Nephrology

331a CAPD Exchange Using Fresenius StaySafe Manual set

  • All Fresenius Stay.Safe balance sets used for manual exchange come as 2L bags with the required administration tubing, control dial and drain bag attached in a closed system. 

    This system should be used on its own for children already established on PD requiring fills greater or equal to 500mls.

    Children commencing on PD and requiring fills less than 500mls should attach the PD Paed system to the 2L Stay.Safe system.   See Protocol 3.3.1(A1)

    All neonates and children less than 2 years should commence and continue on the PD Paed system/Stay.Safe system.  

    PREPARING FOR PROCEDURE

    1. Simple hand wash (ensure no visible dirt and nails are clean)

    2. Collect new bag and check:

    • Glucose Concentration
    • Expiry Date
    • No fluid in outer pouch (outer pouch should be intact)
    • Bag remains divided by lamba seam (λ)  (lamba seam should be intact)
    • The fluid bag should already be attached to drain line and control disc which allows manual prime and fill 
    • Make sure arrow on disc is pointing to the single circle
    • Make sure coloured cap (yellow, green or red) is attached to disc

    3. Warm the fluid in a bag warmer an hour before procedure(It is hospital policy not to warm bag in a microwave)

    4. Collect  the following equipment

    • IV pole
    • Fish hooks or hanging digital scales (and hang on IV pole)
    • Stay Safe Disinfection Cap
    • Microshield
    • Bag of Stay.Safe balance fluid (warmed)

    5. Clean work surface thoroughly with alcohol

    6. Air dry completely

    COMMENCING PROCEDURE

    1. Place bag (in outer packet) face up on work surface and peel back top layer fully.  Take care not to touch the coloured cap with loose clothing or by leaning against it.

    2. Clean hands with  Microshield or similar brand (if microshield unavailable, a thorough 3 minute handwash with antibacterial soap required)

    3. 'Crack' the bag by rolling up the bag from the upper ends until the lambda seam opens ('cracks')

    Peritoneal Dialysis 6.jpg

    4. Unroll the coiled tubing

    5. Place the drainage bag on the floor (without touching the floor), hang the bag on the fish hooks or digital scale (which is hanging on the IV pole). Note the full weight of the bag

    6. Place disc in Fresenius organiser taking care to not touch the cap (ensure organiser is clean, if not, clean thouroughly with water and detergent)

     

                 Peritoneal Dialysis 4.jpg

     

    CONNECTION

    1. Clean hands with Microshield or similar brand (if microshield unavailable, a thorough 3 minute handwash with antibacterial soap required)

    ! NOTE: Please ensure that you disinfect your hands immediately prior to connection and do not touch anything with your clean hands

    2. Keep patients tenckhoff clamped

    3. Twist coloured cap (yellow, green or red) off disc and drop to floor 

    4. Twist patient's tenckhoff catheter until betadine cap is off (betadine cap remains in organiser)

    5. Twist patient's tenckhoff catheter onto disc and remove disc from organiser

     

    DRAIN               

    ssm2.jpg

    1. Ensure the arrow on the disc is pointing at the single circle 

    2. Unclamp the white clamp from patients tenckhoff catheter.

    3. The patient should begin draining, the amount of drainage is dependent on last fill volume from  previous treatment, and fluid status.

    4. Measure this initial drain and note the color of the PD effluentClamp the patients tenckhoff once the patient has finished draining

    PRIME                  

    ssm3.jpg

    1. Keep the patients tenckhoff clamped

    2. Turn the arrow on the disc to the two circles

    3. Fluid will flow from the PD bag into the drainage bag. This primes the line, allow it to prime for 10 seconds, or until minimal air bubbles are seen

    4. After 10 seconds turn the arrow to the three circles

     

    FILL                      ssm1.jpg

     

    1. While the patient's tenckhoff is clamped no fluid will fill (enter) the patient'speritoneum.

    2. Note on the scales how much the bag weighs before filling the patient

    3. Turn dial to the 3 dots, white circle=slow flow,

                                         white/blue circle=medium flow,

                                          blue circle=fast flow

    4. Unclamp the patient's tenckhoff, and fill to the ordered volume keeping an eye on the scales. (The scales will read backwards as the fluid leaves the bag and enters the peritoneum)

    5. Reclamp the patient's tenckhoff once the patient is filled with the ordered volume

     

    DWELL

    1. Allow the fluid to dwell in the patient's peritoneal cavity for the prescribed length of time.

    2. After the dwell time, start the next cycle by draining first and then fill i.e turn dial between 1st dot and 3rd dots. Make sure patient's tenckhoff is clamped after each fill and drain.

     

    DISCONNECTION

     

    1. Once PD treatment is complete clamp patient's tenckhoff catheter 

    2. Turn dial to 4 dots to push in blue pin

    3. Place dial into organiser

    4. Pull open Stay Safe disinfection cap (betadine cap) packet and place cap into side port of organiser without touching the cap with your hands

    5.Clean hands with Microshield or similar brand (if microshield unavailable, a thorough 3 minute handwash with antibacterial soap required)

    ! NOTE: Please ensure that you disinfect your hands immediately prior to connection and do not touch anything with your clean hands

    6. Unscrew betadine cap

    7. Unscrew patient's tenckhoff catheter from manual PD system

    8. Twist patient's tenckhoff onto betadine cap