Abdomen
Abdomen
Peritoneal Dialysis Catheter Care Instructions
Kidneys are a pair of organs in your body that are responsible for filtering your blood by removing waste and maintaining the right levels of electrolytes. Dialysis is a procedure to remove waste products and excess fluid from your blood when your kidneys are not working properly. Options for dialysis include hemodialysis and peritoneal dialysis. Our focus here will be on peritoneal dialysis. With peritoneal dialysis, a synthetic tube is placed in the abdominal cavity. Through this, a cleansing fluid (dialysate) flows through the tube and the lining of your abdomen, called the peritoneum, acts as a filter and removes waste products from your blood. The dialysate stays in the abdomen for about 4-56 hours and then the fluid with the filtered waste products flows out of your abdomen and is discarded.
A peritoneal dialysis catheter is placed through the skin into the abdominal cavity. A small piece of the tubing is left outside of the body which can be covered when not in use. A buried peritoneal catheter is when the small piece of tubing is buried under the skin.
Parts Of The Peritoneal Dialysis Catheter:
General Steps for peritoneal dialysis:
Step 1: Drain
- the used solution in the abdomen containing waste and excess fluid is drained
Step 2: Fill
- new dialysate is put through the catheter to fill up the abdominal cavity
Step 3: Dwell
- the dialysate solution collects waste and excess fluid from your body
*Lastly it is important to perform each therapy exactly as recommended by your provider.
There are two types of peritoneal dialysis:
Continuous ambulatory peritoneal dialysis (CAPD)
These exchanges are done by hand. The dialysate stays in your abdomen for 4-6 hours which is called the dwell time. The fluid is then drained. You may need three to five exchanges during the day with a longer dwell time while you sleep. You can go about your normal activities while the dialysate dwells in your abdomen.
Continuous cycling peritoneal dialysis (CCPD)
This method uses a machine (automated cycler) that performs multiple exchanges at night while you sleep. The cycler automatically fills your abdomen with dialysate, allows it to dwell, and drains into a bag that you can empty in the morning. You have to remain attached to the machine for 10-12 hours at night. You are not connected to the machine during the day.
Continuous Ambulatory Peritoneal Dialysis (CAPD) Step by Step
Preparation:
1. Gather your materials: hand disinfectant, CAPD documentation on MDC website, drip stand, blood pressure monitor, weighing scale, alcohol wipe, surgical mask, minicap x2, dialysis solution with drain bag attached, and a basin.
2. Measure your blood pressure and pulse and document it on your MDC account.
3. Put on a surgical mask then wash your hands with soap and water.
4. Use the alcohol wipe to clean the table you will be using, drip stand, and weighing scale.
5. Check the concentration and expiration date and volume on the dialysis solution. Make sure the green pull-ring, frangible seal, and 2 clamps are included.
6. Wash your hands with soap and water again.
7. Tear the outer pouch of the dialysis solution then hang it on the drip stand.
8. Separate the attached drain bag from the dialysis solution.
9. Separate all of the tubing and hang the patient connector end on the drip stand.
10. Pull both the blue and white clamps down and close them.
11. Check that the green pull ring and frangible seal are intact.
12. Make sure the dialysis solution is clear. Squeeze both sides of the dialysis solution to check for leaks.
Connection:
1. Take out your transfer set from your waist pouch.
2. Wash your hands with soap and water again.
3. Remove the green pull ring from the patient connector tubing and remove the cap from your transfer set. Connect the patient connector to your transfer set securely.
4. Place the drain bag into a basin.
Draining:
1. Open the twist clamp on your transfer set in a counterclockwise direction. Open the white clamp on the drain line.
2. Let your abdomen drain for 20 minutes. While draining is happening, record the time and percentage of dialysis solution.
3. When draining is complete, close your transfer set and close the white clamp on the drain line.
4. Weigh the amount of drainage and record it. Also document the time taken to drain, the color of the drainage, and the balance calculation.
