SOP - Another sample

Another sample of a SOP by Mr Soong Chong Seng to share has been uploaded. Thank you Mr Soong for your kind gesture. Hope these samples can give you an idea as to how to prepare your own SOP......

Latest innovation in vascular graft

Vascular grafts are made from synthetic materials (PTFE). Commonly vascular graft needs approximately 2 weeks after implantation before it can be cannulated. Although 2 weeks is much better than 6 - 8 weeks for a native arterio-venous fistulae to mature.

It is always the best to prepare a CKD Stage 5 patient way ahead by constructing a native AVF before he/she needs haemodialysis treatment. Always try to avoid central venous catheter at all cost.

Now there are new innovation in vascular graft. With the introduction of "Fleixene" by Atrium the next generation composite vascular graft. It is claimed to be 3 times stronger than most PTFE grafts. The waiting period for cannulation after implantation is cut down to a day or two. This may eliminate the need for central venous catheter insertion all together.

However the downside is the price but surely this is a small price to pay for a whole bunch of positive points.

Check it out the next time you need to have an urgent vascular access for one of your patients......

KDOQI Classification

The KDOQI classification of kidney disease are:

Stage 1:
GFR 90+
Description: Normal kidney function but urine findings or structural
abnormalities or genetic trait point to kidney disease

Stage 2:
GFR 60 - 89
Description: Mildly reduced kidney function, and other findings
as for stage 1) point to kidney disease

Stage 3:
Stage 3A GFR: 45 - 59
Stage 3B GFR: 30 - 44
Description: Moderately reduced kidney function

Stage 4:
GFR 15 - 29
Description: Severely reduced kidney function

Stage 5:
GFR <15 or on dialysis
Description: Very severe, or endstage kidney failure
sometimes call established renal failure)

Vascular Access Conference 2010 KL

It was very interesting second and final day of the Vascular Access Conference 2010 in KL.

The speakers enlightened us on the possible problems faced by native AVFs such as steal syndrome, venous aneurysm, multiple vascular access failure, etc.

Ms Monique Sandford, a Neprhology Nurse Practitioner from Australia spoke on the role of Renal Nurse Coordinator in the Australian context which shows the importance of a "informed go-between" to assist all the different disciplines to coordinate the efforts to bring about the best treatment outcome and reduces delays and complications. We need to explore this possibility in Malaysia.....

Another batch of photographs is up, have a look and see if you can spot someone you know.....

Vascular Access Conference 2010 KL

Today, the first day of a two days conference organized by the Vascular Society of Malaysia, held at the Crowne Plaza Mutiara Hotel, KL.

A very big thank you to conference organizing chairman, Prof Dr Liew Ngoh Chin and the Vascular Society of Malaysia for organizing this precious conference to enlighten those involved in providing haemodialysis treatment.

This is especially so for the treatment providers to be better equipped with the latest information and development on blood access so that they can provide a better care and also be empowered to educate patients under their care to achieve better treatment outcome.

According to Prof Dr John Swinnen of Australia who said - education can help to save unnecessary expenditure and cost, early intervention helps to prevent avoidable complications. How true.....

We have upload another set of photographs.....

Vascular Access Conference 2010

"Pre Congress Workshop"

The pre-congress workshops were held at 2 different venues namely Hospital Kuala Lumpur and Mawar Renal Medical Centre Seremban.

At the Seremban held workshop, entitled Care and Preservation of Vascular Access saw Dr Gan Wee Hin, Prof Dr Liew Ngoh Chin, Dr Lily Mushahar and Ms Monique Sandford gave talks on a number of interesting topics.

The most interesting being the use of non invasive tool; duplex ultrasound in haemodialysis. Although it is only a dream for many of us to have this tool but nevertheless it is a tool that we cannot ignore for long if we want to upgrade the standard of care for our patients.

We have upload some photographs taken during the workshop for those who might be interested. Watch out for to come tomorrow......

SOP - Framework and Sample

SOP (Standard Operating Procedure)

Of late there are interests shown in how to prepare a SOP. SOP is a document that needs time and lots of work and dedication in preparing. There are many ways to prepare this document.

