How To Set Up A Dialysis Machine

• Journal List
• Indian J Nephrol
• v.30(Suppl 1); 2022 Jul
• PMC7598394

Indian J Nephrol. 2022 Jul; 30(Suppl ane): S1–S5.

Setting up of Hemodialysis Unit

Setting up of maintenance hemodialysis (MHD) unit is a major challenge for an uninitiated nephrologist. The purpose of this guideline is to assist design a new unit of measurement.

Dialysis (Hemodialysis) Area

We recommend that the hemodialysis (Hard disk drive) treatment area (dialysis automobile + bed or chair) should take the following features:

The dialysis area specifications and requirements shall include plenty space to accommodate the number of provided dialysis stations.

1. The dialysis area should be air conditioned so equally to attain 70°F–72°F temperatures and 55%–60% humidity

2. Each auto should be at the middle of sufficient area [Figure one] to allow piece of cake movement of personnel and resuscitation equipment whenever needed. The layout should have facilities for protecting patient's privacy

   

   Typical hemodialysis machine area. Black dots: electricity outlets, green dots: oxygen outlet, yellow dots: vacuum outlet, blue dots: treated h2o inlet, ash dot: drainage outlet

3. Nursing station (counter): This requires an unobtrusive view of all patient treatment areas. The nursing station should as well be within the range of hearing alarms from the machines for taking appropriate timely actions. The nursing station should have plenty space for on-duty nurses/working technicians, a computer last, and a working desk/demote. There should be a closet/space to shop emergency medicines/disposables

4. Floor covering in the dialysis area shall exist monolithic and joint free. The flooring occupied past each dialysis station shall be large plenty to accommodate the dialysis chair/couch, dialysis automobile, likewise as working room for two dialysis personnel. There should be adequate clearance infinite between the dialysis stations

5. The caput end of each bed should take stable electrical supply with at to the lowest degree half dozen sockets of 5/fifteen A, oxygen and vacuum outlet, treated h2o inlet, and drainage. The wires from the electric sockets should be in such a way that they do not pose a threat to the patient or staff during the dialysis. The minimum door-opening width (desirable – ane.12 yard) should be sufficient for like shooting fish in a barrel send of patient on trolleys/wheelchair to the dialysis station. The minimum ceiling height shall be ii.four–2.7 thou

6. Isolation room: In that location should be separate areas for dialyzing patients with weather condition that crave isolation (desirable) to ensure safety to patients and staff in the dialysis room. This expanse should accept independent water supply and drainage facilities. Facilities that dialyze patients with known blood-borne pathogens shall have at least ii dissever rooms to use for those patients as follows:

   • For hepatitis B virus (HBV) patients, rooms/linen shall exist color coded with blue

   • For hepatitis C virus (HCV) patients, rooms/linen shall be color coded with yellowish

   • This should not exist considered a substitute for universal precautions observed in the dialysis facility

7. Facilities for handwashing and booze-based hand rub/ sterilant dispensers should be bachelor in all patient areas and should be easily accessible. Paw-washing basins (an area of the basin one one thousand²) usually made of porcelain, stainless steel (SS), or solid surface materials should also be available in the facility

8. The dialysis room should incorporate additional equipment that is required for regular employ in the unit such as a weighing calibration and stadiometer, cardiac monitors, defibrillator, and infusion pumps

9. All surfaces and fixtures are to be designed to enable like shooting fish in a barrel and thorough cleaning on a regular and repeated basis to ensure a high level of infection control in all aspects of exercise. Loftier levels of cleaning are to be conducted in the unit daily. All surfaces should be free from seams and creases which may harbor bacteria. Vinyl that requires a warm water wash and does not require daily polishing should be included in all handling areas.

   • Floors: This must exist covered by ceramic or flooring surfaces which may be called in such a way that it is piece of cake to maintain, is readily cleanable, and is resistant to disinfection procedures. Epoxy flooring is desirable

   • Skirting should be covered to prevent dirt congregating in corners. It should extend all the way up the wall upwards to 20 cm or upward to 30 cm (desirable) to protect all potentially wet areas from infiltration

   • Walls: Wall finishes must be scrubbable and should exist smooth and water resistant

   • Ceilings: All exposed ceilings and ceiling structures must exist easy to make clean. All areas where dust fallout would present a potential problem must have finished ceilings that cover all conduits and pipes

   • Window furnishings: Washable blinds are preferable to curtains equally they retain less grit and are easier to make clean and nonflammable. Washable paint should exist applied for all walls and ceilings

   • Natural low-cal contributes to a sense of well-being, assists orientation to building locations, and improves service outcomes. The utilise of natural light should be maximized throughout the unit.

