TIPS, REMINDERS AND LESSONS LEARNED

This link will provide nurses with ongoing updates, troubleshooting tips and reminders regarding the use of the Prismaflex(TM) in CCTC. This page will be regularly updated during the introduction of the new system, to provide nurses with a reference site.

PRIMING REMINDERS:

• Before using the manual prime feature to do additional priming, ALWAYS HANG A NEW 1 Liter bag of priming solution. This will prevent the prime bag from running dry during the prime test.
  • At the end of priming, a prime test is completed. During the prime test, an additional ~200 ml of priming solution is used. One full prime and prime test will take almost the entire 1 L bag of saline solution. If you utilize additional volume for manual prime, the priming bag will run dry, necessitating another full prime to eliminate air.
• Remember to add the heater tubing. Add the heater tubing at the point when the dearation device is installed.
• It is easiest to wrap the heater tubing from FRONT TO BACK before connecting it to the circuit. Use the second colored marking on the heater tubing as the mark for placing the heater tubing into the front hook. Wrap the tubing towards the back. Once complete, connect the heater tubing to the filter circuit.

Anticoagulation

• Always install a syringe in the anticoagulant pump. Use a plain saline filled syringe if no anticoagulant is ordered. This allows you to add heparin at a later date..
• Remember, heparin anticoagulant should not be used if the patient is receiving activated Protein C. Continue with subcutaneous heparin/fragmin (maximum 5,000 units heparin TID or dalteparin 5,000 units OD). Use high predilution hemofiltration and no anticoagulant with activated Protein C..
• If the patient is receiving heparin as CRRT anticoagulation, subcutaneous heparin for DVT prophylaxis should be continued (to prevent DVT prophylaxis interruption if the therapy is stopped).
• When hanging the effluent bag, hang the bag with the connection port facing forward. This will facilitate easy bag changes.
• Remember to connect the saline infusion to the "Y" connector prior to patient hook up.

TURNING ON THE HEATER:

• Do NOT turn the heater on until after the treatment has commenced, and the heater tubing is primed with blood. If the heater is started while the tubing is still filled with dialysate, the bicarbonate is converted to carbon dioxide, increasing the formation of bubbles.
• To turn the heater on, press the on-off button at the bottom right corner. Immediately depress the silence alarm, located above the on-off button. The heater has 3 temperature settings. You can choose the temperature you want based on the need for warming by moving the arrow up and down keys. Highlight the desired temperature and depress the alarm silence button again to confirm the change (the alarm silence button will be flashing with a green light illuminated).

PREBLOOD PUMP (PBP):

• To prevent blood from backing up, the PBP should always have an infusion of at least 100 ml per hour.
• If no anticoagulation is being used, hang a bag of 0.9 NaCl on the PBP hook and administer it at 100 ml/hr.

CHANGING BAGS:

• YOU MUST PULL THE SCALE DRAWER OUT TO CHANGE THE BAG. Don't try to change the bags by simply hanging it onto the hook. This will lead to an incorrect bag weight measurements.

MONITORING:

• Remember to check the dearation chamber hourly and prn. If blood rises into the tubing above the chamber, you must lower the level. If the filter becomes wet, it needs to be changed (a box of filter protectors is available on the dialysis cart).
• If air is in the heater tubing, it will collect in the dearation chamber. This may necessitate raising the fluid level from time-to-time.
• Post dilution replacement must be used (minimum 200 ml/hr) to prevent clot formation in the dearation chamber.

January 21, 2009

Reviewed: March 23, 2010.