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HEMODIALYSIS TREATMENT DAILY RECORD

Patient Name: ____________________________ Time Started : _____________ Time Ended : _______________


NRIC: _______________________________
Date: _______________________________
No of Dialysis : ____________ Hours of Dialysis : ______Hours
Pre Dialysis Post Dialysis Machine Used : M 1/2/3/4/5/6 Type of Dialyser : ___________
B/P mmHG Number of Use : ___________ Heparin : __________________
Pluse b/min Initial Dose : ______________ Continuous Dose :___________
Temperature C Dialysafe : Bibeg & FME2A/3A Flow : 500 mls/min
Weight kg Machine Test : Yes / No
Dry Weight kg Renalin Residual Test : Yes / No
IDWG kg Type of Access : ____________
kg Needle Size : 15G / 16G / 17G

STICKER RECORMON : THRILL NORMAL : YES / NO STAFF PERFORM TREATMENT


INFLAMATION : YES / NO PRIMING BY : _______________________
HAEMOTOMA : YES / NO COMMENCE BY : ____________________
TERMINATED BY : ___________________

TIME B/P PULSE Blood Pump Ven. Pr. TMP Heparin Mach. T. UFV SIGN

UF GOAL SET : __________Kg @ HOURS : ______

REMARKS :
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