Flushing and Filling:
1. Break the green frangible seal on the dialysis solution.
2. Open the white and blue clamps on the dialysis tubing and wait 5 seconds. Then close the white and blue clamps.
3. Open the twist clamp on your transfer set and open the blue clamp on the fill line.
4. Filling of the new dialysis solution takes about 8-10 minutes.
5. Once the filling is completed, close the twist clamp on your transfer set and close the blue clamp on the fill line.
6. Document the volume in and the time taken to fill.
7. Disconnection:
8. Get the two minicamps and make sure they are not expired.
9. Wash your hands with soap and water.
10. Open one minicap package and check for the presence of an iodine sponge. The other minicamp will only be used if the first minicap is contaminated.
11. DIsconnect the patient connector from your transfer set. Then close your transfer set with the minicap.
12. Put your transfer set back into your waist pouch.
13. Empty the contents of the drain bag into the toilet and flush it.
Continuous Cycling Peritoneal Dialysis (CCPD) Step by Step
Preparation:
1. Gather your materials: APD machine trolley, hand disinfectant, CCPD documentation on MDC website, blood pressure monitor, surgical mask,connection shield, alcohol wipe, dialysis solution (make sure to prepare the prescribed number of dialysis solutions), APD cassette, minicap, and a drain bag.
2. Record the date, your blood pressure, pulse rate, and weight on your MDC account.
3. Put on a surgical mask then wash your hands with soap and water.
4. Use the alcohol wipe to clean the APD machine and surface top.
5. Place 1 of the dialysis solutions on the APD machine. Then place the remainder of the dialysis solutions, APD cassette, and hand disinfectant next to the APD machine.
6. Check the concentration, expiration date, and volume of the dialysis solution.
7. Check that the blue pull ring and green frangible seal are intact.
8. Make sure the dialysis solution is clear. Squeeze both sides of the dialysis solution to check for leaks.
9. Repeat steps 6-8 for the rest of the dialysis solutions.
10. Check the expiration date of the APD cassette.
11. Ensure all the clamps and caps that are attached to the lines of the APD cassette are intact.
12. Check the expiration date of the drain bag and make sure the drain bag is intact.
13. Open the outer pouch of the drain bag.
14. Place 1 of the drain bags at the bottom of the APD machine trolley.
15. Switch on the APD machine. When the machine is ready, the screen will show “PRESS GO TO START.”
Setup :
1. Press the green button to begin the setup. The screen will show “LOAD THE SET.”
2. Wash your hands with soap and water.
3. Open the APD cassette package.
4. Load the APD cassette package into the APD machine by inserting the bottom edge and pressing the top.
5. Close and lock the door.
6. Place the organizer over the hook of the door.
7. Close all the clamps on the lines attached to the APD cassette.
8. Next press the green button. The screen will show “SELF TESTING.”
9. Tear the outer pouch of the dialysis solution on the APD machine.
10. Make sure the dialysis solution is clear. Squeeze both sides of the dialysis solution to check for leaks.
11. Check that the green frangible seal and blue pull ring are intact.
12. Repeat these steps for the rest of the dialysis solutions.
13. Once the APD machine has completed self testing the screen will show “CONNECT BAGS OPEN THE CLAMPS.”
Connection:
1. Wash your hands with the hand disinfectant.
2. Remove the pull ring from the dialysis solution placed on the APD machine.
3. Remove the pull ring from the heater line (line with red clamp) from the organizer.
4. Connect the heater line to the dialysis solution.
5. Connect both lines and tighten the connection.
6. Break the green frangible seal. Then open the red clamp.
7. Wash your hands with the hand disinfectant.
8. Using the supply lines (lines with white clamps and clear pull rings), repeat steps 2-7 for any additional dialysis solutions you need to add.
