Clamps on the medication administration lines.
Meter Box Box that displays screen-specific information like timers and dates.
Military Time Time measured in hours numbered to twenty-four (as 0100 or 2300)
from one midnight to the next. For example, 00:00 is midnight and 13:00 is one
oclock PM.
Module Compartment Middle front section of the machine which houses the different
modules such as the blood pump, heparin pump, level detector, etc.
Nausea An unpleasant sensation in the stomach usually accompanied by the urge to
vomit.
Note Advisory comments or recommendations regarding practices or procedures.
Onesiteitis Term used to describe the act of cannulating in the same small area of an
access and can lead to aneurysm or pseudoaneurism development.
Optical Detector Located on the Level Detector module that senses whether or not
the venous line is filled with blood. See also Blood Sensed.
Osmosis The movement of fluid across a semi-permeable membrane from an area of
lower solute concentration (blood) to an area of higher solute concentration (dialysate)
until the concentrations on both sides of the membrane are equal.
Parameter-Button A button on the Touch Screen that displays the changeable value
it controls through software.
Pathogenesis The development of a disease or morbid condition.
Permeate To penetrate or pass through, as through a filter or the RO water that has
already passed through a filter.
pH The hydrogen ion concentration of a solution. A solution with a pH above 7 is
alkaline (base). A solution with a pH below 7 is an acid.
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83
minutesafter that, it is erased. See also Long Power Down and Power Failure
Recovery.
Shunt Door Opening to the device that connects the dialysate lines when not in use.
Shunt Interlock Located on the right side of your machine, it is the device that
connects the dialysate lines when they are not in use. Audible alarms may be silenced
when the dialysate supply lines are on the shunt (unless the Optical Detector senses
blood).
Sodium Chief cation of the extracellular body fluids. Its salts are the most widely used
in medicine. Physiologically the sodium ion plays a major role in blood pressure
regulation, maintenance of fluid volume, and electrolyte balance.
Status Box The Status Box is located in the top, left corner of the Touch Screen. It
displays various operational modes, warnings, alarms, or operator instructions. The
Status Box background changes between three different colors to display your
machines conditions.
Steal Syndrome Pain or weak pulse in affected limb caused by shunting of normal
arterial blood supply through the access thus depriving distal extremity of needed
oxygenation.
Stenosis The narrowing of a blood vessel. Stenosis slows the flow of blood and
causes turbulence inside the vessel.
Sterile Free from living microorganisms.
Stethoscope A medical instrument for listening for sounds within the body.
Syringe Instrument used for injecting or withdrawing fluids.
Systolic Pressure The higher blood pressure number of the two, it is the bloods
pressure during a heartbeat.
Temperature Alarm Indicates that the dialysate temperature is too high or too low.
Dialysate that is too high can cause hemolysis. Too cool dialysate can cause patient
discomfort and reduce the efficiency of the treatment.
Theoretical Conductivity (TCD) The approximate conductivity of the dialysate based
upon the concentrate type, and sodium and bicarbonate values entered in the Dialysis
Home screen. TCD is measured in milliSiemens per centimeter (mS/cm) and is
corrected to 25C.
Thrill The vibration of blood flowing through the patients fistula or graft. It can be felt
by touching the access.
TMP (Transmembrane Pressure) The difference in pressure between the filtrate and
permeate sides of the dialyzer membrane. TMP = Dialysate Pressure Venous
Pressure.
Transducer An electronic sensor in your machine that reads the pressure inside the
arterial and venous drip chambers. Transducers are connected to the drip chambers
through pressure monitor lines.
Transducer Protector A small, disposable, plastic cap containing a hydrophobic
paper filter that fits over each pressure port. Inserted between the pressure monitor line
and the pressure port connection, it is used to prevent the transducer from becoming
84
wet or contaminated with blood. There are two transducer protectors for each
connection: a disposable external TP that is to be replaced with each treatment and a
second, internal TP that comes installed with the module.
