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Policies & Procedures
30.10.01 Use of Fresenius 5008 Delivery System using 0.9% NaCl
30.10.02 Fresenius 5008 Preparation for Hemodialysis using the ONLINEplus ™ System
30.10.03 Initiation and termination of Treatment using the Fresenius 5008 ONLINEplus™ System
30.10.04 Converting to NaCl bolus or NaCl reinfusion using the Fresenius 5008 ONLINEplus™ System
30.10.05 Providing a Fluid Bolus Using the Fresenius 5008 ONLINEplus™ System
30.10.06 Fresenius 5008 ISO Ultrafiltration (Sequential Therapy)
30.10.07 Fresenius 5008 Air Detected Below the Venous Bubble Catcher
30.10.08 Fresenius 5008 Blood Leak Alarms; responding to
30.10.11 ONLINE Circulation of Bloodlines with Substituate After Blood Reinfusion
30.10.12 Single Needle (Click-Clack) Hemodialysis for Fresenius 5008 Dialysis Delivery system
30.10.13 Providing Hemodialysis without Heparinization
30.10.14 Intradialytic Blood Product Administration
30.10.14a Appendix A: How to Order Blood
30.10.14b Appendix B: Notification Card Sample
30.10.15 Calcium Chloride Additive for Hemodialysis Patients
30.10.15a Appendix A: Guideline for Home Hemodialysis and Post Parathyroidectomy Patients
30.10.16 Administration of Intradialytic Parenteral Nutrition to the Hemodialysis Patient
30.10.19 Changing Dialysate Concentrate During Hemodialysis Treatment
30.10.20 Administering a Heparin Bolus during Hemodialysis Treatment using the Fresenius 5008 Heparin Pump
30.10.21 Manually Opening Arterial Pressure Measurement Unit on the Fresenius 5008
30.10.22 Emergency Reinfusion Procedure using the Fresenius 5008
30.10.23 Manual Reinfusion Procedure in the Event of Power Failure and Empty Battery/System Failure
30.20.01 Venipuncture of Arteriovenous Fistula/Graft
30.20.03 Establishing and Maintaining Buttonhole Venipuncture Sites
30.20.04 Use of Closed Needleless Access Device with Hemodialysis Central Venous Catheters (CVC)
30.20.05 Hemodialysis Central Venous Catheter Dressing and Care of Catheter
30.20.05a Appendix A Statlock Application Procedure
30.20.06 AVF/AVG Vascular Access Assessment
30.20.07 Removal of Non-Tunneled Hemodialysis Central Venous Catheters
30.20.08 Alteplase for Clearing Hemodialysis Catheter Thrombosis using the Push (30 minute) Method
30.20.09 Alteplase IV Infusion for Clearing Hemodialysis Catheter Thrombosis
30.20.10 Alteplase for Hemodialysis Central Venous Catheter (Dwell procedure)
30.20.12 Use of BARD Dialysis Catheter Repair Kit
30.20.13 Use of Covidien™ Acute and Chronic Catheter Repair Kit: Palindrome™ Chronic Care and All Mahurkar™ Acute and Chronic Care Catheters
30.20.14 Use of the HEMOdialert™ device with hemodialysis
30.20.15 Obtaining Blood Specimens Pre and Post Hemodialysis
30.20.16 Collection of Blood Culture Specimen from a Hemodialysis Access
30.20.16a Summary Poster Gold Standard Blood Cultures
40.10.01 Attachment of Minicap Extended Life PD Transfer Set to Peritoneal Catheter *revised*
40.10.02 Changing Titanium Adapter in a Peritoneal Catheter
40.10.03 Installation of Medications into Peritoneal Dialysis Solution
40.10.03a Appendix A: Instillation of Medication into Peritoneal Dialysis Solution (IP Drugs Manual)
40.10.04 Application of Locking Cap to Peritoneal Catheter
40.10.05 Peritoneal Catheter Flush
40.10.06 Peritoneal Exit Site Care
40.10.06a Appendix A: Physician Management of Exit Site Infection
40.10.06b Appendix B: Peritoneal Catheter Exit Site Care
