Blood Purification Standard Operating Procedure (SOP)
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Blood Purification Standard Operating Procedure (SOP)
The Ministry of Health of the People's Republic of China*** and the State of China
January 2010
2 PrefaceThe incidence of chronic kidney disease is increasing year by year, and the uremia caused by chronic kidney disease while receiving blood purification treatment, bringing a heavy burden to society and family. Improving the level of blood purification treatment, guaranteeing the medical safety of patients, and reducing the occurrence of infections and other major events in the process of blood purification treatment has become an urgent problem to be solved. In order to adapt to the rapid development of blood purification in China and to meet the needs of the increasing number of blood purification centers and patients, commissioned by the Department of Medical Management of the Ministry of Health, the Nephrology Branch of the Chinese Medical Association organized experts to prepare the standard operating procedures for blood purification.
Under the leadership of the Ministry of Health, the Nephrology Section of the Chinese Medical Association, in the process of preparing the Standard Operating Procedure (SOP) for blood purification, has always emphasized the suitability for China's national conditions and the ease of clinical operation, and has strived to be concise and detailed in the specific operating procedures, so that the clinical staff can operate correctly with reference to the SOP. In view of the current mass occurrence of hepatitis C in hemodialysis patients in China, the hemodialysis operation of patients with combined hepatitis C has been especially standardized. In order to prepare the hemodialysis standard operating procedures, the Chinese Medical Association Nephrology Section widely solicited the opinions of medical and nursing personnel engaged in hemodialysis, and organized 4 meetings for revision and finalization, and finally completed the hemodialysis standard operating procedures (2010 edition). Due to the vast area of China, the conditions of medical units engaged in blood purification are different in different regions, and the specific methods of blood purification operations are different; therefore, the SOP for blood purification (2010 version) needs to be constantly revised and improved in the process of clinical use.
Academician Chen Xiangmei, Chairman of the Chinese Medical Association Division of Nephrology
January 2010
3 List of experts in the preparation of the Standard Operating Procedures for Blood Purification (2010 version)
(in alphabetical order)
Ding Xiaoqiang, Ma Zhifang, Wang Linning, Wang Li, Fu Ping, Shi Wei, Liu Wenhu
Liu Fuyou, Xiang Jing, Sun Xuefeng, Xing Changwing, Li Ying, Chen Jianghua, Chen Menghua
Chen Xiangmei, Ji Daxi, Lin Hongli, Jiang Elie, Zhao Jiuyang, Ni Zhaohui, Yuan Weijie
Jia Qiang, Mei Changlin, Zhang Youkang, Xie Ruijuan
4 Table of ContentsTitle I: Blood Purification Laboratory (Center) Management Standard Operating Procedures
Chapter 1: Hemodialysis (Filtration etc.) Management Standards Operating Procedures
I. Establishment and Qualification of Blood Purification Room (Center)
II. Structural Layout of Blood Purification Room (Center)
(I) Waiting Room
(II) Dressing Room
(III) Receiving Area
(IV) Dialysis Treatment Room
(V) Dialysis Preparation Room
(VI) Special operating room
(7) Water treatment room
(8) Storage room
(9) Sewage treatment room
(10) Office and living room for medical staff
(3) Management regulations of hemodialysis rooms (centers)
(1) Management of dialysis medical records
(2) Management of reuse of dialyzers
(3) Infection control of hemodialysis centers
( (C) Management requirements for infection control in hemodialysis centers
(D) Qualification of professionals in hemodialysis treatment
(A) Doctors
(B) Nurses
(C) Engineers and technicians
Chapter 2: Standard operating procedures for management of peritoneal dialysis
(A) Establishment and qualification of peritoneal dialysis units (centers)
(B) Management of peritoneal dialysis units (centers)
(C) Management of peritoneal dialysis units and qualification of peritoneal dialysis units (centers)
II. Structural layout of peritoneal dialysis units (centers)
III. Personnel qualification standards for peritoneal dialysis centers
Chapter III: Standard operating procedures for infection control in blood purification
I. Basic facility requirements for infection control in blood purification units (centers)
II. Preparation for treatments
III. Dress code of the staff and wearing of personal protective devices
IV. p>
IV. Hand hygiene for staff
V. Transfer of treatment items
VI. Disinfection of dialysis machines
VII. Disinfection of dialysis consumables
VIII. Disinfection of air and object surfaces
IX. Disposal of medical filth and wastes
X. Infection control monitoring
XI. Monitoring and prevention
xii. Infectious disease reporting
Chapter 2: Blood purification dialysis fluid and equipment maintenance, management standard operating practices
Chapter 1: Water treatment system and water quality control
i. Operation and maintenance of the water treatment system
ii. Water quality monitoring of dialysis water
Chapter 2: Reuse of dialyzer and filter
i. Operation and maintenance of dialysis system
ii. Operation and maintenance of dialysis fluid
iii. p>
I. Principles of reuse of dialyzers and filters
II. Training of personnel for reuse of dialyzers and filters
III. Disinfection procedures for reuse
IV. Requirements for water for reuse of dialyzers or filters
V. Adverse events caused by reuse
VI. Maintenance and upkeep
I. Maintenance and upkeep of hemodialysis machines
II. Maintenance and upkeep of continuous renal replacement therapy machines and plasma exchange machines
III. Cleaning and sterilizing operation of machines
Chapter IV. Configuration of dialysate
I. Configuration rooms
II. Ingredients and concentration
III.
