Infection Control and Patient Safety
Standard precautions first
Perform hand hygiene before and after every patient contact and before and after glove use. Wear gloves for cannulation and any blood exposure, and eye/face protection when splashing is possible. Treat every patient's blood as infectious - serostatus is never assumed at the chair.
Vascular access and bloodstream infection
Central venous catheters cause most dialysis bloodstream infections. Use strict aseptic technique with chlorhexidine, and have both patient and nurse masked during catheter connection and exit-site care. For fistulae and grafts, use rope-ladder rotation or a buttonhole track established by the same cannulator, and scrub the site before needling. Redness, warmth, purulent drainage, or fever at the access must be reported before cannulation.
Bloodborne viruses
Hepatitis B drives patient placement: HBsAg-positive patients are dialyzed in a separate room with dedicated machines where local policy requires it, and all patients should be vaccinated with titres checked. Hepatitis C and HIV do not require dedicated machines under standard precautions - a classic exam trap.
Medication and general safety
Use two-identifier checks for blood transfusion and verify heparin concentration. Keep UF and sodium settings visible to the team. Address fall risk from post-treatment orthostasis, prevent needle-sticks (no recapping; sharps container at point of use), and keep spill kits available.
Rule of thumb: if a needle dislodges or a line separates, clamp the line and stop the pump; never return blood from a circuit that may be contaminated.