40.10.06c Appendix C: Peritoneal Dialysis Exit Site
40.10.07 Intraperitoneal tPA for Obstructed Peritoneal Dialysis Catheters
40.10.08 Peritoneal Dialysis Bag Exchange Utilizing Twin Bag System
40.10.08a Appendix A: W00353 CAPD Flow Sheet
40.10.09a Appendix A: v W00354 Automated Peritoneal Dialysis Record
40.10.10 Peritoneal Catheter Irrigation
40.10.11 Silver Nitrate Application
40.10.12 Measuring Peritoneal Dialysis Adequacy: KT/V Collection
40.10.12a Appendix A: Incremental PD Protocol
40.10.13 Ascites drainage utilizing a Peritoneal Catheter
40.10.14a Appendix A: Site Specific Requisitions
40.10.14b Appendix B: Decision Tree for obtaining Peritoneal Effluent Sample
40.10.15 Peritoneal Equilibration Test (PET)
40.10.15a Appendix A: PET (Peritoneal Equilibration Test) Collection Sheet W-00714
50.20.01 NxStage Ordering Supplies
50.20.02 Nxstage Installing SAK
50.20.03 NxStage Adjusting the Temp of the SAK
50.20.04 NxStage Changing SAK Type
50.20.05 NxStage Draining aSAK
50.20.06 NxStage Initiation and Discontinuation of Dialysis
50.20.07 NxStage Instillation of New Dialysate SAK
50.20.08 NxStage Setup of Cycler
50.20.09 NxStage Testing Chloramines
50.20.10 Boil Water Advisory Procedure for NxStage Dialysis System
New policies currently being finalized (Nov 2020)
60.10.01 Renal Nursing Kardex Standard
60.10.01a Appendix A: Renal Patient Kardex (form #W-00195A)
60.10.01b Appendix B: Hemodialysis Patient Kardex (form #W-00195B)
60.10.01c Appendix C: PD Kardex
60.10.02 Hemodialysis Renal Medication Flow Sheet Standard (eKHR) (re-numbered from 60.20.04)
60.10.02a Appendix A eKHR reference guideline *new*
60.10.02b Appendix B W-00581 Update eKHR medication (re-numbered from 60.20.04b)
60.10.03 Hemodialysis Renal Medication Flow Sheet Standard (non eKHR) (re-numbered from 60.20.05)
60.10.03a Appendix A: Hemodialysis Renal Medication Flow Sheet (Form #NS01708)
60.20.01A Hemodialysis Treatment Record Standard (For Fresenius 5008 Delivery System)
60.20.01Aa Appendix A: Hemodialysis Treatment Record for Fresenius 5008 (form #1592)
60.20.01B Hemodialysis Treatment Record Standard HSC
60.20.01Bb Appendix B: Form W-00497 HSC Hemodialysis Treatment Record
60.20.02 Hemodialysis Flow Sheet Standard (for Fresenius 5008)
60.20.02a Appendix A: Hemodialysis Flow Sheet (Form #W-1593)
60.20.03 Hemodialysis Signature Sheet Standard
60.20.03a Appendix A: Hemodialysis Signature Sheet (Form #NS 00714)
60.20.06 Documentation Standard – Manitoba Renal Program & Long Term Care Communication Record
60.30.02 Standard for Completion of Continuous Ambulatory Peritoneal Dialysis Assessment Report
60.30.02a Appendix: Continuous Ambulatory Peritoneal Dialysis Assessment Report (Form #W-00472)
60.30.03 Working Alone Standard for Peritoneal Dialysis Community Care (PDCC)
60.30.03a Appendix A: Peritoneal Dialysis Community Care Reporting form for missing employee
70.10.01 Human Leukocyte Antigen Antibody Testing Routine and Post Transfusion Protocol
70.10.02 Adult Patient Screening and Vaccination Protocol for Hepatitis B and Hepatitis C
70.10.02a Appendix A: Algorithm for Hepatitis B Vaccination and Monitoring in Susceptible Patients
70.10.02c Appendix C: How to Switch a Patient from one product to the other
70.10.04b Appendix B: Patient Transfer Letter *revised*
70.10.04d Appendix D: Permanent Transfer of Renal Patients to a Home Dialysis Unit *new*
