removing the set from the package, check all luer lock connections
to ensure they are tight. In particular, check the access and
return connections, the connections to all spikes and the connections
at the dearation filter. Connections are loosely connected to
facilitate gas sterilization.
solutions. Remember to add KCl to dialysate per protocol. If dialysate
is not being administered, KCl should be ordered to replacement
solutions per protocol.
replacement administered via Pre Blood Pump (PBP)
pump programmed to deliver POST DILUTION replacement (usually
at 200 ml/hr) to prevent clotting in the dearation chamber
citrate via PBP
all replacement fluid (e.g., 1000 ml/hr) POST DILUTION
via replacement pump.
turn the machine "OFF", then back "ON" before
setting up a new filter (even if you restarting the same patient).
This will ensure you have cleared any alarms from the previous
- Do not turn
the heater on until after the circuit is connected to the patient
and the heater tubing is filled with blood. When bicarbonate containing
solutions are heated, CO2 gas is produced, increasing the number
setup in "CVVHDF" mode.
to connect the heater tubing.
the green marking on the heater tubing at the front of the
heater and wrap from front to back.
and stretch the tubing during positioning to reduce the chance
of kinking when the cover is replaced.
a second person assist you as you open up the blue connection
in the return tubing (below and to the left of the dearation
chamber) and connect the heater tubing. There is only one
way the heater tubing can be connected (male to female). It
is normal for the return tubing to cross behind the filter
and again underneath the heater.
sure that the connections are tight, especially at the return
protector (the filter above the dearation chamber), the access
and return connections, and the luer lock connection on the spike
inserted into the prime collection bag.
- Priming with a filter of 150 or higher will required 2 bags of priming solution (smaller filters such as 100 and 60 only require a single bag).
- In a two bag prime (usual for ST 150):
- The "ST" stands for surface treated. Surface treating makes heparin adsorb (adhere) to the filter surface.
- Tthe first bag usually has 5,000 units of heparin added per liter, unless there is an absolute heparin contraindication (e.g., HITT).
- The second priming bag is 1 L of plain normal saline. At the onset of therapy, the patient does not receive a bolus of heparin if the second bag was heparin free.
- In small size filters (used in paediatrics), only 1 L of priming solution is required. If that liter contains heparin, the patient will receive roughly 150 - 180 ml of heparinized saline at the onset of the treatment unless additional priming is done.
heparin is not being administered, prepare a 20 ml syringe with
a LUER LOCK connection with 0.9 NaCl and install into the syringe
- Hang a bag
of normal saline on any pump that is not being used (e.g., if
dialysate had not been ordered, hang saline on the dialysate pump
during priming and set the dialysate flow rate at "0".
- In the last
minute of priming, you can gently flick or wiggle the loop in
the heater tubing to faciliate removal of air bubbles. Small air
bubbles do not need to be removed.
- It is normal
to have air in the effluent pod or a few inches of air in the
effluent tubing. You DO NOT need to prime a second time; this
air will be eliminated during the Prime Test.
- Air bubbles
in the blood side will be collected in the dearation chamber.
- At the end
of priming, check the dearation chamber and adjust the level if
priming, an air pocket will sometimes collect in the dearation
chamber below the mesh filter, displacing fluid into the tubing
above the dearation chamber.
check the dearation chamber carefully; it can be difficult
to differentiate fluid from air.
- If fluid
has risen into the tubing above the chamber, lower the fluid
level by choosing "adjust level", and using the
DOWN arrows to drop the fluid level below the dearation chamber.
After the level is dropped, select the UP arrows and move
the fluid level to the desired location.
- It can
be difficult to differentiate fluid from air. Dropping the
level , appearing as though fluid is in the chamber.
NOT do any additional priming without hanging a second bag
of priming solution or the bag will run dry during the prime
test (the prime test using the remaining 150 ml of the 1 Litre
bag of solution).
At the end of
priming, select "continue" and enter flow rates prior
to connecting the circuit to the patient.
treatment with fluid removal set at "0" and blood flow
rate at 150 ml/min.
Prior to connecting
the circuit to the patient, switch the blue return line and the
effluent line. (The effluent line should be moved to the effluent
bag, and the return line should be moved to the "Y" connector
on the priming "Y". Clamp the access and return lines
and move the priming bag close to the patient's access site to facilitate
access tubing from the "Y" connector and add a 3-way stopcock.
Prime a regular IV tubing set with normal saline and connect to
limbs (check for clots with a 3 cc syringe and flush with saline).
heparin bolus (if ordered) into the access limb and connect the
stopcock at the end of the access line to the access limb.
Conect the return
line to the return limb (blue to blue).
MUST CONNECT THE PATIENT WITHIN 30 minute of priming. If more than
10 minutes elapses, repriming must be performed again.
Gambro Training Manual 1 and 2
Slides from Gambro Training package, reproduced with permission
March 30, 2010, April 8, 2016
Reviewed: January 30, 2015.