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MANITOBA RENAL PROGRAM
SUBJECT
Changing the Extracorporeal circuit during hemodialysis
treatment for the Fresenius 5008 delivery system
SECTION
30.10 Hemodialysis Equipment
and Procedures
CODE
30.10.09
AUTHORIZATION
Professional Advisory Committee, Manitoba Renal Program
Nursing Practice Council, St. Boniface Hospital
EFFECTIVE DATE
November 2013
REVISION DATE
March 2014
April 2016
October 2018
EQUIPMENT:
KEY POINTS:
2- 10 mL syringes with 0.9%NaCl
Supplies as needed for accessing CVC as per MRP
procedure 30.20.02 Accessing and Locking Central
Venous Catheter
Supplies as needed for setting up Extracorporeal
Circuit as per MRP procedure 30.10.01 Use of
Fresenius 5008 Delivery System or 30.10.02
Fresenius 5008 Preparation for Hemodialysis Using
the OnLINEplus™ System
PROCEDURE:
KEY POINTS:
1. Reinfuse blood if possible as per 30.10.01 Use of
Fresenius 5008 Delivery System or 30.10.03
Initiation and Termination of Treatment Using the
Fresenius 5008ONLINEplus™ System.
If unable to reinfuse, continue with step 2.
If extracorpeal circuit is being changed due to
blood leak alarm, do not return blood as per MRP
Policy 30.10.08 Fresenius 5008 Blood Leak
Alarms; responding to.
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PROCEDURE:
KEY POINTS:
2. From the treatment screen, note UF time
remaining, UF removed, current Na+ level (if Na+
profile in use), delivered Kt/V and the amount of
heparin infused.
Details of the interrupted treatment will be
displayed in the patient card ID/treatment window.
3. Stop the blood pump if not already done. Clamp
arterial and venous access lines and blood lines.
Using aseptic technique attach a 10mL syringe
containing 0.9% NaCl to each access. Flush the
access lines and then clamp.
If using CVC, perform cleaning procedure as per
MRP policy 30.20.02 Accessing and Locking Central
Venous Catheter or 30.20.04 Use of Closed
Needleless (TEGO)Access Device.
4. Touch Blood Systems menu and then select
“Remove all lines”.
If blood still in the lines then message will appear
“Remove lines selected. CAUTION! Treatment still
in progress. Selection will reset the treatment data
and stop the treatment!” Touch Blood lines
REMOVE button.
5. Message appears “Bloodlines will be removed
automatically. Keep doors closed whilst waiting”.
Once lines are unloaded message appears “Please
open outer doors to continue.” Open the outer
doors.
6. Message displayed “Please remove the bloodlines
completely and close the doors”. Remove and
discard all lines. Close outer doors.
7. Message displayed “Please insert the dialyzer
coupling into the shunt interlock to empty the
dialyzer.” Open the shunt door, place the blue
dialysate coupling onto the shunt and close the
door.
Drain program for the dialyzer is in progress.
Message displayed “The dialyzer is being emptied.”
8. Once the dialyzer has drained completely, the
message will read “The dialyzer is now empty,
Please insert both dialysate couplings into the shunt
interlock!” Open the shunt door and place the red
coupling onto the shunt and close the shunt door.
9. DO NOT RETURN THE RED WAND TO THE
RINSE CHAMBER ON THE DELIVERY SYSTEM.
Returning the acid bath red wand to the rinse
chamber and closing the flap will require that a T1
be repeated.
10. Bi-bag will have emptied after “remove all lines
confirmed”. Open the bicarbonate flap, lift the Bi-
bag off, and then replace. Bi-bag will refill.
11. Establish new set up and prime the lines and
dialyzer as per MRP Procedure 30.10.01 Use of
Fresenius 5008 Delivery System or 30.10.02
Fresenius 5008 Preparation for Hemodialysis Using
the OnLINEplus™ System
The T1 test does not have to be repeated.
12. Enter recalculated parameters for the remainder of
the treatment. If using Na+ profile, the start Na+ will
be the last Na+level as recorded in step 1.
If less than 2 hours remaining, Na+ profile will not
be available. Set Prescribed Na+ as ordered.
Ensure additional reinfusion volume added to total
UF volume target if applicable.
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PROCEDURE:
KEY POINTS:
13. Re-establish treatment as per procedure 30.10.01
Use of Fresenius 5008 Delivery System or 30.10.03
Initiation and Termination of Treatment Using the
Fresenius 5008ONLINEplus™ System