Dialyzer Reprocessing Area

Nosotros recommend an independent expanse for reprocessing the dialyzers. This should take a workbench and a sink with a sideboard and drainage. The workbench should have separately marked treated too equally untreated water supplies at a h2o line pressure of 1.3 kg/cm² (20 psi). In that location should be two sinks (one for initial cleaning and the other for filling sterilent, packing, and labeling) of the dialyzer. We suggest that the space should be sufficient for 2 persons working simultaneously.

1. We suggest that the reprocessing area should be equipped with a hood and an frazzle fan

2. Nosotros recommend the employ of sinks with a depth of at to the lowest degree 45 cm with a drainage mesh at a depth of around 20 cm to prevent the dialyzer and tubing resting in the effluent

3. We recommend that the washing area exist equipped with ii outlets or a "T" connection. Two different fittings should be provided on the water line at each reprocessing area, a standard tubing to make clean the blood compartment, and a Hansen connector for backwashing the dialysate compartment

4. We recommend the use of a 316 SS or medical-grade polyvinyl chloride (PVC) for fittings

5. We recommend a physically separate reprocessing area for processing dialyzers of patients with HCV infection

6. We suggest that space should also be provided for dialyzer reprocessing motorcar(south)

7. We recommend stabilized electrical supply and drainage for the workbench.

Drainage Organization

Services that facilitate the drainage of waste fluids from the Hard disk machines must exist ventilated to prevent condensation and the subsequent growth of mold. This fact should exist kept in mind when designing covers or screens for the drainage systems. Drainage systems should be constructed of a chemically resistant material such every bit high-density polyethylene. The dialysate and the reprocessing effluent should drain into a separate drainage system/tank with adequate capacity to handle the book.

We recommend that the number of bends in pipelines be kept to a minimum and blind loops be avoided.

We recommend that all drainage systems should be connected directly to the main drainage line in a straight line without bends or blind loops [Figures ​ 2a, ​ 2b, ​ 3 and ​ four].

Spout with appropriate pinnacle and slope

Push-pull connector for machine h2o inlet

Spout capped with aperture to accommodate automobile effluent pipe snugly

Conventional Drainage system

Storage Areas

1. We recommend two divide storage areas: one for new supplies (dry storage) and another for reprocessed dialyzers (wet storage)

2. The dry storage area should accept sufficient space to shop adequate supply of dialyzers, tubings, dry out powder Hd concentrate solutions, intravenous (IV) fluids, and other consumables. It should also have space for stationery, linen, and records

3. The wet storage is for reprocessed dialyzers and tubings

4. We recommend a separate area with a workbench for preparation of sterile trays for dialysis startup kit and grooming of injections

5. We propose that there should be designated places for storage of emergency equipment and keeping wheelchairs/trolleys and weighing scale

6. Clean and muddy utility

7. We propose that in that location should be an expanse for dirty utility. The area should be designed in such a way that one time personnel and fabric enter this area, they practice not have to come dorsum to the make clean dialysis area.

Other areas (applicative to independent units. In case such facilities are bachelor in any other surface area of the infirmary, the Hd unit can share it):

1. Minor operation room/procedure room (120 sq.ft desirable) – We suggest that all activities non directly related to a Hard disk drive process including creation (not puncture) of vascular access be done in a separate procedure room

2. The following equipment are suggested for the procedure room:

   1. Operating table

   2. Operating lights

   3. Ultrasound: Preferably with a vascular probe for localizing and puncturing central veins

   4. C-Arm imaging system (optional)

   5. Musical instrument storage facility.

3. Consultation/examination room (120 sq. ft. desirable) for examining patients

4. Recovery room (to manage postdialysis complications such every bit bleeding from access-site hypertension [HTN] and hypotension)

5. Authoritative areas – Multiuse rooms for meetings, health education, and clerical piece of work and to store files and other documents of the unit

6. Area for staff

7. Doctors' room

8. Common rooms (with toilet) for staff – male and female

9. Pharmacy

10. We recommend provision of sufficient designated expanse for the stay and relaxation of attendants accompanying the patients. Patients waiting to continue dialysis and those who have recently completed dialysis could also utilise the same area

11. Audio–visual entertainment, educational booklets, and magazines for the patients (desirable) may exist provided within this area

12. Nosotros recommend that in that location should be adequate number of toilets for patients and accompanying persons, preferably separately for males and females

13. We suggest that the waiting area exist continued by some form of communication with the dialysis unit of measurement in order that communication can be carried out without the need for physical movement between the two areas

14. Nosotros recommend that if the MHD unit of measurement is a part of a general hospital setup, then the areas for reception, waiting, records, consulting room, and storage could be shared. The to a higher place recommendations have been summarized in Table 1.

