Online Priming Haemodialysis Lines in Acute Dialysis Unit

SusQI project completed as part of the UK Kidney Association and Centre for Sustainable Healthcare Kidney Care Sustainability Group Scholars Programme.

Scholar: Dr Rosa M Montero
Team members: R Calayag, C Baanag, R Cubita

Key Learning Point:

This project illustrates how small changes result in a reduction in CO2e that can easily be adopted and scaled nationally to decrease the use of this unnecessary resource in priming lines for dialysis.

Issue to be addressed:
In the majority of cases, haemodialysis is performed three times a week for 4 hours. Every session approximately12mls of a 500mls bag of 0.9% normal saline (N/saline) is used to prime the dialysis lines so that there is no air in the tubing that attaches to the patient, the rest of the bag is  discarded into the waste bin. In the instance of low blood pressure some of this fluid is used to administer this to the patient.

Intervention:
This project assessed the safety of online priming and whether in the case of an emergency whether bolus fluid could be given quickly via the dialysis machine. This was found to be possible with no patient safety concerns. The dialysis education nurse visited units that were using online priming and learnt this technique ensuring there were no breaches in infection control when using this.

Specific Aims
1) Reduce waste from unnecessary use of 0.9% normal saline 500ml bag on haemodialysis
2) Staff education for online priming

Results
Clinical outcomes:
- Patients require less tubing to be connected to the dialysis machine therefore reducing time and risk of infection.

- No safety concerns. 

Environmental benefit:
- CO2e saving for 1 person on haemodialysis per year = 809.64 kgCO2e 

- Minimum of 36 patients per week per year = 29,147.04kgCO2e = 29 tonnes of CO2e per year on the Acute dialysis unit as a conservative CO2e saving.

Financial benefit:
- Cost of boxes of N/saline per day is £50, bringing a weekly saving of £350 and annual saving of £18,200.

Social sustainability:
- Staff found the change made connection shorter and more efficient allowing more time to speak with patients. Also took less time to set machines up allowing more time to document. - - Patients noticed they were put on their dialysis faster and were happy knowing there was less waste in their dialysis.

Conclusions
Using dialysis machine dialysate for online priming avoids the need to use N/saline thereby reducing carbon emissions and waste. Online priming has been shown to be safe and has the additional benefit in allowing staff to have more time to be with patients and to do their documentation. There are health and safety benefits with the removing the need to deliver and stack boxes of N/saline.

For more information see attached report.