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Dialysis Program Outpatient Manual

Chapter 0 : Dialysis Program Organizational Chart

Organizational Chart

Chapter 1 : Administrative

DP024 Bood Administration

DPA01 AMI pre-post Assessment of the Dialysis Flow Sheet Policy

DPA02 Care Across the Continuum Admission and Discharge

DPA03 Cell Phone Usage by Employees

DPA04 Dialysis EMR Access

DPA05 Dialysis Program Attendance Addendum

DPA06 Dialysis Program Committees

DPA07 Employee Health Monitoring

DPA09 Governing Body and Management

DPA10 Health Care Provider Licensure Certification

DPA11 Home Hemodialysis and Peritoneal Dialysis Evaluation and Supervision

DPA12 Management of Patients with Behavioral Issues

DPA13 Medical Coverage of Dialysis Patients

DPA14 Medication preparation and Administration Policy

DPA15 B. Braun Dialog Hemodialysis Machine Disinfection

DPA16 Mission Statement

DPA17 Patient Assessment and Care Plan Policy

DPA18 Patient Grievance Policy

DPA19 Patient Memorial Fund Policy

DPA20 Patient Rights and Responsibilities

DPA21 Quality Assurance and Performance Improvement

DPA22 Storage of Dialysis Medical Records Policy

DPA23 Water Treatment Room Security

ECP Outpt Dialysis Program

Flowsheet for Problematic Behavior Patients

Transplant Selection Criteria

Chapter 2 : Outpatient Dialysis Treatment

Section 1 : In-Center Outpatient Dialysis

Anaphylaxis Hypersensitivity Drug Reaction

Blood Cultures

Crit Line Monitoring

Dialysate Delivery

Dialysis Specific Infection Prevention and Control

Dialysis Treatment Bypass

DP025 Braun Machine Dialyzer Build with Airless Bloodlines

DP526 Blood Product Administration During Dialysis and/or Apheresis

DP536 Machine Verification and Hourly Patient Checks

Identifying Contact Isolation Patients

No Heparin Dialysis

Obtaining Post Dialysis BUN (Braun)

Obtaining Pre-Dialysis Lab Specimens

Obtaining PT/PTT from Catheter

Preparation and Use of Bleach Solutions

Securement of dialysis needle sets during dialysis

Section 2 : Vascular Access Care

AV Fistula and Graft

DP512 Management of New AV Fistula

DP513 Clamp Fistula Use

DP516 Creating Constant Sites Buttonhole in Native AVF

DP517 Buttonhole Cannulation

DP542 Complications of Fistula and Grafts

DP543 Discontinuation of Hemodialysis with an AV Fistula or Graft - Braun

DP547 Nipro Safety Fistula Needle

DP548 Venous Dialysis pressure Monitoring

DP549 Vascular Access Surveillance

DP550 Chloraprep Single Swabstick

Initiation of Dialysis for Fistula or Graft Braun

KECN Online Clearance

Kt/V Online Clearance


Antibiotic Therapy for Catheter Infection

Catheter Disconnect

Catheter Disconnect with Tego Cap - Braun

Catheter-Secondary Access Care

Initiation of Dialysis for Dual Lumen Catheters - Tego Caps (Braun)

Patient Education

Bleeding from access after dialysis

How to care for your dialysis access

How to care for your dialysis catheter

Instructions: Patients going home after femoral catheter

Section 3 : Medical Complications

Air Embolism




Blood Leak

Cardiac Arrest

Dialysis Disequilibrium Syndrome

Fever and Chills

First Use Syndrome

Heparin Overdose




Muscle Cramps

Power Failure



Section 4 : Medications



Cathflow Activase Administration

Cefazolin (Ancef)


Cefoxitin Administration


Citrate Catheter Lock

Contrast allergy premed

Daptomycin (Cubicin) Administration

Diphenhydramine Hydrochloride (Benadryl) Administration

DP363 Heparin Administration

Engerix B (Hepatitis B) Vaccine Recombinant

Epinephrine 1-1000 Injection Administration

EPO Administration


Etelcalcetide (Parsabiv) Administration

Ferumoxytol (Feraheme)

Gentamicin (Garamycin)

Hectorol Doxercalciferol

IDPN Infusion Administration

Iron Sucrose (Venofer)

Meropenem Administration

Methylprednisolone (Solu-Medrol) Administration



Sodium Ferric Gluconate Complex Administration

Sodium Thiosulfate

Solu-cortef Administration


Vancomycin Dosing and Administration

Zemplar - Paricalcitol

Section 5 : Protocols

Algorithm: Adequacy for Low Kt/V or URR

Algorithm: Catheter Malfunction

Algorithm: Conversion of Tunneled Catheters to AVF or AVG

Algorithm: Infection

Calcitriol (Calcijec)

Darbepoetin (Aranesp)

Doxercalciferol (Hectorol)


Ferric Gluconate (Ferrlecit)

Hep B Flow Chart


Hepatitis B Vaccine Recombinant (Engerix-B)

Iron Sucrose (Venofer)

Lab Orders

Nutrition Algorithm

Nutrition Supplement Flow Diagram

Paricalcitol (Zemplar)

