Online Priming Haemodialysis Lines in Acute Dialysis Unit

Ben Whittaker
Ben Whittaker • 21 February 2024

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

In the majority of cases, haemodialysis is performed three times a week for 4 hours. Every session 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. This uses approximately12mls of N/saline the rest of the bag is rarely used and discarded into the waste bin at the end of the session. In the instance of low blood pressure some of this fluid is used to administer this to the patient.
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

Patient outcomes:
Patient requires less tubing to be connected to the dialysis machine therefore reducing time and risk of infection. No safety concerns.  A decrease in connection time for dialysis sessions improves patient experience.

Environmental benefit:
CO2e saving for 1 person on haemodialysis per year = 809.64 kgCO2e (based on: N saline in PVC packaging 460g, N saline PVC bag
0.875kg, N saline packaging bag, PVC plastic tubing 0.100kg, Incineration factor 220; PVC = (3.39918kgCO2e/kg + 0.220 kgCO2e/kg) x
(0.875 kg + 0.100 kg +0.460 kg) = 5.19kg; 3x sessions = 15.57kgCO2e per week; 52x weeks = 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.

When scaled up to satellite dialysis units there is a greater reduction in PVC, less N/saline would need to be made and would avoid the need for packaging or delivery. A lifecycle assessment has not been performed that would increase the CO2e savings.

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. They reported having more time to speak with patients as they were not going to get the N/saline. They also found setting up the dialysis machines took less time and they had more time to document. Patients noticed they were put on their dialysis faster and were happy knowing there was less waste in their dialysis.

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.

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.

For more information see attached report.

Resource author(s)
Montero RM
Resource publishing organisation(s) or journal
Centre for Sustainable Healthcare
Resource publication date
September 2023

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