STANDARD OF CARE FOR MAINTENANCE …

1 _____ guidelines for MAINTENANCE hemodialysis in india Page 1 of 143 STANDARD OF care FOR 1 MAINTENANCE 2 hemodialysis IN india 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 _____ guidelines for MAINTENANCE hemodialysis in india Page 2 of 143 TABLE OF CONTENTS 1 2 Contents 3 Title 4 AUTHORS DECLARATION.

2 Error! Bookmark not defined. 5 TABLE OF CONTENTS .. 2 6 LIST OF ABBREVIATIONS .. 3 7 INTRODUCTION .. 6 8 UP OF hemodialysis UNIT FOR MAINTENANCE hemodialysis .. 8 9 PERSONNEL FOR hemodialysis UNIT FOR MAINTENANCE hemodialysis . 12 10 SELECTION OF MACHINE AND DIALYSER UNIT FOR MAINTENANCE 11 19 12 WATER treatment FOR hemodialysis .. 31 13 VASCULAR ACCESS .. 39 14 PRIMING, CONNECTING AND DISCONNECTING DIALYSER .. 47 15 11. ANTICOAGULATION IN HAEMODIALYSIS .. 52 16 12. DIALYSER REUSE (MANUAL & AUTOMATED) .. 57 17 13. DIALYSIS DOSE/ADEQUACY .. 65 18 14. PREVENTION OF INFECTIONS IN hemodialysis UNIT.

3 68 19 SCHEDULE I-CATEGORIES OF BIO-MEDICAL WASTE .. 77 20 SCHEDULE II- COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF 21 BIO-MEDICAL WASTES .. 79 22 SCHEDULE III- LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS .. 80 23 15. EMERGENCY SERVICES .. 82 24 16. LABORATORY BACKUP .. 85 25 17. NUTRITION .. 94 26 18. CVD MONITORING & THERAPY .. 110 27 19. MBD MONITORING & THERAPY .. 114 28 20. HYPERTENSION & THERAPY .. 118 29 21. DIABETES MONITORING & THERAPY .. 124 30 22. RENAL REPLACEMENT IN INTENSIVE care SETTING .. 128 31 32 33 _____ guidelines for MAINTENANCE hemodialysis in india Page 3 of 143 LIST OF ABBREVIATIONS 1 AAMI : Association for the Advancement of Medical Instrumentation ACE angiotensin-converting enzyme ACLS : Advanced cardiac life support ACT American College Testing AKI acute kidney injury ALP Alkaline phosphatase Amps.

4 Ampere APTT activated partial thromboplastin time ARB angiotensin receptor blockers AV Atrioventricular BBV Blood Borne Virus BUN blood urea nitrogen BP Blood pressure CAPD Continuous Ambulatory Peritoneal Dialysis CAG Coronary Angiography CFU : Colony forming unit CNS Central nervous system CKD : Chronic Kidney Disease cm Centimeter CRRT : Continuous renal replacement therapy CPR : Cardiopulmonary Resuscitation CPKMB Creatine phosphokinase, muscle band CT Computed tomography CVD : Cerebrovascular disease CVS cardiovascular system DM : diabetes mellitus DNB : Diplomate of National Board ECG : Electrocardiogram EIA enzyme immunoassay EKG electrocardiogram EPO Erythropoietin ESR Erythrocyte sedimentation rate ESRD : End stage renal disease EU European Union G Gauge GFR Glomerular filtration rate GI Gastrointestinal Hb Hemoglobin HbA1C Glycosylated hemoglobin (HbA1c or HbA1c) HBV : Hepatitis B virus HCV : Hepatitis C virus _____ guidelines for MAINTENANCE hemodialysis in india Page 4 of 143 HD.

5 hemodialysis HIT Heparin-Induced Thrombocytopenia HIV Human immunodeficiency virus Hr Hour ICU Intensive care unit IU/kg International unit/kilogram IV : Intravenous IVC Inferior vena cava Kg/cm2 Kilogram/square centimeter LAL Limulus Amebocyte Lysate LDH Lactate dehydrogenase LPS Lipopolysaccharide LV Left ventricular LVF Left ventricular failure LVH Left ventricular hypertrophy : Bachelor of Medicine, Bachelor of Surgery degree MBD : Mineral and Bone Disorder MD : Doctor of Medicine Mg/l milligrams per litre MHD : MAINTENANCE hemodialysis MI Myocardial infarction MIBI Methoxyisobutyl Isonitrile Stress ml/min Milliliter per minute mmol/L Milli moler per liter mmHg millimetres of mercury Micron N Normal NAT nucleic acid test NKF National Kidney Foundation PCR protein catabolic rate pH potential of hydrogen Psi per square inch PTFE Polytetrafluoroethylene PTH Parathyroid hormone PVC.

6 Polyvinylchloride PT Prothrombin R2A R2A Agar RO Reversed osmosis RRT Renal Replacement Therapy Secs Seconds SGPT serum glutamic pyruvic transaminase SGOT serum glutamic oxaloacetic transaminase _____ guidelines for MAINTENANCE hemodialysis in india Page 5 of 143 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 spkt v single pool Kt/V Sq. ft : Square feet SLEDD Slow extended daily dialysis SVC Superior vena cava TCV Total Cell Volume TSA Tryptic (Trypticase) Soy Agar UF Ultrafiltration UPS : Uninterrupted power supply URR urea reduction ratio 0C : Degree Celsius 0F : Degree Fahrenheit %.

7 Percentage l Microliter _____ guidelines for MAINTENANCE hemodialysis in india Page 6 of 143 INTRODUCTION 1 2 The burden of Chronic Kidney Disease (CKD) is increasing in alarming proportion all over the 3 world. In india due to lack of financial resources, lack of trained manpower & infrastructure 4 leads to severe strain on existing health policies in the light of the increasing burden of CKD. 5 Kidneys are probably the only vital organs which can be realistically replaced by artificial 6 means.

8 MAINTENANCE dialysis is a well-recognized modality of treating patients having end stage 7 renal disease. Several thousands of patients all over the world are surviving and achieving 8 reasonable quality of life on MAINTENANCE dialysis. The exact burden of CKD needing 9 MAINTENANCE dialysis and/ or renal transplantation is not known; however, from the existing 10 published data prevalence of CKD ranges between to Whereas the incidence of end 11 stage renal disease was estimated to be 180 to 200 per million population1. 12 13 World over there is severe shortage of donor kidneys.

9 In our country deceased donor 14 transplantation programme is as yet in its infancy and because of breaking up of joint family 15 structure the live donor programme is not enough for the needs of ESRD patients. Therefore 16 several thousands of patients have to live on MAINTENANCE dialysis in india . MAINTENANCE dialysis 17 importantly serves as a bridge to kidney transplantation. 18 19 In india the first hemodialysis facility was established in 1961 2 at the CMC Vellore; soon it was 20 started at 3-4 major centers during that decade viz. CMC Vellore, KEM Mumbai, PGI 21 Chandigarh & All india Institute of Medical Sciences, New Delhi.

10 Over the last three decades 22 many more dialysis facilities have been established in Government sector, in Charitable Trust 23 run institutions & by Private Nephrologist. There has been persistent improvement in the 24 numbers & quality of dialysis delivered over this period. 25 26 Good quality of life and survival on MAINTENANCE dialysis depends on following major factors 27 namely; i) the dose of dialysis delivered or solute removal achieved, ii) time on dialysis, iii) 28 adequacy of nutrition, iv) family and socio-economic support, v) management of co-morbid 29 illnesses and vi) prevention & management of infections.