Tubing Guides Components on the blood pump module to properly align the blood
pump segment within the blood pump module.
Tx Abbreviation for treatment.
Tx Clock The amount of time remaining until the end of the treatment. The Tx Clock
is viewable in the Dialysis Home screen as a pie chart button.
Tx Paused Indicator that treatment is paused.
Tx Running Indicator that dialysis is in progress.
UF Abbreviation for Ultrafiltration.
UF Goal Total amount of fluid to be removed during the treatment.
Ultrafiltration The process of drawing off excess fluid from the patient during
treatment. Your machines hydraulic system is a closed system that uses a separate
UF pump for greater measured accuracy.
Ultrasonic Sensor Used to sense fluid in the venous chamber.
Urea Dissolved protein waste product.
Users Guide Set of instructions on the proper use of the 2008K@home machine.
Venous Access Route used to return dialyzed blood back to the patient.
Venous Drip Chamber Chamber within the extracorporeal circuit where venous
pressure is monitored. A bubble trap inside the drip chamber collects any air that enters
the blood tubing.
Venous Line Clamp Metal piece on the level detector module that clamps the venous
line when there is a blood alarm to prevent blood from being delivered to the patient.
Venous Outflow The flow of blood leaving a fistula.
Venous Pressure The pressure within the venous drip chamber of the extracorporeal
circuit.
Venous Pressure Port Opening on the level detector module to monitor venous
pressure.
Venous Side of Dialyzer The end of the dialyzer returning the dialyzed blood back to
the patient.
Vinegar Acid used for the Acid Rinse Cycle.
Vomiting The forcible expulsion of the contents of the stomach through the mouth.
Warning Statement that identifies conditions or actions that could result in personal
injury or loss of life.
Your K Map Map for patient to navigate the 2008K@home machines modules and
control panel.
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WHAT IS HEMODIALYSIS?
The option you chose to manage your kidney disease is hemodialysis. During a hemodialysis
treatment, your blood is continuously moved between your body and the hemodialysis system.
Your blood is drawn into the system and passed through a dialyzer or artificial kidney. The
dialyzer is sometimes called the artificial kidney because it performs three of the functions that
healthy kidneys perform. The dialyzer:
Removes the excess fluid that builds up in your body (cardiovascular system, tissues,
and lungs) in between treatments
Removes the toxins that build up in your body from the byproducts of the food you eat
and from the normal breakdown and repair of muscle and tissue helps to readjust your
body chemistry closer to normal values - things like your blood potassium, sodium,
phosphorus, and acid base balance
How the Dialyzer Works
The processes that occur inside the dialyzer are actually quite interesting. As your blood enters
the top of the dialyzer, it is channeled into thousands of tiny fibers or straws that are the size of
a human hair. The dialyzer fibers are surrounded by a solution called dialysate. Dialysate is
made up of purified water and prescribed chemicals that help correct your body chemistry and
carry away the waste products that come out of your blood. Even though the dialysate
surrounds the fibers containing your blood, the blood and dialysate never come into direct
contact with each other. The fibers are semipermeable - that is, they allow impurities to go out
but keep the good things, like blood cells and proteins, in. The dialyzers semipermeable fibers
allow excess fluid and impurities to move out of your blood and into the dialysate. The three
processes that take place inside the dialyzer that make this happen are diffusion, osmosis,
and ultrafiltration.
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High Temperature
The oral temperature of dialysis patients can often be below the normal ranges for healthy
adults and for older adults. Kidney disease and dialysis treatments can change the bodys
normal fever response - your temperature reading could be on the high end of the normal range
for a healthy adult but be a sign that you have an infection.
Possible Causes
Infection In Your Vascular Access
Cold Or Flu
Nausea Or Vomiting
Open Sores Or Wounds
Response
Follow your clinics recommendations. They may include the following:
Notify your home training staff if your temperature is above normal before you start
treatment.
Start medications as ordered by your doctor.
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What is Hypertension?
High blood pressure is called hypertension. Current guidelines define high blood pressure as a
pressure greater than 130/90.