IV. Quality control
Chapter 3: Clinical operations and standard operating procedures for blood purification
Chapter 1: Establishment of vascular access
I. Temporary central venous catheterization
II. Long-term central venous catheterization
III. Autologous arteriovenous endovascular fistulas
IV. Transplantation of blood vessels with bypass grafting fistulas
Chapter 2: Establishment of blood vessels
I. Temporary central venous catheterization
II. p>
Chapter 2: Anticoagulation for blood purification
I. Assessment of coagulation status of patients before blood purification
II. Contraindications to the use of anticoagulants
III. Reasonable choice of anticoagulants
IV. Selection of anticoagulant dosage
V. Monitoring anticoagulant therapy
VI.
Chapter 3: Hemodialysis
I. Definition and overview
II. Preparation of patients for hemodialysis treatment
III. Indications and contraindications
IV. Establishment of vascular access
V. Determination of and adjustment to dialysis prescriptions
VI. Monitoring
VIII. Hemodialysis Complications and Management
IX. Assessment of Hemodialysis Adequacy
Chapter 4: Hemodiafiltration
I. Definition and Overview
II. Indications and Contraindications
III. Pre-treatment Patient Evaluation
IV. Treatment Modalities and Prescription
V. Vascular Access
VI. p>
VI. Anticoagulation
VII. Filter Selection
VIII. Replacement Fluids
IX. Operational Procedures and Monitoring
X. Complications and Management
Chapter 5: Hemodialysis Filtration
I. Definition and Overview
II. Indications and Contraindications
III. Pre-treatment Patient Assessment
IV. Treatment modalities and prescription
V. Vascular access
VI. Anticoagulation
VII. Filter selection
VIII. Replacement fluids
IX. Operational procedures and monitoring
X. Complications and management
Chapter 6 Continuous Renal Replacement Therapy
I. Definition and overview
II. Indications and contraindications
III. Pre-treatment patient assessment
IV. Timing of treatment
V. Treatment modalities and prescription
VI. Vascular access
VII. Anticoagulation
VIII. Hemofiltration selection
IX. Replacement fluids
X. Operational procedures and monitoring
XI. Complications and Management
Chapter 7: Simple Ultrafiltration
I. Definition and Overview
II. Indications and Contraindications
III. Pre-treatment Patient Evaluation
IV. Device Selection
V. Vascular Access
VI. Dialyzer or Hemofiltration Selection
VII. Treatment Modalities and Prescription
VIII.
VIII. Anticoagulation
IX. Procedure and monitoring
X. Complications and management
XI. Precautions
Chapter 8 Plasma exchange
I. Definition and overview
II. Indications and contraindications
III. >
Chapter 9 Plasma Adsorption
I. Definition and Overview
II. Indications and Contraindications
III. Operational Procedures
IV. Complications and Management
Chapter 10 Hemoperfusion
I. Definition and Overview
II. Indications and Contraindications
III.
IV. Operational procedures
V. Factors affecting efficacy
VI. Complications and management
Chapter 11: Peritoneal dialysis
I. Definition and overview
II. Indications and contraindications
III. Selection, implantation, and maintenance of peritoneal dialysis catheters
IV. Operational procedures
v. Peritoneal dialysis solution
vi. Prescription and adjustment
vii. Adequacy assessment and safeguards
viii. Complications and management
ix. Patient management and training
Appendices
i. Calculation of renal function formulas
(a) Simplified formula for MDRD
(b) CKDEPI Formula
II. Residual renal function formula
(I) Hemodialysis residual renal urea clearance (Kru) formula
(II) Peritoneal dialysis residual renal urea clearance (Kt) formula
III. Dialysis adequacy urea clearance formula
(I) Hemodialysis
1. spKt/V formula
2. eKt/V calculation formula
3. URR calculation formula
(B) Peritoneal dialysis total Kt/V formula
(C) Proteolysis rate (PCR) formula
IV. Informed consent related to hemodialysis treatment
V. Hemodialysis (filtration) medical records and treatment record sheets
VI. > Sixth, the infectious disease report form for patients undergoing blood purification treatment
Seventh, the standard operation flow chart for temporary central venous cannulation
Eighth, the standard operation flow chart for long-term central venous cannulation
Ninth, the standard operation procedure flow chart for long-term central venous cannulation
Tenth, the flow chart for hemodialysis
Eleventh, the standard operation procedure flow chart for prevention and control of low blood pressure in hemodialysis Flowchart of operating procedures
XII. Flowchart of hemodialysis Kt/V substandard treatment