70.10.04e Appendix E : Permanent Transfer of Stage V Renal Health Patients to a Hemodialysis Unit *new*
70.10.04f Appendix F: Staff Resources
- Staff Memo on Patient Transfer Communication
- Transfer Information Process
- Staff Script for Patient Transfer
- Dialysis Care Transfer poster
70.10.06a Appendix A: Checklist/Fax Cover Sheet for Temporary Patient Transfers due to Overcapacity
70.10.06b Appendix B: Algorithm: Temporary Hemodialysis Transfers due to Overcapacity
70.20.02 Management of HBsAg Positive Hemodialysis Patients
70.20.03a Appendix A: MRSA Admission Screening Algorithm
70.20.03b Appendix B: Transient Letter
70.20.03c Appendix C: Transient Patients Forms (Orders and Information) ENGLISH or FRENCH
70.20.04 Initial and Monthly Lab Tests Protocol for Chronic Hemodialysis Patients
70.20.04a Appendix A: Dialysis Panel HSC and LRHU
70.20.04b Appendix B: Dialysis Panel SOH
70.20.04c Appendix C: Dialysis Panel SBH
70.20.04d Appendix D: Dialysis Panel Brandon
70.30.01 Continuous Ambulatory Peritoneal Dialysis Protocol
70.30.01a Appendix A: Fluid Management Guidelines
70.30.01b Appendix B: CAPD Flow Sheet (Form #W-00353)
70.30.02 Continuous Cycling Peritoneal Dialysis Protocol
70.30.02a Appendix A: Fluid Management Guidelines
70.30.02b Appendix B: Automated Peritoneal Dialysis Record (Form #W-00354)
70.30.04 Care of Patient on Home Peritoneal Dialysis Protocol
70.30.05 Peritoneal Dialysis Contamination Protocol
70.30.05b Appendix B W-00681 Part 1 Determining Peritonitis in Rural Patients
70.30.05c Appendix C W-00682 Part 2 Collection of Peritoneal Effluent in Rural Setting
70.30.05g Appendix G Decision Tree for Managing Contamination
70.30.06 Initial and Monthly Lab Tests Protocol for patients receiving Chronic Peritoneal Dialysis
70.30.06a Appendix A: SOH PD bloodwork panel
80.10.02 Guidelines for Medication Reconciliation *updated*
80.10.02a Appendix A: Guidelines for Medication Reconciliation – Medication Change Form
80.10.02b Appendix B: Guidelines for Medication Reconciliation – Medication Card
80.10.03a Appendix A: Manitoba Renal Program Health Information Transfer Tool
80.20.01 Guidelines for Heparinization during Hemodialysis
80.20.02 Ordering & Returning Dialysis Supplies for Local Centre Dialysis Units
80.20.02a Appendix A: Exchange Cart and Forms/Labels
80.20.03 Discharge Criteria for Hemodialysis Patients from the Dialysis Unit following Treatment
80.20.04 Contacting a Patient who does not Attend a Hemodialysis Treatment
80.20.05 Guidelines for Managing Hospitalized Hemodialysis Patients (Form #W-00346)
80.20.05a Appendix A: ER Poster
80.20.06a Appendix A: Guidelines for the Treatment of Intradialytic Hypotension
80.20.06b Appendix B: Guidelines for the Treatment of Post Hemodialysis Hypotension
Disclaimer: The information and data in this document (“Information”) is based on scientific evidence current as of the date issued and is subject to change without notice. The Information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Any person consulting or applying the Information is expected to use independent medical judgment and expertise in the context of individual clinical circumstances. Winnipeg Regional Health Authority and the Manitoba Renal Program make no representation or guarantees of any kind whatsoever regarding the content or use or application of the Information and specifically disclaim any responsibility for its application or use in any way.
