Peritoneal dialysis exchange policy and procedure

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Purpose

Safe, sterile PD exchange.

 

POLICY

To meet the needs of the adult renal failure patient manual peritoneal dialysis exchange is available to be Performed by the nursing staff or the patient with assistance/supervision of the nursing staff.

PROTOCOL:

A. PD exchanges are done seven days a week, at intervals of from one to six hours as prescribed by the
Physician.
B Patients trained in doing their own exchanges may do so with the nurse’s assistance/supervision.
C. PD procedure should be done in an area that is free from drafts and interruptions. Preferably, the supplies are brought into the patient’s room, and the procedure is done at the bedside behind the pulled curtain with both patient and nurse wearing masks.

PROCEDURE:

Continuous Ambulatory Peritoneal Dialysis (CAPD)

A. Dialysate should be warmed by placing on a heating pad for a minimum of 2 hours prior to time of exchange.
B. Check bags for clarity, leaks, expiration date, and against physician order.
C. Close the door, place occluding clamp on the patient catheter.

D. Perform 3 minute hand scrub and don gloves.

E. Mask patient and everyone in the room. In a semi-private room, pull curtain. It is not necessary to mask the
other patient or visitors outside the curtained area.

F. Attach fill line to hanging dialysate bag using sterile technique, let the drain bag fall to the floor.

G. Break the cones underneath the dialysate bag and prime the tubing, clamp the fill line to stop the flow of
dialysate.

H. Using sterile technique, remove the cap from the fill line and attach to the patient line.
I. Unclamp the patient line and catheter allowing the peritoneal cavity to drain.
J. When drainage is complete, clamp the drain line. Note characteristic of effluent fluid.
K.Open the fill line and allow dialysate to flow by gravity into the peritoneal cavity.

L. When fill is complete, clamp all lines.

M Close the clamp that is on the fill line, disconnect from the patient.
1. For Fresenius, clamp the blue del clamp that is on the fill line, snap disconnect from patient.
2. For Baxter, using aseptic technique remove fill line from patient’s tubing and cap off.

N. Document effluent characteristics and weight/volume.
O. Flush effluent down the toilet or hopper.
P. Ensure dialysate is warming for the next exchange.

 

NURSING IMPLICATIONS:

A. Add medications to the solutions after warming the bag.

B. Effluent dialysate should be examined for color, clarity, and amount.

C. Samples of dialysate effluent can be obtained after the exchange procedure is completed by the following
method:

1. Place the blue outlet clamp on the patient line;
2. Open the clamp on the drain line;
3. Allow the effluent to move from the drain bag into the dialysate bag with the sample port.
D. Observe for cramping during fill or drain period. Rate should be decreased if cramping occurs.

 

PATIENT/FAMILY EDUCATION:

A. Reinforce clean technique and hand washing.

B. Reinforce patient inspection of new dialysate bag with each exchange.

 

DOCUMENTATION:

A. Documentation is done on the CAPD flowsheet. Each exchange should be noted and the following information recorded:

1. Exchange number;

2. Dialysate concentration (1.5%, 2.5%, 4.25%);

3. Volume of exchange;

4. Medications added;

5. Amount of effluent obtained, if drained;

6. Appearance of effluent.

B. Teaching:

Document patient education in notes or teaching record, as applicable to area.

 

EQUIPMENT

  • Heating pad
  • Dialysis solution(1.5%, 2.5 %, 4.25 %)
  • Continuous Ambulatory Peritoneal Dialysis (CAPD) Manual Set
  • Continuous Ambulatory Peritoneal Dialysis (CAPD) Manual Set
  • Line Occluding Clamp
  • Mask
  • 1 pair gloves

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