This disease Covid-19 that is caused by the novel coronavirus(SARC CoV-2) has been currently declared as a pandemic and it has caused a very high morbidity rate especially in older people and in patients suffering from comorbidities. Another group of people who have been diagnosed with Chronic Kidney Disease stage-5 (CKD-5) and are on a continuous process of dialysis [maintenance hemodialysis – MHD ] or CAPD – continuous ambulatory peritoneal dialysis are equally vulnerable in contacting Covid, the reason being they will be repeatedly exposed to hospital environment which are unavoidable. These patients are more prone to contracting the disease as well as it becomes a lot more severe when compared to the general group of people and hence may need dialysis treatment if covid persists.
General Instructions for Administration
a). There must be at least one hemodialysis facility with enough dialysis units, reverse osmosis water system and other support equipment in case of any Covid-19 cases.
b). Health departments may issue directives to the direct administrations to allow the movement of these patients with an attendant for dialysis. Those patients who do not have their personal vehicles, should be alloted government transportation to reach the dialysis centre.
c). District administration should make sure that the service providers for dialysis treatment for Covid patients with MHD or CAPD should be allowed to deliver the material to the hospital or home.
Guidelines for a Dialysis unit for treatment for Covid patients
# Adequate supplies – while the dialysis treatment for Covid is on at a unit, make sure to have adequate medical supplies like the dialysate, dialyser and tubing, catheters, fistula needles, disinfectants and medicines etc.
# Sign Board – There must be a sign board posted in the local language as well as in English and Hindi instructing people to report if they have fever, cough, or breathing issues in the dialysis unit and waiting area.
# Educate Staff – All staff which includes nephrologists, nurses, technicians and others who are in the hemodialysis unit should be well educated about Covid-19 symptomes.
# Hand Hygiene – All nurses and staff who are in charge of any patient should follow the norms of washing hands with soap and water for 20 seconds, or use a hand sanitiser if soap is not available before and after treating a patient.
# Medical staff check – All medical staff who are treating patients should be monitored for covid infection at the dialysis facility unit and take immediate action if found infected.
# Organize Shift Duty – Organize shifts duty for the healthcare staff in such a way that the dialysis unit does not suffer.
# Awareness – All the hemodialysis units should be aware of the directives about testing, triage, and notification policy issued by the Union Ministry of Health and Family Welfare of the state or UT.
# Training for Personal Protective Equipment (PPE) – Some staff who are involved in the dialysis treatment for Covid should be trained for donning and doffing the PPEs so that they can be used for covid patients.
# Hygiene and Self protection – Train the staff for cough etiquette, hand hygiene, proper use and disposal of masks, gown, eyeglasses and learn to protect themselves.
During Dialysis Follow These Instructions
- Make sure that the staff or patient should not become the reason for a Covid outbreak.
- Disposable tissues and waste disposal is a must for every covid bed/chair during dialysis.
- All personnel, attendents, and nurses should strictly wear a three layer mask while they are attending to a covid dialysis case.
- Dialysis for covid positive patients should be carried out in isolation ideally in a separate room with closed doors.
- Staff who are taking care of covid positive patients should not be allowed to take care of others.
Dialysis for Covid Patients with Acute Kidney Disease
A small percentage of Covid-19 patients develop AKI and might require RRT (Renal Replacement Therapy) or even a smaller number might develop secondary bacterial infection and have a septic shock with worsened conditions of CKD and end up in RRT.
Inpatients who are in a ward should be given bedside dialysis and portable reverse osmosis water in a tank should be enough for dialysis. In case some more dialysis is required for the patient, the dialysis machine should be left there itself.
When the patient needs dialysis regularly and are covid-positive, centers are now limiting accompanying visitors, or some others are having patients wait in their cars instead of the waiting room to keep patients at a distance from each other. The response that each centre has to an emergency dialysis treatment for covid may change from day to day, therefore it is better you are informed.