PREFACE __________________________ Procedures Manual Procedures Manual This pape

r aims to guide Procedures Manual nurses about system assembly and description o
f materials in various procedures in intensive therapy Procedures Manual. The nu
rse deGilberto Procedures Manual in its training in the Intensive Care Unit of H
ospital de Clinicas de Porto Alegre realized the need for a Manual of Procedures
Manual for guidance assembly systems such Procedures Manual slow hemodialysis a
nd continuous ultrafiltrate, breathing circuits , Swan-Ganz and others. Talking
to this Manual aProcedimentos leadership was challenged to use their artistic ta
lents (drawing) in these schemes Manualdesenvolvimento Procedures systems. This
manual is the result of their work and Procedures Manual deo collaboration of co
lleagues Simone and Ivan. Congratulations Manualbem as its employees by having t
he Enf. Gilberto, Procedures accepted this challenge and have produced a work of
this Manual that this manual can quality. We believe Procedures to assist nursi
ng students Manualárea Intensive Care. and future nurses in the Procedures Manu
al of Procedures Enf ª Prof. Deborah Vieira, Chief of Staff SETI. Procedures Ma
nual
Procedures Manual
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GLOSSARY ________________________
VP VD PCWP PCP DC PVC CO HR MAP DAP PASP PMAP SF ETO ATC BH Un Cm IPR L MI HEP-P
CR IV BIA CPAP 2Via Via Proximal Distal Pulmonary Artery Occlusion Pressure, Pul
monary Capillary Pressure Central Venous Pressure Cardiac Output, Cardiac Index
Right Atrial Pressure Heart Rate Mean Arterial Pressure, Pulmonary Artery Systol
ic Pressure Pulmonary Artery Mean Pressure Saline Ethylene Oxide Anti-coagulatio
n Continuous Water Balance Units Intermittent Peritoneal Dialysis Liters Centime
ters Millimeters Heparin Parada Cardio Respiratory Intra-venous Intra-aortic Bal
loon Continuous Positive Airway Pressure
Procedures Manual
SUMMARY __________________________
HDLC - equipment ............................................... ...............
. 04 HEMODIÃ LIS SLOW AND CONTINUOUS - system ................... 05 ADO-ultrafilt
er system ..... ........................................... 05 HDLC - system set
up. ...................................... 06 HDLC - water balance sheet ..... .
.............................. 08 DPI - equipment and system ............. .....
................................ 09 DPI - spreadsheet control ....... ..........
.............................. 10 Assembly and exchange of IPR system ..........
..................... 11 SWAN-GANZ-material ...... .............................
................. 13 SWAN-GANZ - implanted catheter system and hemodynamic measu
res ................ 14 ...................... ........................ 15 LINE
MAP - equipment and system ................... ................. 17 BIA - equipm
ent and systems - with a specific transducer ... 18 BIA - equipment and systems
- without specific transducer ... 20 MARK BIRD MARK 7 and 8 - system ...........
....................... 22 BEAR and Venturi Mask - system ...... ...............
....... 23 SERVO 300 and CPAP mask - valve ................... .. 24 CPAP Mask -
FIO2 control and the IBRD ................ 25 Clean respirators and masks .....
........... ............ 26
Procedures Manual
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SLOW CONTINUOUS HEMODIALYSIS ______ MATERIAL
Mesa Machine to Machine hemolenta sensor bubble Extension electrical (voltage co
mpatible) Support specific clamp with protector (6cm.) Gauge Syringe 20 ml Tape
artery line (red) venous line (blue) filter dialyzer Hansen Hansen red blue bag
collector Silicone sterile closed urinary system (5 cm) Pointer (2 pcs.) Equipo
drops (2un.) SF 0.9% 1000 ml (2un.) Solution for dialysis in 1000 ml (2un.) Glov
e procedure if medically indicated: Solution heparin (ATC) Equipo serum Infusion
pump Heparin (to flush the system) Syringe Needle
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Procedures Manual
SLOW CONTINUOUS HEMODIALYSIS
Line Line venous blood drainage system closed
Peritofundin Bottle w / Filter dialyzer tubing (capillary)
Ultrafiltered
Procedures Manual
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SLOW CONTINUOUS HEMODIALYSIS ______ MOUNTING SYSTEM
Connect a filter in the arterial and venous lines obeying the colors. 2 Adapting
the filter in the holder. 3 Secure with tape catabolha the venous line in the s
upport and
the arterial line at the table
4 Secure the machine with bubbles in the sensor holder 5 Position in the venous
part of the line machine with sensor
bubbles
6 Connect the pressure gauge with a pointer towards specific
venous line (longer end up catabolha) and place it in the holder.
