Nephrology

3.3.3 Tenckhoff Catheter Flush Using Fresenius Stay.Safe 2 Litre bags for Catheter Not Being Used

  • In/Out flushes of tenckhoff catheter should be performed in the following situations:

    When the child returns post operatively after tenckhoff insertion

    When the child returns post operatively after manipulation of tenckhoff due to drainage problems

    When the child's tenckhoff is not being used, requiring weekly flushes

    When the child has abdominal pain related to peritonitis (if child has peritonitis without abdominal pain do not flush tenckhoff)

    Preparation

    Collect 2L 1.5% Stay.Safe bag and check:

    Concentration 

    Expiry Date

    "Y" Seam intact, and no fluid in outer pouch

    No discolouration of fluid

    Warm new bag on plate warmer (with outer pouch still intact)

    Simple handwash (ensure hands and nails are cleaned of any visible dirt)

    Clean work surface and dry thoroughly

    Collect:

    Betadine disinfection cap

    Microshield antimicrobial hand gel

    Fish or digital scales

    Heparin 1000u ampoule

    3ml syringe

    1 x 19g needle

    1 x 25 g needle

    Alcohol swabs

    Simple hand wash

    Open new bag of dianeal and place on work surface, writing side up.

    Crack "Y" seam by rolling bag into itself 

    Ensure disc is pointed to single circle.

    If ordered add Heparin 1000 u/L to bag.  See procedure 3.7.1.  Intra-peritoneal heparin

    Connection

    Hang up new bag on fish/digital scales, uncoil tubing so drain bag touches the floor

    Ensure patients Tenckhoff catheter is clamped (white clamp)

    Procedure handwash/or microshield (antimicrobial hand gel) 

    Unscrew yellow cap from disc, and unscrew betadine cap from patients Tenckhoff catheter (ensure that the uncapped connections do not touch anything) 

    Connect patient

    Drain

    Leave disc pointing at single circle

    Open white clamp on patients Tenckhoff to commence draining

    Once drain is completed (lines feels cool and no fluid movement seen in tubing or bag), close Tenckhoff (white) clamp.

    Weigh to ensure adequate volume has drained out

    Prime 

    Keep patients Tenckhoff clamped

    Turn  disc to the two circles

    Count 5-10 seconds to prime the line

    Fill  

    Keep patients Tenckhoff clamped

    Turn disc to triple circles 

    Take note of measurement on fish/digital scales 

    Open white clamp on patients Tenckhoff

    Fill to 10ml/kg 

    Repeat fill and drain procedure three times, turn disc to single and triple circles respectively. Make sure white clamp is closed when disc is turned between the single and triple circles, and open clamp when you are ready to drain and fill the patient

    Once drain is completed prepare for disconnection.  Leave patient empty

    Disconnection

    Keep patients Tenckhoff clamped

    Turn disc to the four circles, this pushes in the blue pin

    Open packet of betadine cap (leaving cap in package while attending hand cleaning)

    Procedural hand wash/or microshield antimicrobial hand gel 

    Twist patients Tenckhoff anticlockwise to disconnect from disc (non touch)

    Put new betadine cap securely on the end of patients Tenckhoff

    Discard fluid lines and bags

    Procedure complete