We have upload a framework and samples of procedures for those who may be interested. We welcome any sample of a complete set of SOP for those who may wish to have a look.

What is "SOP"?

SOP - Standard Operating Procedure

Standard Operating Procedure (SOP) is a written document or instruction detailing all steps and activities of a process or procedure. It is used to ensure consistency and quality within the organisation and making sure the right people are trained for the job.

The said procedures should be carried out without modifications or changes to ensure uniformity in the expected outcome. Once the process and procedure in any SOP has been rigidly tested and audited then it can be set in place.

SOP is a useful tool to help manage the workplace and also an important tool in training staff, standardization and also sharing the best practices leading to a higher accreditation of the services rendered.

SOP should be regularly/periodically reviewed to assure compliance to regulatory requirements and best working practices. A review of SOP can be activated by changes of processes or procedures to ensure the maintenance of best practices protocol.

However, this can only be done after an internal audit and change control procedure has been initiated and the final test result meets the required standard.

It is pertinent that only relevant activities have SOPs. Like the old adage “too many cooks, spoil the soup”, therefore too many unnecessary SOPs may create unwarranted “red tapes” which can inevitably leads to restrictions and chaos, leading to decline in the standard of care and treatment outcome.

Arterial & Venous Pressure Monitoring..(Final Part)

The Pre-pump Arterial Blood Pressure…..

This method is not slowly but surely catching up in usage popularity. It uses a different type of arterial bloodline set where the arterial blood pressure line is before the blood pump segment. This method results in the pressure reading in the negative.The cost is the same for the post blood pump arterial bloodline set.

This method detect the negative pressure exerted onto the AVF by the suction action of the blood pump. A higher blood pump speed will result in a higher negative pressure reading. The reading is reflective of the blood pump speed unless the AVF is having problem in supplying the arterial blood, which will result in a much higher figure than the blood pump speed. This is a good indication of the AVF ability in supplying blood. The slightest change can be detected long before any physical indication is detected.

As in the post-pump arterial blood pressure method, the fullness of the “pillow” on the arterial bloodline set or the “jerking” movement of the blood flow into the arterial chamber is used to determine the arterial blood supply. This method is crude and not very reliable as it can only be detect as in extreme situations by then it is too late.

A treatment practitioner with a keen eye would be able to detect impending supply problem way before it happens. It also prevents AVF being pushed beyond its capability thus resulting in its premature failure.

Please do consider using the pre-pump arterial monitoring method if you have not started using it. The benefit outweighs the cost or the hassle for the treatment betterment of the patients...

Arterial & Venous Pressure Monitoring..(Part 3)

Arterial pressure monitoring….

Arterial blood pressure monitoring is the monitoring of blood supply from the patient and the pressure within the extra-corporeal blood circuit up to the dialyser. There are two arterial blood pressure monitoring that can be carried out, that is the pre-pump arterial blood pressure monitoring and the post-pump arterial blood pressure monitoring.

The Post-Pump Arterial Blood Pressure….

This method is commonly employed by most HDCs where the arterial blood pressure monitoring tubing is attached to the arterial chamber of the arterial bloodline set.

This method monitors the arterial blood pressure of the extra-corporeal blood circuit after the blood pump until the dialyser. The pressure monitored is the positive pressure exerted by the blood pump, pumping blood into the dialyser. This method will only detect any back pressure built-up as where the hollow-fibers in the dialyser begin to clot.

Since it will only detect clotting of the dialyser, most HDCs felt that there is no need to waste a transducer protector for its use.

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English to Bahasa Malaysia

Just drop us a line if you are interested.

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Arterial & Venous Pressure Monitoring..(Part 2)

Venous pressure monitoring,,,,

It is to monitor extra-corporeal blood pressure within in the bloodline while returning to the patient. A low pressure indicates a good flow back to the patient whereas a high positive pressure indicates some form of obstruction from the venous return site to the venous chamber of the venous bloodline set.

A higher positive pressure is expected when the blood pump speed increases. The positive pressure registered will normally be at about the same as the blood pump speed or lower.

A much higher positive venous pressure can mean that a wrong choice of AVF needle size or misalignment of the AVF needle. Pre-emptive action must be taken or else back pressure may occur resulting in clotting of the dialyser.