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Peritoneal DialysisPeritoneal dialysis is performed via manual exchange duringhospitalization at WCMC. Upon discharge, patients may resume useof cycler equipment as directed by their physician.Peritoneal dialysis is implemented by licensed nursing associatesaccording to physician orders regarding fluid type used forexchange and number/frequency of exchanges. Any changes made regarding type of fluid or number of exchanges is made by physician’s order and immediately communicated to materials management/pharmacy
Peritoneal Dialysis (continued) When medication additives are ordered by the physician, the fluid is prepared/mixed/labeled by pharmacy and is then dispensed to nursing for administration. Education regarding aseptic technique/infection prevention is reinforced by nursing staff Intake and output is determined by pre and post- treatment by bag weight unless direct fluid measurement is ordered by the physician and this is documented in CPSI by nursing
Peritoneal Dialysis (continued)Procedure: Review Physician’s order, lab values, height and weight Educate family and patient as needed Close the door to the patient’s room, placing sign on door so others know not to enter room during the procedure The nurse will mask self and patient, there should be no one else in the room during the procedure Hand hygiene is performed and gloves donned Remove dialysate bag from protective pouch checking the expiration date, strength and amount along with fluid clarity and any leaks in the bag
Peritoneal Dialysis (continued)Procedure continued:Connect – break frangible on patient connector end andremove pull ring from UltraBag system. Remove and discardMinicap from transfer set and immediately connect UltraBagsystem to transfer set. Be careful not to contaminate transferset.Drain – Clamp the fill line with the blue outlet port calm andbreak the frangible near the solution bag. Hang new solutionbag, place empty drainage bag lower than the patient with theshiny side facing up. Open transfer set to drain observingeffluent for cloudiness. Allow 15-20 minutes to completelydrain then close the transfer set.
Peritoneal Dialysis (continued)Procedure continued:Flush – Remove the blue outlet port clamp from fill line to flushtubing counting to five slowly watching new solution flow into thedrain bag (while the transfer set is closed). Next clamp the drainline with the blue outlet port clamp.Instill – Open the transfer to instill fluid regulating the flow rate byadjusting the height of the dialysate bag. Allow bag to completelyempty, then close the transfer set and clamp the fill line with thesecond blue outlet port clamp.Disconnect – Mask, wash hands, and don gloves. Open sterileMinicap with betadine package and have ready. Disconnect bagsystem from transfer set and apply Minicap with betadine twistingfirmly to secure.
Peritoneal Dialysis (continued)Procedure continued:Dwell – Allow fluid to dwell in theperitoneal cavity for approximatelyfour hours based on the physician’sorders. *A betadine Minicap is only used once*
Peritoneal Dialysis (continued)Documentation by nursing includes the following; I & O by post treatment bag weight Color/quality of post-treatment fluid Any medication added to treatment fluid Patient’s tolerance of the exchangeAny personal PD supplies used by the patient during admissionare reimbursed to the patient from WCMC supplies prior todischarge.Contact purchasing associate to order the patient’s supplies
Peritoneal Dialysis (continued)When initiating, discontinuing, performing a culture, or other postdialysis fluid collection the following PPE must be worn Gown Sterile gloves Mask with splash protectionDisposal The used bag is weighed post treatment The fluid is then disposed of into a toilet After donning proper protective equipment, the fluid is disposed of by lowering the end of the tubing below the surface of the water prior to opening the clamp to prevent splashing The bag can be hung on an IV pole while fluid is draining Any inadvertent spills are cleaned with expose The empty bag is then disposed of in a red biohazard bag