Dialysis Event Log

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Dialysis Event Log
FACILITY ID# :
Month/Year:__________/__________
For each IV antimicrobial start; positive blood culture; or onset of pus, redness or increased swelling at the
vascular access site, complete one row on this log and complete one Dialysis Event form. Please refer to the
Dialysis Event Protocol for reporting guidelines and procedures.
Data from this log are not entered---this log is for your own use.
Date
Event Form
Patient’s Name
Dialysis Event Type
(mm/dd)
Completed?
1.
/
Y
2.
/
Y
3.
/
Y
4.
/
Y
5.
/
Y
6.
/
Y
7.
/
Y
8.
/
Y
9.
/
Y
10.
/
Y
11.
/
Y
12.
/
Y
13.
/
Y
14.
/
Y
15.
/
Y
16.
/
Y
17.
/
Y
18.
/
Y
19.
/
Y
20.
/
Y

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