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Policies,Clinical,UWHC Clinical,Department Specific,Hemodialysis

Hemodialysis treatment using the Gambro Phoenix® Machine (3.1)

Hemodialysis treatment using the Gambro Phoenix® Machine (3.1) - Policies, Clinical, UWHC Clinical, Department Specific, Hemodialysis

3.1

University of Wisconsin Hospital and Clinics
Inpatient Hemodialysis
Department 55400

TITLE: Hemodialysis treatment using the
Gambro Phoenix® Machine

POLICY #:3.1
REVISED: October 1, 2014
Page 1 of 8
Nurse Manager: Joan Watson, MS, RN
Director: Ann Malec, MS, RN
Medical Director: Alex Yevzlin, MD


I. PURPOSE

Dialysis Nurses and Technicians will be able to safely prime the Gambro Phoenix machine for
the purpose of Hemodialysis, assuring that the extracorporeal circuit is free of air, sterility of all
connections are maintained, machine set-up parameters match the dialysis prescription and
dialysate is being supplied to the dialyzer in a counter-current fashion delivering the most
effective dialysis treatment possible.

Dialysis Nurses and Technicians will be able to safely initiate, discontinue and re-initiate dialysis
on the Gambro Phoenix machine.

II. POLICY

A. Refer to the Gambro Phoenix operator’s manual for specific information concerning
dialysis machine functions.
B. Registered nurses or Dialysis Patient Care Technicians will prepare, initiate, reinitiate
and discontinue dialysis treatment after demonstrating competency.
C. The Registered nurse or Dialysis Patient Care Technician will be responsible for
verifying the machine is disinfected, prepared and tested per manufacturer’s
recommendations. Dialysis treatment will not be initiated unless the equipment and
monitor systems are functioning properly and treatment will commence within 4 hours of
preparation.
D. The Registered nurse will be responsible for verifying the machine is prepared per
physician’s orders prior to initiating dialysis.
E. Dialysis machines, dialysate solutions, tubing, and dialyzers will be inspected for defects
and expiration dates prior to initiating dialysis.
F. Dialysate:
i. Only acid and bicarbonate concentrations approved for the proportioning pump
settings of the Gambro machines will be used. Current proportioning pump
settings are for 45x solutions.
ii. Unless there is a physician’s order to vary the concentrations; our baseline
bicarbonate will be set to 35 meq/L and sodium at 139 meq/L.
iii. Machine conductivity will be verified as correlating to an independent meter.
Dialysate conductivity, pH and temperature will be verified as within range,
13.4 to 14.4, 6.5 to 7.5, and 35-37º C, respectfully.

Page 2 of 8
G. Prior to the initiation of the first dialysis treatment, informed consent is required. See
Hemodialysis Departmental Policy 1.1 Informed Consent for Dialysis and Related
Procedures.
H. Hepatitis B infectious disease status will be determined with the first dialysis treatment
and if unable to determine transmission status screening labs will be drawn per
Hemodialysis Departmental Policy 5.0 Hepatitis B Screening and Hepatitis B
transmission prevention in Hemodialysis.
I. Hand hygiene will be performed and aseptic technique used when making any blood
tubing connections. Standard precautions, i.e., gloves, protective eyewear, isolation
gown, mask or a chin length face shield must be worn if there is a risk of splash or spray
of moist patient materials.
J. Inspect of all clamps and blood pump segment for proper occlusion and visualize the
patient’s access and blood tubing for secure connection or the presence of air.
K. Dialysis delivery system alarms will be monitored throughout the dialysis procedure. See
Hemodialysis Departmental Policy 3.9 Patient assessment and monitoring before, during
and immediately after hemodialysis.
L. Occasionally dialysis may need to be interrupted to check patency of the vascular access
or to allow the patient to go to the bathroom during the treatment. In these instances the
extracorporeal system can be recirculated for a maximum of 20 minutes. Every effort
should be made to return the blood prior to initiating recirculation.

IV. EQUIPMENT
A. Gambro Phoenix machine
B. Gambro Phoenix cartridge and tubing
Manufacturer  Machine   Tubing   
 
PRIMING 
VOLUME 
Blood Pump 
Segment (mm)  
Gambro  Phoenix  Adult Cartridge Blood Set 103 ml 6.4 mm 

C. Prescribed dialyzer
DIALYZER  Membrane/Sterilant  PRIMING  SIZE  (m
2

F3  Fresenius Polysulfone ® /Ethylene Oxide  24 ml 0.4  
F4  42 ml 0.7  
F5  63 ml 1.0  
F6  82 ml 1.3  
F8  110 ml 1.8  
Revaclear  Polyarylethersulfone, Polyvinylpyrrolidone 
(Poracton™)/Steam   
84 ml 1.4  
Revaclear Max  100 ml 1.8  
Asahi Rexeed 
21S  
Polysulfone / Gamma Rays  
Use for people with “allergic” reactions  
112 ml 2.1  

D. 1Liter normal saline
E. Prescribed Acid concentrate solution
F. Bicart®
G. Blue plastic hemostat clamps
H. Recirculator/prime connector
I. Personal protective equipment.