    Tabular array 1

    Summary of designated areas in the dialysis unit of measurement

    Designated areas	Suggested dimensions (desirable)	Functions of the space
    HD area [Effigy 5a]	xi ft × ten ft	Adapt dialysis auto, chair/couch, resuscitation equipment every bit and when required, and working room for two dialysis personnel
    Nursing station	Sufficient infinite for on-duty nurses, technicians, a figurer final, and a working desk	Unobtrusive view of all patient handling areas. Constant monitoring of patients and timely action in case of emergency
    Dialyzer reprocessing area [Figure 5b]	Sufficient space for two persons to work simultaneously	Reprocessing the dialyzers
    Storage areas: Two separate storage areas	Space should be in conformity with the size of the dialysis unit (number of dialysis performed/day)	Storage of disposables and consumables (dry) Storage of reprocessed dialyzers and tubings (wet)
    Separate surface area for preparation of sterile tray and dialysis startup kit/injections	Sufficient infinite
    Clean and muddy utility	Sufficient space
    Space for emergency equipment, wheelchairs, trolley	Sufficient infinite
    Minor performance/procedure room	Sufficient space (120 sq.ft.) (desirable)	Insertion of dialysis catheters, AVF creation, etc.
    Examination/consultation room	-DO-
    Recovery room	Sufficient infinite	To manage the complications postal service dialysis, medication administrations, etc.
    Administrative areas [Figure 5b]	Sufficient space	For meetings, health teaching clerical work, and storage of documents
    Common rooms for doctors and staff	Sufficient space (with toilet) separate for males and females
    Pharmacy (desirable)	Sufficient space
    Waiting area	Sufficient space (with toilets) in conformity with the workload of the facility	For the stay and relaxation of the patients and their attendants

Ability Supply and Plumbing

1. We recommend stable and continuous voltage supply. The supply should exist stable and uninterrupted, of pure sine moving ridge, and both voltage and frequency regulated. The use of electric surge protectors is recommended to protect dialysis machines' electronics

2. A minimum of half-dozen plugs per station is recommended

3. Online uninterrupted power supply (UPS) with at least 30-min backup is suggested. The ability capacity of the UPS should be able to support all functions of the dialysis machine and water treatment system if located in the same area

4. In units having >25 machines, we propose that 1 UPS backup unit is capable of supplying 20 to 25 machines

5. We recommend a generator of adequate capacity where ability supply is erratic

6. We recommend the employ of SS-grade 316 or medical-form PVC for treated water pipelines.

Austenite steels make up over lxx% of the total SS production. They contain a maximum of 0.xv%

carbon, a minimum of sixteen% chromium, and sufficient

nickel and/or manganese to retain an austenitic structure at all temperatures from the cryogenic region to the melting point of the blend. The most widely used austenite steel is the 304 grade or A2 SS (not to be dislocated with A2 class steel, also named Tool steel, a steel). The widely used austenite steel is the 304 grade or A2 SS. The second nigh common austenite steel is the 316 grade, besides called marine-form SS, used primarily for its increased resistance to corrosion.

SS does not corrode, rust, or stain with water every bit ordinary steel does, only despite the name, it is non fully stainproof. It is also chosen corrosion-resistant steel when the alloy blazon and grade are not detailed, particularly in the aviation industry. There are unlike grades and surface finishes of SS to suit the environment the alloy must endure. SS is used where both the properties of steel and resistance to corrosion are required. 300 serial, SSs, has an austenitic crystalline structure, which is a face-centered cubic crystal structure.

Nosotros recommend that the area should exist brightly lit to facilitate the performance of procedures. If possible, provision should be fabricated for dimming the lighting.

Others

Nosotros recommend that there should exist an established arrangement for record keeping. Nosotros suggest the utilise of an electronic system for patient as well as unit of measurement records. The records organization should have adequate security to ensure the protection of privacy of the patients.

Nosotros recommend that all statutory precautions are taken against fire. Fire escapes should be clearly visible.

Due north.B. Dialysis machines may be kept in two rooms in the ratio of either 20/lxxx or 50/l, with independent water handling and drainage facilities, equally disinfection procedure oftentimes washed in the weekends could be carried out without causing disturbance to emergency dialysis, the need of which may arise at whatsoever time.

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Articles from Indian Periodical of Nephrology are provided here courtesy of Wolters Kluwer -- Medknow Publications

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598394/

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