Nephrology

343 Management Of Contamination Episodes

  • All contamination episodes should be reported immediately to the PD Nursing staff (ext/pager 5721) or to Consultant on call after office hours. 

    Examples of contamination are

    • Touch contamination during connection or disconnection
    • Disinfection cap removed and end of catheter in contact with clothing, hands, air etc.
    • Break in Tenckhoff or extension tubing or connections.
    • Holes in lines or bags noted during or after dialysis treatment.

      Low risk contamination

      Touch contamination to end of extension with closed clamp 

      Contamination of extension above closed clamp - not occurring during dialysis treatment

      High risk contamination

      Break in Tenckhoff or extension with open clamp or on the patient side of a closed clamp

      Any contamination that occurs during dialysis treatment 

      CAUTION

      If prolonged exposure of open Tenckhoff or fluid infused after contamination or contamination occurring in particularly high risk environment consider treating as per peritonitis protocol Peritonitis Protocol ( 3.4.1)

      All patients treated with IPAB need concurrent nystatin as fungal prophylaxis

      Reassess at 48 hours based on cultures and cell count to determine ongoing treatment.

      If peritonitis occurs, treat as per Peritonitis Protocol ( 3.4.1)

      High risk contamination

      • Patient should not continue dialysis until PD extension catheter is changed
      • Change extension set, see protocol 3.5 Extension Catheter Change
      • Take a sample of PD fluid see protocol 3.9 Sampling and Culturing PD Effluent
        • send for urgent WCC + differential and Microscopy 
        • If poor sample send for microscopy ONLY
        • Interpret high cell count with caution – account for low fill volume and length of dwell     
      • If high risk contamination perform a manual fill see protocol 3.3.1(A) CAPD Exchange Using Fresenius Stay.Safe (manual) set with 500mg/l cephazolin see protocol  3.7.1(a) IP Cephazolin to be drained at the start of normal overnight dialysis or within 4-6 hours 

      Low risk contamination

      • Patient should not continue dialysis until PD extension catheter is changed
      • Change extension set, see protocol 3.5 Extension Catheter Change
      • Take a sample of PD fluid see protocol 3.9 Sampling and Culturing PD Effluent
        • send for urgent WCC + differential and Microscopy 
        • If poor sample send for microscopy ONLY
        • Interpret high cell count with caution – account for low fill volume and length of dwell   
      • Perform overnight dialysis as normal at home