Page 3 of 8
V. PROCEDURE LIST
A. PRIMING GAMBRO PHOENIX
B. See UWHC Nursing Policy 1.28AP Care of the Hemodialysis/Apheresis Catheter for
detailed information on care, maintenance, and use of a hemodialysis catheter
C. See HD Policy 6.2 Insertion and Removal of Hemodialysis Access Needles for
detailed information on care and use of an Arteriovenous hemodialysis access.
D. PATIENT CONNECT GAMBRO PHOENIX
E. PATIENT DISCONNECT GAMBRO PHOENIX
F. RE-PRIME AND RE-CONNECT GAMBRO PHOENIX
G. UF AND CONDUCTIVITY PROFILES
H. RECIRCULATION
VI. PRIMING GAMBRO PHOENIX
1. Power on machine. Be sure water is on.
2. Plug acid wand into acid concentrate. Should hear and feel a ‘snap’. Verify with
patient’s orders.
3. Label Bicart with date and time and place Bicart® cartridge into the Bicart holder
arms.
4. Open blood pump door and the air bubble detector door. Verify that the blood pump
holder is in the horizontal position. Place Gambro® cartridge blood set in securely and
close the blood pump door. Make sure the latch clicks.
5. Insert the cartridge blood set lines in order:
a. Put venous line in the air bubble detector and venous line clamp. Close the air
bubble detector door.
b. Place the heparin line, arterial access line, saline line, and venous line into the
appropriate positions in the 4-position line clamp and close the clamps.
c. Insert the arterial line in the arterial line clip.
6. Press the SETUP action key to enter Setup mode. Do not touch any buttons or change
the acids or Bicart® while in test mode.
7. Place the dialyzer into the dialyzer holder on the left side of the machine.
8. Attach the arterial blood line to the dialyzer.
9. Close the clamp of the saline administration line that is attached to the venous line, and
spike the saline bag.
10. Confirm that the arterial and venous pressures are zero then open the clamp on the
saline administration line and gravity prime the venous blood line. When saline has
reached the end of the venous line, clamp the saline line and connect the venous line to
the dialyzer.
11. Once PRIME key available, connect the dialysate lines to the dialyzer, blue to venous
end and red to arterial end.
12. Open the WHO device door and observe that any fluid drains within 6 seconds. If
fluids remains visible, DO NOT USE THE WHO DEVICE.

Page 4 of 8

VII. PATIENT CONNECT GAMBRO PHOENIX


13. Insert the white priming connector attached to the arterial line into the WHO device
drain port. Unclamp the saline administration line. Press the PRIME action key, select
PRIME without UF. The blood pump will automatically start at its preset value.
14. Once the Operator Message appears: “Dialysate preparation complete” clamp the
arterial, venous and saline administration lines. Connect the saline administration line
to the cartridge saline line utilizing the prime connector on the cartridge saline line.
15. Remove arterial line from the white priming connector, leaving the connector in the
WHO device drain port. Connect the arterial and venous lines together utilizing the
connector on the venous line. Remove the priming connector from the WHO and
discard. DO NOT USE THIS PRIMING CONNECTOR FOR PATIENT USE.
16. Close the WHO device door.
17. When the prime is complete on both the blood and dialysate sides of the system, the
RECIRCULATE action key will appear.
18. Unclamp the arterial, venous, saline administration and the cartridge saline line and
press the RECIRCULATE action key. The blood pump will start automatically to
preset value.
19. When RECIRCULATE time is complete, the action key will remain yellow, the time
on the home view will remain at 0:00, and the UF rate will decrease to 0.000 to inform
the operator that recirculation has been performed.
20. At this time make sure that arterial and venous chambers are at target levels.
21. PROCEED TO PATIENT CONNECT.
1. Before proceeding to PATIENT CONNECT, press SET to validate treatment time,
target loss, ultrafiltration rate, dialysate rate and temperature against the physician’s
order. Press CONFIRM to verify each value.
2. If Profiling is needed, Set at this time by pressing PROFILE navigation key. Press
CON navigation key if using Na variation and chose your curve type, progressive or
step. Press UF navigation key if using UF profiling. Select curve type. Press
CONFIRM after setting each value.
3. Activate UF and/or CON profile curves before pressing to HOME navigation key to
return to the Home view.
4. Once patient arrives, press the PATIENT CONNECT action key. Press the
CONFIRM button. The blood pump will automatically stop. Clamp the arterial,
venous and saline lines.
5. Connect the arterial and venous lines to the patient’s access and unclamp all four
clamps.
6. Press the blood pump ON/OFF button to start the blood pump. Wait until the machine
senses blood in the venous line and an alarm message will appear, press override to
clear the alarm.
7. Press DIALYSIS action key to initiate the treatment.
8. Increase the blood pump speed to the prescribed blood flow rate, monitoring the
venous and arterial pressure as increasing the rate.