Symptoms
There are often no symptoms of high blood pressure, but symptoms can include headache,
blurred vision, and flushing.
Possible Causes of High Blood Pressure:
Unusually High Stress
Failure To Take Blood Pressure Or Heart Medications As Ordered By Your Doctor
Greater Than Normal Weight Gain Between Treatments
Eating A Lot Of Salty Foods Between Treatments
Over-The-Counter Medications
Drinking Alcoholic Beverages
Response
Follow your clinics recommendations. They may include the following:
Notify your home training staff or doctor if your blood pressure is above normal before
you start treatment.
Have a record of previous blood pressure readings available when you contact your
home training staff or doctor.
Have a list of your current medications (prescription and over-the-counter) available
when you contact your home training staff or doctor. Let them know if you have missed
or changed any of your medication doses in the past 48 hours.
2
What is Hypotension?
Low blood pressure is called hypotension. Current guidelines define low blood pressure as
less than 90/50.
Symptoms of Hypotension
Signs and symptoms include: dizziness, sweating, feeling of illness/uneasiness/restlessness,
ringing in the ears or decreased hearing, nausea, vomiting, change in level of alertness, chest
pain or tightness, change in skin tone to pale, or seizures.
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Possible Causes:
Incorrect dosage of blood pressure or heart medications
Removing too much fluid during treatment
Rapid change in position
Weight loss between treatments caused by nausea,
Vomiting, or diarrhea
Response
Follow your clinics recommendations. They may include the following:
Notify your home training staff or doctor if your blood pressure is low before you start
your treatment.
Administer saline during treatment as needed.
Set the system to remove the minimal UFR.
Drink additional fluids before and during your treatment.
Have a record of previous blood pressure readings and a list of your current medications
(prescription and over-the-counter) available when you contact your home training staff
or doctor. Let them know if you have missed or changed any of your medication doses in
the past 48 hours.
Tips for Taking Your Blood Pressure
Take your blood pressure in the same sitting position.
The cuff must fit correctly to your arm. A tight cuff can give a false high blood pressure
reading, and a large cuff can give a false low blood pressure reading.
If signs or symptoms of hypotension occur when you are sitting or lying down, dont get
up. Call for help and treat the signs and symptoms of hypotension before you change
position. If you are standing, sit down.
If your first blood pressure check is high or low, wait for about 10 minutes and then take
your blood pressure again. When you take your blood pressure the second time, make
sure the cuff is placed directly on your skin and is positioned correctly on your arm.
If you have questions about your blood pressure monitor refer to the 2008K@home
Users Guide that you will use once your training is complete and you are at home.
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The most common place to feel the pulse is on your wrist over your radial artery. Move
your fingertips around your wrist - stopping for a few seconds in each area to try to feel
your pulse. Continue moving from area to area on your wrist until you find an area where
you can easily feel your pulse.
Try holding your arm pointing toward the floor -sometimes your pulse is easier to feel
with your arm down than when your arm is pointing up.
You can take your pulse over your vascular access.
Try changing the pressure of your fingertips on your wrist- try increasing the pressure
and decreasing the pressure by small amounts.
Be sure to count your pulse rate for 1 full minute.
If your pulse rate is low or high, rest for 10 minutes and take your pulse again.
PROCEDURE
Taking Your Pulse
STEP 1 Locate your radial artery on the inside of your wrist on the thumb side.
STEP 2 Place two fingers of one hand over the radial artery on your opposite wrist. Dont press
too hard, just hard enough to feel your heartbeat.
STEP 3 Count the heartbeat for 1 full minute - use a watch or a clock with a second hand for
timing.
STEP 4 The number of beats you counted in 1 minute equals your pulse rate.
STEP 5 Skipped or irregular beats can occur if your heart rate is irregular. If the beats occur at
an irregular interval, make a note that your pulse was irregular when entering your pulse rate on
your flowsheet.