7
Connect the 20 ml syringe in the specific pathway of the venous line (the shorte
r catabolha above) receives input from turning around the route of replacement)
8 Adapting the silicone part of the arterial line to hemolenta (9 Adapt the gear
on the road with SF replacement every 10 Hansen Adapt the filter (corresponding
colors). 11 Fit the bottle of solution to dialysis tubing with the Hansen
blue using a pointer to the connection for connecting the silicon
12 Adapting the urine collection bag in red using Hansen
-6Manual Procedures
13 Connect the wires, giving equal voltage of
appliances - machine to machine with the sensor hemolenta bubble - bubble machin
e with sensor on the wall - if necessary, to the machine with sensor bubbles rea
ch the wall, use the extension cord with voltage compatibility
14 Carry out cleaning of the system:
- If medically indicated, adding heparin to SF - with the aid of forceps, rinse
in sections following the path that blood flow will make it from the patient and
always leaving an escape route open for air and SF - all seek to withdraw air f
rom the system - using two liters SF washing system
15 Fill the filter with a solution for dialysis
- Use two liters of solution during the washing system
16 If medically indicated, install the appropriate route in the solution ATC
infusion pump and / or add heparin in SF to do the washing system insensible los
ses (body weight x 0.5 x number of hours)
17 The water balance should be calculated every 6 hours, including the
Procedures Manual
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8SAÃ AD-VO LU ME TO BH BH Parc La BSERVAÃ Ã The TAL ES
H RA
BAN H O No.
The TRAD EN VO LU M E
00 h
01 h
02 h
03 h
04 h
05 h
06 h
06h
07 h
08h
09 h
10 h
11 h
12 h
12 h
13 h
14 h
15 h
16 h
17 h
18 h
18 h
19 h
20 h
21 h
22 h
23 h
Procedures Manual
24 h
HDLC - WATER BALANCE
Intermittent peritoneal dialysis ___ MATERIAL
Dialysis bag 5000 ml with 1.5% glucose or 4.25% (as a medical indication (4un.))
5000 ml dialysis bag empty bag for dialysis in 2000 ml empty Equipo octopus Bur
eau for dialysis (with heater) Scale Labels tapes to record weights of sterile g
loves handbags Mask
Intermittent peritoneal dialysis
SCHOLARSHIP FOR BATH 200ml
Hot plate
Collecting bag 5000ml
TEMPERATURE CONTROL BOARD
EQUIPO OCTOPUS
Procedures Manual
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10TÃ RM EN-ION TO TRAD ES BSERVAÃ Ã I II N CO SAI SAI AD AD TERM WEIGHT ION BO LSA CO
LETO RA VO LU MEDE SAI AD BALAN SERVICE TO SUCH Parc La BH =
No. The H BAN
I II N CO A EN TRAD
VO LU M EN AND TRADE
Procedures Manual
PERITONEAL DIALYSIS
FITTING AND CHANGING THE SYSTEM DPI __
1) Weigh each bag and put 5000ml sticker with the weight found. Add the weight o
f all and note the balance sheet as initial weight (IW) - the column of comments
. Wear a mask and sterile gloves. Connecting pathways equipo octopus grants dial
ysis. In the case of adding to drugs and / or electrolytes to purses, antisepsis
, the route of medication should be taken with alcohol or iodine 70% alcohol. Dr
ugs and / or electrolytes should be added to the bags so far as they are being u
sed. Fill the bag smaller (2000ml) with the volume specified in the prescription
for the baths and put it on the hot plate to warm the liquid (37 ° C). Start t
he infusion bath obeying the time of entry and note the time prescribed in the b
alance sheet. During the time spent preparing the next bath (warm). After the pr
escribed time shall start the drainage time (output), always noting the times on
the balance sheet. The collection bag should be placed on the scale. At the end
of exit time, check the weight of the collection bag and write it on the balanc
e sheet.
2) 3) 4)
5)
6) 7) 8)
9)
10) Repeat steps 4-9 until the successive entry of all purses. Carry the exchang
e system.
Procedures Manual
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11) In the exchange system, clamp the bags filled with clamps IPR. 12) Repeat st
eps 1 and 2. 13) Remove the old tip of the bag and introduce the new purse and t
he most careful not to contaminate. 14) Restart the system again by repeating st
eps 40-10. 15) carry bags weighing of old. The sum of the values found is equal
to weight (BW) - note on the sheet below the IP. 16) Make the water balance (PF-
PI). 17) After the disregard of the scholarships in the purge old clamps IPR mus
t be cleaned and reused
CLAMPS CLEANING OF IPR
1) 2) When in use, during the IPR, do álccol disinfection with iodine (no need
to soak). After use, when the system shuts down, wash with soap and water, dryin
g and disinfecting do in CIDEX for 30min.