Page 5 of 8
VIII. PATIENT DISCONNECT GAMBRO PHOENIX


IX. RE-PRIME AND RE-CONNECT GAMBRO PHOENIX

1. Once treatment complete, select RINSEBACK action key. A message appears asking
the operator to confirm. Press CONFIRM, the blood pump will stop automatically.
2. Clamp the arterial line in the patient’s arterial access line. Disconnect the saline line
from the cartridge connecting it to the arterial line utilizing the priming connector.
Flush the patient’s arterial access per protocol.
3. Unclamp the saline line and the arterial line.
4. Press the blood pump ON/OFF button to the start the pump.
5. Once the preset Rinseback volume is complete, the blood pump will stop
automatically.
6. Press the OVERRIDE button to clear the AUTORINSEBACK COMPLETE
message.
7. Clamp the venous line and patient’s access line to disconnect the patient from the
machine. Flush patient’s access per unit protocol.
8. Proceed to EMPTYING and/or AUTOEMPTYING options. Once complete remove
cartridge and discard.
9. Perform DESCALING by pressing the DESCALING action key or the NEXT TX
action key to perform and integrated DESCALING and FINAL RINSE.
10. Proceed to NEW SESSION, SETUP or ADR procedure.
1. Press the RINSEBACK action key and confirm to return the patient’s blood. The blood
pump stops automatically.
2. When the desired amount of blood has been rinsed back. Clamp blood tubings and
access lines and disconnect patient. Make sure to lock both ports with NS flush.
3. Press the CHANGES action key. Press DIALYZER PRIME action key and
CONFIRM.
4. Wait for the CLICK sound, the venous line clamp opens and the Pt. Sensor Icon
changes from red to white. Remove the Dialyzer and cartridge bloodset and install new
ones. Connect the dialysate lines to dialyzer Insert the white priming connector
attached to the arterial line into the WHO device drain port
5. Deselect BYPASS action key and Press the Prime w/o UF action key.
6. As soon as the Prime Volume is complete (takes 3 minutes), the PATIENT CONNECT
action key shows up in the main screen.
7. Prepare for recirculation. Connect red and blue blood lines with recirculator and open
both clamps. Connect saline port and open the NS line Touch Patient connect and press
on/off bottom to start the pump in order to clear lines with air
8. As soon as the lines are free of air, stop the pump, clamp the saline line and connect
the red and blue ports to the patients HD catheters. Press the on/off button to start the
pump and increase the blood flow to 200 ml/min, wait until an alarm message “Blood
in venous line” appears. Clear the alarm and press DIALYSIS to resume the treatment.
Increase the blood flow according to prescribed rate. Monitor the venous and arterial
pressure as increasing the rate.

Page 6 of 8

X. ULTRAFILTRATION AND CONDUCTIVITY PROFILES
A. Three profile types can be set for each for each parameter (UF) or (conductivity)
1. CONSTANT – the ultrafiltration and/or the conductivity parameter can be set to a
constant the value set that is maintained for the duration of the dialysis.
2. STEP – This profile allows the (UF) or (conductivity) value to be set in 15 minute
intervals. (Figure 1. UF step Profile)
3. PROGRESSIVE – This profile allows the (UF) or (conductivity) values to be
gradually changed to follow a pre-determined graph. (Figure 2. Conductivity
Progressive Profile)

Figure 1. UF Step Profile Figure 2. Conductivity Progressive Profile


B. Ultrafiltration Profiles
To set CONSTANT (the default Dialysis Mode with profiling not enabled)
1. Press SET on the main screen. TREATMENT TIME will be highlighted. Press the +
or – to change the value and CONFIRM the changes.
2. TARGET LOSS will be highlighted. Press the + or – to change the value and
CONFIRM.
3. UFR will be highlighted. Press the + or – to change the value and CONFIRM the
changes. Press SET to exit to the main screen.