Wearing shoes when you normally weigh yourself without shoes - or wearing heavier
shoes than normal
Wearing heavier clothing than normal
Scale not level
Response
Follow your clinics recommendations. They may include the following:
Verify that you are weighing yourself with the same amount of clothing and wearing the
same type of shoes as normal.
Verify that the scale is level.
Remove the maximum fluid your can tolerate in a single session - Ask your doctor if
there is a specific maximum amount of fluid you can remove in a single treatment.
Monitor your fluid gain closely between this treatment and the next, and try to reach your
goal weight in the next treatment.
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Serious
Common
Less Serious
Hypotension
Headache
Dialyzer reaction
Nausea/vomiting
Electrolyte disturbance
Cramping
Uncommon
Hemolysis
Febrile reaction
Itching
Bleeding
Chest/back pain
Seizures
Air embolism
Hypoxia
Arrhythmia
Dysequilibrium Syndrome
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Important Definitions
Aseptic Technique
Aseptic technique refers to the practices that help reduce the risk of infection. The
transfer of germs is prevented by keeping the number of germs to a minimum.
Aseptic techniques include:
Removing or killing bacteria or viruses on hands and objects
Preventing direct contamination of materials and supplies
Using sterile products to maintain a sterile fluid pathway
Reducing the risk of exposure to patients and caregivers to potentially infectious blood
and tissue during treatment
Using clean nonsterile gloves when contact with bloodborne pathogens is possible
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Universal Precautions
Universal precautions is an approach to infection control that assumes that all human blood and
body fluids are infectious. Using universal precautions when performing dialysis involves using
barriers to prevent the exposure of caregivers to bloodborne pathogens from patients when a
blood or body fluid exposure is likely to occur.
Barriers used in standard universal precautions include:
Fluid-resistant barrier gown
Clean, nonsterile gloves
Mask and eye protection or face shield
Warning Statements
The following warning statements should be reviewed with each patient regarding the
procedures that requires using aseptic technique or universal precautions.
WARNING: Use aseptic technique when handling blood or dialysate tubing, treatment
fluids, or connecting to the system to prevent and control the possibility of infection.
WARNING: Universal precautions should be used during the use and maintenance of
the Fresenius 2008K@home machine for dialysis treatment to reduce the risk of
exposure to bloodborne pathogens.
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STEP 2 Lather your hands with soap, and rub your hands together vigorously. Scrub
your hands, in-between your fingers, and under your fingernails, for about 20 seconds.
STEP 3 Rinse your hands with warm water. Let the water run from the tips of your
fingers down to your hands. After you wash your hands, you must be very careful not to
recontaminate your hands by touching any objects in the washroom.
STEP 4 Leave the water running while you dry your hands with a clean towel. Use the
towel to turn off the faucets on the sink.
The second step in preparing your access is to put on gloves. You must use
aseptic technique when preparing your access and connecting to the Fresenius
2008K@home machine. This will help prevent bacteria on your skins surface
from being pushed into your bloodstream by the needle.
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The first step in preparing your access is washing your hands and your vascular
access site.
The third step in preparing your access is to check your access and the area
around your access. The steps for checking your access are slightly different for
fistulas or grafts - please read the appropriate section for your type of access.
FISTULAS (AVF)
LOOK
Check the entire length of your fistula and old puncture sites for signs of infection.
Specifically you should look for redness, swelling, drainage, tenderness, or bruises. It is
normal for the buttonhole site to have a small scab.
Check your vein to make sure it is healthy. You will need a 1-inch straight segment of
vein to cannulate with the 1- inch fistula needle. You should look for a well-developed,
main vein outflow of the fistula. Make sure there are no bulging vein areas. Bulging
areas are aneurysm formations and must not be used for needle cannulation.
Raise your vascular access arm. Your entire fistula should flatten and become soft. If
your fistula does not flatten and stays enlarged, this means there is a narrowing in the
vein (stenosis) somewhere between the area where your fistula was made and your
heart. Notify your home training staff if you note this change in your fistula.
