Hemodialysis Flow Sheet- Catheter
Hemodialysis Flow Sheet – Catheter Resident Name
Goal
To ensure the safety and well-being of residents undergoing hemodialysis with a permanent catheter by providing structured monitoring and documentation of the catheter site and related health indicators.
Policy
To ensure continuous and effective monitoring of residents with permanent catheters undergoing hemodialysis, ensuring timely identification and management of any complications or issues.
Hemodialysis Flow Sheet – Catheter Resident Name: __________________________________
Access Site Permanent Catheter Location: _________________________________ Dialysis Schedule: _____________________
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Assess Site for the Following: |
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Shift |
Sunday |
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
Vitals BP TPR |
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11-7 |
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7-3 |
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3-11 |
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Dressing Intact/Catheter Cuff Intact (Cuff Protrudes if dislodged) |
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11-7 |
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( + ) Positive ( - ) Negative |
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7-3 |
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If negative notify MD |
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3-11 |
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Signs & Symptoms of Infection (Pain, Redness, Swelling, Drainage, Fever) |
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11-7 |
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( + ) Positive ( - ) Negative |
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7-3 |
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If positive, notify MD |
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3-11 |
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Signs & Symptoms of Fluid Deficit (Dizziness, Decrease BP, Increase P) or Fluid Overload (Shortness of Breath, Abnormal Lung Sounds, Increase in Edema) |
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11-7 |
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( + ) Positive ( - ) Negative |
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7-3 |
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If positive, notify MD |
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3-11 |
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Initials of Nurse |
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11-7 |
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Initials of Nurse |
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7-3 |
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Initials of Nurse |
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3-11 |
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Abnormal Findings Require Documentation in the Nurse’s Notes & MD Notification New 9/07
References:
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Centers for Medicare & Medicaid Services (CMS), State Operations Manual (SOM)
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Requirements of Participation for Nursing Homes, CMS