3) Condition in plastic boxes with lids.
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Procedures Manual
Swan-GANZ _____________ MATERIAL
Swan-Ganz catheter 8.5F 7F Introducer Tray subclavian puncture sterile gloves (p
air) Gauze (3 packets) Chlorhexidine Field sterilized (2 pcs. Large) 2 or 1% Xyl
ocaine without epinephrine Syringe Needle 25x06 10 ml (2un) SF 0, 9% 250ml (bott
le) 20 ml Syringe (3ml) taps (7un) Extension for serum (4 pcs) membrane pressure
transducer Transducer Support Support for serum cardiac Monitor Module PRESS
Procedures Manual
Catheter for infusion pump (2un) 250ml 0.9% SF +0.3 ml heparin (2un) Infusion pu
mp (2un) Equipo drops serum (flush) SF SF 250 ml 0.9% 0.9% 100ml (for thermomete
r cable cardiac output CO Module. Equipo for serum (drops or micro, depending on
the choice of infusion introducer Soro as medical indication for infusion into
the introducer) wire suture material for dressing (obs. .. routine) PCR Micropor
e Car
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- SWAN - GANZ - SYSTEM
CO Cape Cape module module press membrane pressure transducer taps
Via proximal distal SWG SWG Via Via Via cardiac output cuff - SWAN - GANZ - cath
eter
Thermistor
PULMONARY ARTERY
Balonet
VIA PROXIMAL
VIA DISTAL RIGHT ATRIUM
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Procedures Manual
Hemodynamic __________
1. Position the patient obeying the level "zero" the bed x membrane pressure. 2.
"Zero" the pressure of the membrane permeability and confirm VP and VD (flush).
3. PCWP - Open RV to the membrane pressure. - Monitoring Procedures + Wedge - I
nflate cuff (check specific change in the pressure curve). - Stop Trace: deflate
the cuff. - Edit + Wedge. - Position the cursor over the line pressure curve: a
t the end of expiration, or if pulmonary hypertension, the wave deflection (PCP)
. - Note the value. - Record values of systolic, diastolic and mean. - Open to V
P membrane pressure. - Monitoring Procedures + Wedge - Note value.
4. PAP 5. PVC
6. DC - Display Standard Monitoring Procedures + + CO - repeat three times: SF a
spirate 10 ml syringe connected to the VP Start CO (read inject Now) quickly inj
ect the syringe, maximum 4 sec.
Procedures Manual
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- Edit CO. obs tolerance 10% of the difference of values of the DC if you want t
o delete some cur va: Select Curve + On / Off For 7th Avg. Confirm Hemo + Calc.
8. Register the table values: CO, HR, SBP or DBP + MBP, PASP + PDAP or PMAP, PVC
, PCP or PCWP, Weight, Height. 9. Perform Calc 10. Copy values to the control sh
eet Hemodynamic Monitoring
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Procedures Manual
___________________ MATERIAL FOR ONLINE MAP
- IV Catheters (abocacath options caliber) - Glove procedure - Gaze (1pacote) -
Chlorhexidine - Micropore - tape - Extension for serum (3un.) - taps - Membrane
- pressure transducer - Support for transducer
- MAP -
-
Support for serum cardiac Monitor Module PRESS Equipo 20 ml Syringe for infusion
pump SF. 0.9% 250 ml + 0.3 ml heparin infusion pump Equipo drops serum (flush)
SF. 0.9% 250 ml (flush) to level Ruler
Cape module press membrane pressure transducer taps Extender w / PAM Procedures
Manual
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Intra-aortic balloon ______________
(With specific transducer)
MATERIAL

Intra-aortic balloon catheter Control Console cable console for cardiac monitori
ng electrodes (5un.) Tray subclavian puncture sterile glove (Pair) Gauze (3 Pack
s) Chlorhexidine Field sterilized (2 pcs. Large) 2 or 1% Xylocaine without epine
phrine syringe Needle 10 ml 25 x 06 (2 pcs.) SF 0.9% 250 ml (bottle) Syringe 20
ml (3un.) taps (5 pcs.) Extension for serum (2un.) membrane pressure (dome) Tran
sducer specific (Island) Support for serum cardiac Equipo Monitor for infusion p
ump 250ml 0.9% SF +0.3 ml heparin
Procedures Manual
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Infusion pump Equipo drops serum (flush) 0.9% 250ml SF (flush) Material for dres
sing (obs. routine) Micropore Ruler for CRP level car
- BIA with a specific transducer
Membrane pressure (dome) Cape console w / cardiac monitoring Extender specific B
IA
Via taps w / BIA pressure monitoring (pressure) transducer specific console
Procedures Manual