Remember: if your gloves become contaminated (by touching your face, hair, furniture,
the dialysis system, or any other surface), change your gloves immediately before
proceeding.
LISTEN
Using a stethoscope, listen for the bruit. The bruit is the low-pitched, continuous swishswish sound you hear with the diastolic and systolic phases of your blood pressure. The
bruit is strongest at the arterial inflow and weakens as you move your stethoscope up
the vein.
If the bruit has a high pitched, interrupted swish-swish sound, it may be an indication of
stenosis, a narrowing within the fistula or in the vein leading all the way back to your
heart.
If you think that you may have a problem with your fistula, contact your home training
staff for instructions.
FEEL
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Using your second and middle fingers, feel your fistula. Your fistula should feel soft and
be easy to compress with your fingers. You should feel a buzzing sensation, which is
called the thrill. The thrill is strongest at the arterial inflow and weakens as you move
your fingers up the vein.
If the thrill feels strong and pulse-like, and the vein is firm instead of soft, it may be an
indication of stenosis. Feel the fistula for tenderness or warmth, which may indicate that
you have an infection.
If you are concerned that your fistula feels different than normal, contact your home
training staff.
GRAFTS (AVG)
LOOK
Check the entire length of your graft and old puncture sites for signs of infection.
Specifically you should look for redness, swelling, drainage, tenderness, or bruises.
Inspect the graft to make sure it is healthy. You will need a 1-inch straight segment of
graft to cannulate with the 1- inch fistula needle. You should look for a healthy graft that
is well-defined and regular in shape. It will not contain any pseudoaneurysm formations
(large bulging areas that cannot be used for cannulation).
LISTEN
Using a stethoscope, listen for the bruit. The bruit is the low-pitched, continuous swishswish sound you hear with the diastolic and systolic phases of your blood pressure. The
bruit is strongest at the arterial inflow and weakens as you move your stethoscope up
the graft.
If the bruit has a high pitched, interrupted swish-swish sound, it may be an indication of
stenosis, a narrowing within the graft or in the vein leading all the way back to your
heart.
If you think that you may have a problem with your graft, contact your home training staff
for instructions.
FEEL
Using your second and middle fingers, feel your graft. Your graft should feel round and
smooth and free from dips or indentations on the surface. It should not feel soft or
mushy. If your graft feels soft, this can be an indication of onesite- itis and lead to the
formation of a pseudoaneurysm.
You should feel a buzzing sensation, which is called the thrill. It is strongest at the
arterial inflow and weakens as you feel the graft at the venous outflow.
If the thrill feels strong and pulse-like, it could be a sign of stenosis. The change in the
thrill can be felt over the area where the narrowing has occurred if it is within the body of
the graft itself. If the narrowing is in the outflow vein, the entire graft will have a strong,
pulse-like thrill.
Feel the graft for tenderness or warmth, which may indicate that you have an infection.
If you are concerned that your graft feels different than normal, contact your home
training staff.
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Never insert needles into an access that looks infected. Bacteria can quickly enter your
bloodstream through an infected access. Contact your home training staff or doctor
immediately if you suspect an infection.
A change in the sound of the bruit may indicate a problem. A decrease in the thrill or in
the bruit should be immediately reported to your doctor and home training staff.
You can evaluate your fistula or graft for Steal Syndrome. Your fistula or graft changes
the normal blood flow to your hand, which can lead to Steal Syndrome. If your hands
begin to hurt, become cold or blue, and the movement and sensation in your fingers is
decreased, notify your home training staff.
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STEP 1 Wash your hands and access area with germicidal soap and water.
STEP 2 Put on a pair of gloves and personal protection equipment.
STEP 3 Prepare the saline medication port on the I.V. bag with the alcohol prep pads,
and fill both of the syringes with 8 ccs of normal saline solution.
STEP 4 Open the needle package and place it on a clean work area.
STEP 5 Attach the syringes to the end of each fistula needle tubing, but do not prime the
needles.
STEP 6 Place an underpad under your access arm.
