<Li> The pump does not directly contact the blood or fluid in the plumbing--it works by applying pressure to the tubing, then moving that pressure point around . Think of a disk with a protrusion in it . Put this into a close fitting 270 degree enclosure . Put plastic tubing between the enclosure and the disk, entering and exiting in the 90 open degrees . Now imagine the disk turning . It will put pressure on the tubing, and the pressure point will roll around through the 270 degrees, forcing the fluid to move (see also Peristaltic pump). It is characteristic of dialysis machines that most of the blood out of the patients body at any given time is visible . This facilitates troubleshooting, particularly detection of clotting . </Li> <Li> The patient arrives and is carefully weighed . Standing and sitting blood pressures are taken . Temperature is taken . </Li> <Li> Access is set up . For patients with a fistula (a surgical modification to an arm or leg vein to make it more robust, and therefore usable for high capacity blood movement required by dialysis) this means inserting two large gauge needles into the fistula . This is painful for the patient but there are various methods of numbing the entry sites before the needles are inserted--the two most common are lignocaine (lidocaine), a local anaesthetic injected under the skin, and there is also a cream called EMLA which is applied to the skin 45 minutes before the needles are inserted . Fistulas are widely considered the desirable way to get access for hemodialysis, but they take time to set up and mature (anywhere between 5 weeks to 15 weeks). For other patients, access may be via a catheter installed to connect to large veins in the chest . Other arrangements can be made as well . </Li> <Li> When access has been set up, the patient is then connected to the preconfigured plumbing, creating a complete loop through the pump and filter . </Li>

State the documentation requirement intra and post dialysis