9. If your prescribed therapy includes a last fill, use the last fill line (line with blue clamp).
10. Remove the drain line (line with blue ring cap without a clamp) from the organizer.
11. Connect the drain line to the drain bag.
12. Close the big white clamp on the patient drain bag.
13. Open the patient line clamp (line with blue ring cap with a white clamp).
14. Next press the green button on h blue clamp).
15. While priming is in progress, check the expiration date of the connection shield.
16. Place the connection shield on the APD machine. Then fold the end of the connection shield package.
17. When priming is complete, the APD screen will show “CHECK PATIENT LINE CONNECT YOURSELF.”
18. Check that the patient line is filled with dialysis solution. If the line is not filled, you will have to re-prime.
19. Close the clamp on the patient line.
20. Take out the transfer set from your waist pouch.
21. Wash your hands with soap and water.
22. Open the connection shield.
23. Remove the patient line from the organizer and remove the blue pull ring.
24. Attach the patient line onto the connection shield and ensure it is secure.
25. Remove the minicap from your transfer set and drop it. Then connect the patient line to your transfer set.
26. Open the twist clamp on your transfer set. Open the clamp on the patient line.
27. Press the green button on the APD machine to begin therapy and check the clarity of the drainage.
28. If you do not have a last fill, the screen will show “VERIFY IDRAIN.” If you had a last fill it will show “INITIAL DRAIN.”
29. If the screen shows “VERIFY IDRAIN,” press the green button and then the screen will show “INITIAL DRAIN.”
30. Record the following: time on, heater bag solution, supply bag solution, last fill bag (if applicable), type of therapy, therapy volume, therapy time, fill volume, last fill volume, concentration, number of cycles.
Therapy in Progress:
1. Once the initial drain is completed, the APD machine will show the cycle counts for “FILL,” DWELL,” and “DRAIN.”
2. Once you have completed one full cycle of the therapy another cycle of “FILL,” DWELL,” and “DRAIN” will begin. This will be repeated until the entire therapy is complete.
3. You can go to sleep now.
Completion and Closure:
1. When therapy has completed, the APD screen will show “END OF THERAPY.”
2. Press the arrow down button to check the initial drain volume.
3. Press the arrow down button to check the total UF (ultrafiltration).
4. Press the arrow down button to check the average dwell time.
5. Press the arrow down button to check the lost dwell/added dwell time.
6. Check the clarity of the drainage.
7. Record all of this information.
8. Press the green button on the APD machine to end the therapy session. The screen will show “CLOSE ALL CLAMPS.”
9. Close the twist clamp of your transfer set. Close the clamp on the patient line. Close the red clamp on the heater line. Close all the clamps on the other lines, ending with the clamp on the patient drain bag.
10. Press the green button on the APD machine. It will show “CLOSE ALL CLAMPS DISCONNECT YOURSELF.”
11. Prepare a new minicap and check its expiration. Place the minicap package on the APD machine.
12. Wash your hands with the hand disinfectant.
13. Open the minicap package and check for the presence of an iodine sponge.
14. DIsconnect the patient line from your transfer set. Then close your transfer set with the minicap.
15. Put your transfer set back into your waist pouch.
16. Press the green button on the APD machine. It will say ‘PLEASE WAIT” followed by “REMOVE CASSETTE.”
17.Remove the used APD cassette.
18. The screen will now show “TURN ME OFF.”
19. Turn off the APD machine.
20. Empty the contents in the drain bag into the toilet and flush it.
Activity
Shower as normal. In general, you should limit physical activities when the peritoneal cavity is full. You should discuss your activities with your provider.
Weight gain can happen because the dialysate contains a high concentration of dextrose which is a type of sugar. A dietician can provide guidance to minimize weight gain.
Hernias can happen due to increased stress on the muscles of the abdomen. Hernias can occur near the belly button, in the groin, or near the catheter sight. You can still perform peritoneal dialysis with a hernia, but you should contact your provider to determine the next steps.
Call your doctor and seek immediate medical care if you notice the following signs and symptoms:
- Signs of infection
- Increase pain, swelling, warmth, redness around drain site
- Pus draining from the insertion site
- Fever
- Severe abdominal pain
- Sudden change in color and smell of your drainage
- Tube is coming loose out of your insertion site
- There is no drainage from the catheter. There could be a fibrin clot in your catheter.