STEP 7 Check the vascular access area for any signs or symptoms of infection. If the
thrill is not present or is weak, stop and notify your home training staff.
STEP 8 Clean the insertion site using aseptic technique and cleanser recommended by
your dialysis clinic. Using a back and forth motion, wet the treatment area for 30
seconds. Do not touch the site after it has been cleaned. (If you touch the site after it has
been cleaned, you must reprep the site.)
STEP 9 Take off your gloves and put on a new pair.
STEP 10 Apply a tourniquet to your arm above the insertion site. (You do not need a
tourniquet if you have a graft).
STEP 11 Anchor the vein or graft between the thumb and forefinger to prevent
movement.
STEP 12 Insert the needle, bevel-up, at a 45-degree angle for a graft or at a 35- (or less)
degree angle for a fistula. Advance the needle until blood is seen in the tubing and or a
decrease in resistance is felt. Level the needle and advance into the vessel.
STEP 13 Check for the blood flashback (you may need to release the needle clamp to
see the blood flashback) and, if visible, pull back 1 to 5 ccs of blood with the 10 cc
syringe. Flush the needle with saline and clamp. The needle must pull back and flush
with ease. If not, reposition the needle.
P/N 490167 Rev A
STEP 14 Apply a bandage over the insertion site and tape down the needle. Repeat
steps for second needle
Check the skin over and around your access. Signs and symptoms of an access
infection can include fever, skin redness, drainage, pain, or warmth to the touch over or
surrounding the access. Report any signs or symptoms of an access infection to your
home care staff.
Check your access thrill two times per day. A decrease in the strength of the thrill could
mean that the blood flow inside the access has clotted. Call your home care staff right
away.
To prevent blood flow from decreasing, do not wear tight jewelry or tight clothing over
the access, and do not carry heavy items over your access arm.
Pre-Dialysis Care
Check your access thrill. Report any changes before the access is used for treatment.
After the needles are inserted for treatment, ensure that the tape has not been wrapped
too tightly around your access (this will cause the thrill to decrease).
If you notice symptoms of infection, notify your home care staff before your access is
used for treatment.
Wash your access arm with soap and water.
Your arm should be prepped with a cleaning solution right before needles are inserted.
Post-Dialysis Care
When the needles have been removed, hold direct pressure on the access site for at
least 5-10 minutes. Wait until the skin and the hole in the vein have stopped bleeding
before you place a dressing over the site. The access thrill should be present while you
are holding your needle sites and after the bleeding has stopped.
The dressing from the needle sites should be removed in the timeframe per facility
protocol. Check your access for signs or symptoms of infection. Report any signs to your
home care staff.
You will be carefully trained to open your TDC to make the connections to the blood tubing.
Anytime the TDC has the clamps and caps opened, you can be at risk to get an infection. You
will be trained to use the proper infection control techniques when using your TDC for dialysis
treatment and changing the dressing over the catheter.
Daily Care
Dressing Check:
Inspect the dressing to make sure it covers the TDC exit site.
Make sure the catheter clamps and caps are closed at all times.
If your dressing becomes wet or loose, refer to your unit specific instructions.
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Your TDC site may not be visible through the dressing, so your exit sites should be
checked with each dialysis treatment for any signs or symptom of infection by the
dialysis care team.
Report any fevers, night sweats, general weakness, nausea or a general feeling of
malaise (discomfort, uneasiness). Infections can become severe in a short period of time
if bacteria enters the blood stream through your TDC.
You and your dialysis nurse should wear a surgical mask anytime your TDC has the
dressing changed or the caps are removed for use. This prevents germs from entering
the TDC area.
Never let anyone use your TDC for any reason other than dialysis without notifying
your nephrologist first.
The EMS and emergency room staff should not use the TDC to draw blood or give you
IV fluids.
If your TDC should move out of your vein or fall out of your skin, place direct pressure on
the skin site with the palm of your hand and call for help.