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Intra-aortic balloon ______________
(No specific transducer)
MATERIAL

Intra-aortic balloon catheter Control Console cable console for cardiac monitori
ng electrodes (5un.) Tray subclavian puncture sterile glove (Pair) Gauze (3 Pack
s) Chlorhexidine Field sterilized (2 pcs. Large) 2 or 1% Xylocaine without epine
phrine syringe Needle 10 ml 25 x 06 (2 pcs.) SF 0,9% 250 ml (bottle) Syringe 20
ml (3un.) taps (5 pcs.) Extension for serum (2un.) membrane pressure (flat) tran
sducer (heart monitor) support Support for serum transducer module PRESS Cardiac
monitor catheter for infusion pump
Procedures Manual
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250ml 0.9% SF +0.3 ml heparin infusion pump Equipo drops serum (flush) 250ml 0.9
% saline solution (flush) Material for dressing (obs. routine) Micropore Ruler f
or CRP level car
- BIA without specific transducer
Module cable press-membrane pressure transducer (flat)
Procedures Manual
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BIRD MARK 7_______________________
BIRD MARK 8_______________________
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Procedures Manual
BEAR ______________________________
Oxygen Extender
VENTURI MASK _______________
MASK
TRACHEA
PIPE
VALVE
Extender OXYGEN
Procedures Manual
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SERVO 300 _________________________
Gray wire long gray wire short
MASK CPAP _____________________
(With valve)
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Procedures Manual
MASK CPAP _____________________
(FiO2 control)
MASK CPAP _____________________
(With Bird)
Procedures Manual
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CLEANING AND MASKS BREATHERS _______________________
BIRD MARK 7, MARK 8 and 5 BEAR
1) Remove and rinse the circuit with warm water and soap enzyme (soak for 30 min
utes.). 2) Rinse in running water. 3) Dry the material. 4) Put in glutaraldehyde
for 30min. 5) Remove the material from the glutaraldehyde, rinsed in sterile di
stilled water and dried with compressed air on the sterile field. 6) Establish a
nd adjust the respirator assembly, protecting the length of the trachea.
SERVO SERVO 900 and 300
1) Remove the respirator and replace the green filter short internal circuit. 2)
Clean the respirator externally with a damp cloth. 3) Wash the circuit with war
m water and soap enzyme (soak for 30 minutes.). 4) Remove the soap, brush and ri
nse under running water. 5) Dry the material in compressed air.
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Procedures Manual
6) Assemble the circuit (with having the unit) and send it, properly identified,
the CME, with IC. 7) The respirator should be fitted with loose circuit sterili
zed.
NOTE:
a) Thermometer SERVO - damp mop with water and soap (not wet the plug) - pass we
t cloth to rinse and dry. b) Sensor temperature control circuit of the Servants
(gray wire) - Skip cloth dampened with water and soap, rinse and dry. - Replace
in place. - When assembling the circuit, pass gauze soaked with 70% alcohol only
in the tip of the plug circuit. c) Sensor electrical internal circuit - should
be immersed in a tank round with 70% alcohol for 30min. - After dry, put it back
in its place.
Procedures Manual
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CPAP MASK
1) Wash the mask with warm water and soap enzyme, along with the clip (soak for
30 minutes.). 2) Dry and store in plastic box dry, clean and closed 3) The expir
atory valve, the plastic hose and connector should be washed with soap and water
enzyme (soak for 30 minutes.), Rinsed in running water and dry. 4) After should
be placed for 30min. in glutaraldehyde and rinsed with sterile distilled water.
Should be dried in the air on the sterile field. 5) After dried must be packed
in plastic box with the mask.
VENTURI MASK
1) Wash the mask, the trachea, the valve and nebulizer (pipe) in warm water and
soap enzyme (soak for 30 minutes.). Remove secretions and / or crusting. 2) Rins
e with tap water and dry the material. 3) Place the material in glutaraldehyde f
or 30min., Remove and rinse in sterile distilled water. 4) 1sec in the compresse
d air on the sterile field. 5) placed in boxes, dried, cleaned and closed.
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Procedures Manual