To set a PROFILE (UF)
1. Press the PROFILE navigation key. Press SET. TREATMENT TIME will be
highlighted. Press the + or – to change the value and CONFIRM the changes.
To set a PROGRESSIVE (UF) PROFILE
2. Press the UF navigation key and select PROGESSIVE and CONFIRM.
3. Press TARGET LOSS. Press the + or – to change the value and CONFIRM.
4. Press CURVE COEFFICIENT. Press the + or – to change the value and
CONFIRM. The initial value of the curve will be automatically calculated. Press SET
to exit.
5. Press the PROFILE navigation key. Press ACTIVATE UF RATE CURVE.
To set a STEP (UF) PROFILE.
2. Press the UF navigation key and select STEP and CONFIRM.
3. Press STEP UFR.

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C. Conductivity Profiles

XI. RECIRCULATION – Pause Therapy

 Each bar represents a 15 minute interval.
 Red bar indicates the step you are working with.
Press the + or – to change the value and CONFIRM. The red bar will automatically
move to the next step.
4. For the same value, press CONFIRM.
To change the value, press the + or – to change the value and CONFIRM.
Repeat this action for each 15 minute interval.
5. Press TARGET LOSS. Press the + or – to change the value and CONFIRM. The
graph displayed will compensate for the change in target loss accordingly. Press
SET to exit.
6. Press the PROFILE navigation key. Press ACTIVATE UF RATE CURVE
To set a PROFILE (CONDUCTIVITY)
1. Press the PROFILE navigation key. Press SET. TREATMENT TIME will be
highlighted. Press the + or – to change the value and CONFIRM the changes.
To set a PROGRESSIVE ( CONDUCTIVITY) PROFILE
2. Press the CON navigation key and select PROGESSIVE and CONFIRM.
3. Press INITIAL VALUE. Press the + or – to change the value and CONFIRM.
4. Press FINAL VALUE. Press the + or – to change the value and CONFIRM
5. Press CURVE COEFFICIENT. Press the + or – to change the value and
CONFIRM. Press SET to exit.
6. Press the PROFILE navigation key. Press ACTIVATE CONDUCT CURVE.
To set a STEP ( CONDUCTIVITY) PROFILE.
2. Press the CON navigation key and select STEP and CONFIRM.
3. Press STEP
 Each bar represents a 15 minute interval.
 Red bar indicates the step you are working with.
Press the + or – to change the value and CONFIRM. The red bar will automatically
move to the next step.
4. For the same value, press CONFIRM.
To change the value, press the + or – to change the value and CONFIRM.
Repeat this action for each 15 minute interval.
5. Press TARGET LOSS. Press the + or – to change the value and CONFIRM. The
graph displayed will compensate for the change in target loss accordingly. Press
SET to exit.
6. Press the PROFILE navigation key. Press ACTIVATE CONDUCT CURVE.
PAUSE THERAPY action key is available on the CHANGES view during Dialysis Mode.
1. Press CHANGES. Select PAUSE THERAPY then CONFIRM.
2. Return patient’s blood. If at all possible.
a. Clamp the arterial line in the patient’s arterial access line.

Page 8 of 8


XII. RESOURCES
A. Gambro Phoenix Operator’s Manual
B. Gomez, N. J., (Ed). (2011). Nephrology nursing scope and standards of practice (7
th

ed., pp. 123-144). Pitman, NJ: American Nephrology Nurses’ Association.

REVIEWED:
JMW 07/10/14
b. Disconnect the saline line from the cartridge connecting it to the arterial line
utilizing a sterile priming connector.
c. Unclamp the saline line and the arterial line
d. Press the blood pump ON/OFF button to the start the pump and re-infuse.
e. Press the blood pump ON/OFF button to the stop the pump when complete.
f. Clamp the arterial and venous lines and the patient’s access sites.
g. Flush the patient’s access per protocol.
3. Disconnect the saline line from arterial line and connect the saline line to the cartridge
utilizing a sterile priming connector.
4. Connect the arterial and venous blood lines together utilizing a sterile priming
connector or recirculation device.
5. Unclamp the saline line.
6. Unclamp the arterial and venous blood lines.
7. Press the blood pump ON/OFF button to the start the pump and adjust the blood flow
rate at 150-200 mL/min.
To reconnect the patient.
8. Press the blood pump ON/OFF button to the stop the pump.
9. Clamp the saline line, arterial and venous blood lines.
10. Aseptically reconnect the arterial and venous bloodlines to the patient’s access. Open
the clamps on the access, arterial and venous blood lines.
11. Press the blood pump ON/OFF button to the start the pump and adjust the blood flow
rate to the prescribed flow rate.
12. Press PAUSE THERAPY then CONFIRM. Touch CLOSE and resume treatment.