Section 6 : Standard Work

Bbraun Dialog Disinfection

Chapter 3 : Acute Renal Failure/CRRT/Apheresis

Section : Acute Kidney Injury

Accessing catheters by non-renal staff in the ICU Setting

Albumin (Human) 25% Solution Administration

Calcium Bath Mixing

Citrate Anticoagulation

Connecting CRRT to ECMO

Crit Line

Culturing Catheter Tip

Dialysis in the Emergency Department

Guideline: Red Cell Exchange Transfusion in Sickle Cell Disease

Heparin Administration

Heparinization Protocol

Mannitol Infusion Protocol

Potassium Dialysate Protocol

Section : Apheresis

Apheresis Assessments

Apheresis Drug Removal

Apheresis Signs and Symptoms

Apheresis: Standing Guidelines

Section : CRRT

Albumin Priming in CRRT

Calcium Dosing in CRRT

CRRT Calcium Chloride Titration

Heparin Anticoagulation in CRRT

Section : Pediatric

Pediatric CRRT Protocol

Pediatric Guidelines

Chapter 4 : Home Therapy

Section : Check Sheets and Misc

Check List - CAPD CCPD Home Visit

Check List - Fresenius Hemodialysis Home Visit

Check List - NxStage Hemodialysis Home Visit

Home Patient Compliance Letter

Home Therapy Agreement

K Machine Training Schedule

New Patient Letter (KC Home)

Section : Home Therapy Guidelines

Guideline: CAPD CCPD Emergency Kit list

Guideline: CAPD CCPD Initial Patient Supplies

Guideline: CAPD CCPD Monthly Patient Supplies

Guideline: CAPD Training

Guideline: CCPD Training

Guideline: HHD Home Visit

Guideline: PD Home Visit

Section : Home Therapy Procedures

Adding Medication to Dialysate Bag

Catheter Dressing Change

Changing PD Extension Tubing (Fresenius)

Converting Baxter Cath to Fresenius - Permanent

Converting Baxter Cath to Fresenius - Temp

Converting Fresenius Cath to Baxter - Permanent

Converting Fresenius Catheter to Baxter - Temp


Exit Site Infection Protocol

Flushing PD Catheter

Healed PD Exit Site Care

Initial PD Extension Tubing Placement and Flush

NxStage Training Procedure

Obtaining an effluent sample from a PD bag

PD Catheter Repair

PD Exit Site Care (Initial Post-Op)

Peritoneal Equilibration Test (PET)

Peritonitis Protocol

Resin Pack Exchange

Silex Chemical Disinfection

Silex Home Setup

Ultra-Low Total Chlorine Test - NxStage

Section : Patient Education

Are you wearing your mask and washing your hands?

Care for your PD Catheter After Surgery

CCPD Disconnection - Patient Instructions

Guideline: Exit site care for patients

Helpful Hints for First Week at Home for CAPD

Helpful Hints for Preparing You and Your Home for PD Exchanges

Kt/V patient instructions

Kt/V Bag Labels

Liberty Cycler Training Test

PET Instructions


When to call the clinic

Chapter 5 : Water & Biomedical Service

Section : Water & Biomedical Service

Conductivity Bicarb Na Conversion Chart

DP700 Microbiological Testing

DP701 Dialysate Culturing via Sample Port Collection

DP703 Ascend Labs (Packaging and Shipping)

DP705 Total Chlorine Chloramine Testing

DP706 Water Culture Collection

DP707 Ultra-Low Total Chlorine Testing for Direct Feed

DP708 Amherst Only: Ultra-Low Total Chlorine Test

DP709 Ultra-Low Total Chlorine Testing for the 23G RO

DP710 Ultra-Low Total Chlorine Testing for the BioLab 4400

DP711 Surface Terminal Disinfection

DP712 Serim Residual Chlorine Testing

DP713 Water Hardness (Steri-Chek)

DP715 Amherst Bicarb Mixing

DP716 Myron L D-4 Calibration

DP717 Myron LD-4 Validation

DP718 pHoenix Meter Level 1 Calibration

DP719 pHoenix Meter Level 2 Calibration

DP720 pHoenix Meter Validation

DP721 Kidney Center Bicarb Mixer Loop End of Day Rinse

DP722 Amherst DI Bypass

DP723 Amherst Treated Water Loop Chemical Disinfection

DP724 Farmville Bicarb Chemical Disinfection

DP725 Farmville Bicarb Disinfection Rinse

DP726 Farmville Bicarb End of Day Rinse

DP727 Farmville Bicarb Mixing

DP728 Kidney Center Bicarb Mix Tank Rinse

DP729 MRO5 Chemical Disinfection

DP730 Ultra-Low Total Chlorine Testing

DP732 Water Hardness RPC

DP733 Appomattox Bicarb Loop and Water Inlet LIne Ozonation

DP734 Appomatox Ozonation

DP736 Amherst Bicarb End of Day Rinse

DP741 Technical Service Request

DP742 Aquaboss Chemical Disinfection

DP743 Aquaaboss Citric Acid Cleaning

DP744 Aquaboss Manual RO Heat Disinfection

DP745 Dialysate pH Verification

DP747 Aquaboss Hot Rinse Water Loop Heat Disinfection

DP749 Conductivity (Braun)

Chapter 6 : Transplant

Chapter 7 : Emergency Management

DP001 : Emergency Management of Outpatient Dialysis Facilities

Section : Forms

FORM - Agreement to Comply with Established Procedures

FORM - Bulletin Board Consent

FORM - Chair-side Rounding Consent

FORM - Dialysis Downtime Worksheet

FORM - Dialysis Downtime Worksheet

FORM - Hepatitis B Declination

FORM - Technical Service Request

FORM - Technician Certification Acknowledgement

FORM - Transient/Transfer Information

FORM - Utility Failure

Section : Guidelines

Guideline: Bundled Medication

Guideline: Care for patients with Acute Kidney Injury

Guideline: Care Plans

Guideline: Code and Demise of Patient during dialysis

Guideline: ESRD Patients requiring gadolinium as contrast

Guideline: Hemodialysis Catheter Exit Site and Tunnel Infection

Guideline: Nutrition Supplement

Guideline: Parathyroidectomy

Guideline: Parsabiv

Guideline: Sensipar

Guideline: Standing Routine Outpatient Hemodialysis

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