Facility trainer:
Address:
Student:
City:
In-service specialist:
State:
Warning:
Zip:
Date of training:
The facility trainer or student must read and understand the users guide including all Warnings and Cautions
statement.
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Entering Prescription
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Setup
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test
2. Touch Start Test and press CONFIRM to begin testing
machine
3. When Status Box reads Test Complete, press RESET to
clear message
4. Touch Done button to go to the next screen
5. Explain steps required to retest machine after failed test
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into pump
a. Open blood pump door, press and hold Start/Stop
key until blood pump stops (to align for placement of
blood pump segment)
b. Firmly insert left side of pump segment into pump
housing and make sure hard plastic piece is below
housing
c. Press and hold Start/Stop key until pump segment is
fully loaded and blood pump stops
6. Remove Tape 2 and connect arterial line to bottom of
dialyzer
7. Insert line into tubing guides and explain risk of kinked lines
8. Touch Done button to go to the next screen
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of saline
7. Touch Done button to go to the next screen
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1. Roll venous chamber into holder; make sure the filter is below
transducers protector
4. Draw up heparin dose into prescribed syringe
5. Prime heparin line, insert your selected syringe, close clamp H
6. Open saline line clamp S
7. Gravity prime arterial patient line to drain bag
8. Close arterial patient line clamp A
9. Turn on the blood pump
10. Touch the Prime button and press CONFIRM to begin priming
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11. Set arterial drip chamber level using the arterial Level Up key
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clamp A
14. Touch Recirc Saline and press CONFIRM to begin
recirculation
15. When recirculation is complete, touch Done button to go to
a.
b.
c.
d.
screen
Connecting for Treatment (Tx Connect)
1. Check that machine has passed all pressure and alarm tests
2. Check that the dialysate is at proper temperature,
conductivity, and pH
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disinfectant
4. Check that machines bypass mode is functioning correctly
by opening and closing the shunt door and watching the float
in the dialyzer line
5. Explain use of integrated Blood Pressure Monitor and the
anticoagulant
7. Touch the Tx Connect button to begin connecting for
treatment
Flush Saline (Tx Connect)
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blood pump
3. Open clamp D and gravity flush arterial line to drain bag
4. Close arterial patient clamp A
5. Change saline bag
6. Start blood pump and run 300 ml saline into drain bag
7. Stop blood pump and close clamps S
D V
CONFIRM.
9. Touch Done button to go to the next screen
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1. Remove Tape 5
2. Disconnect arterial line from drain bag and connect to arterial
A V
v
H
treatment
3. Restate how to adjust the level of the arterial drip chamber
4. Explain importance of arterial, venous, and TMP pressure and
entire treatment
6. Calculate TMP
7. Touch Done button to go to the next screen
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screen, if required
2. Monitor the bloodline connections, arterial, venous, and TMP
End Treatment
1. Wait for UF Goal Reached message at end of treatment
R S
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R A
R A
v
program protocol
5. Touch Done button to go to the next screen
connector
2. Open clamps
V A
3. Rotate dialyzer
4. Return the blue dialysate connector to shunt
5. Close shunt door to empty
6. Touch Done button to go to the next screen
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2.
3.
4.
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NOTES: ________________________________________________________________
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2008K
Bringing Home Therapy Excellence
Fresenius Medical Care
2008K
Bringing Home Therapy Excellence
Fresenius Medical Care
Fresenius Medical Care North America 2637 Shadelands Drive Walnut Creek, CA 94598 1.800.227.2572
The FMCNA 2008K@home machine is indicated for acute or chronic dialysis treatment in a facility or in the home.
In the home, a trained and qualified person as prescribed by a physician must observe the treatment. See the full labeling for
complete descriptions of instructions for use, warnings, hazards, contraindications, side effects, and precautions.
Fresenius Medical Care, the triangle logo, 2008, @ home logo and Diasafe are trademarks of Fresenius Medical Care Holdings, Inc. or its affiliated companies.
2011 Fresenius Medical Care North America. All rights reserved.