Download 6.11 Renal Baxter Freeline Solo Continuous Ambulatory Peritoneal

Renal: Baxter Freeline Solo Continuous Ambulatory Dialysis (CAPD) Exchange Draft
Guideline and
Procedure
Renal: Baxter Freeline Solo Continuous Ambulatory Peritoneal Dialysis
(CAPD)
Sites where Guideline and Procedure
applies
Target audience:
Description
This Guideline and Procedure applies to:
1. Adults
2. Children up to 16 years
3. Neonates – less than 29 days
All sites where a Peritoneal Dialysis patient receives care.
Nephrology and Non- Nephrology clinical staff, who provide
care to Peritoneal Dialysis patients
This document comprises part of the clinical information
package for care of Peritoneal Dialysis patients.
Yes
No
No
Keywords
Freeline Solo, CAPD, Exchange
Replaces Existing Guideline and Procedure Yes
Registration Number(s) and/or name and of HNEH GandP 10_02
Superseded Documents
Related Legislation, Australian Standards, NSW Health Policy Directive, NSQHS Standard/EQuIP
Criterion and/or other, HNE Health Documents, Professional Guidelines, Codes of Practice or Ethics::



NSW Health Policy Directive 2007_079 Correct patient, Correct procedure, correct site
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_079.pdf
NSW Health Policy PD 2005_406 Consent to Medical Treatment
http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf
NSW Health Policy Directive PD 2007_036 Infection Control Policy
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_036.pdf
Prerequisites (if required)
All Endorse Enrolled Nurses and Registered Nurses competent in Peritoneal
Dialysis
Guideline and Procedure Note This document reflects what is currently regarded as safe and appropriate
practice. The guideline section does not replace the need for the
application of clinical judgment in respect to each individual patient but the
procedure/s require mandatory compliance. If staff believe that the
procedure/s should not apply in a particular clinical situation they must
seek advice from their unit manager/delegate and document the variance
in the patients health record.
If this document needs to be utilised in a Non- nephrology area please
liaise with the Nephrology Service to ensure the appropriateness of the
information contained within the Guideline and Procedure.
Position responsible for the
HNELHD Health Renal Clinical Stream Leadership Group
Guideline and Procedure and
authorised by
Contact Person
Tina Straker & Kelly Adams- Renal Stream Coordinator
Contact Details
67769914
& 49048800
Date authorised
This Guideline and
No
Procedure contains advice
on therapeutics
Date of Issue
Review due date
TRIM Number
Version Number
Month and Year
Renal: Baxter Freeline Solo Continuous Ambulatory Dialysis (CAPD) Exchange Draft
Note: Over time links in this document may cease working. Where this occurs please source the document in
the PPG Directory at: http://ppg.hne.health.nsw.gov.au/
OUTCOMES
1
Safe practice demonstrated when attending a peritoneal dialysis exchange using the Baxter
Freeline Solo system
ABBREVIATIONS & GLOSSARY
Abbreviation/Word
Definition
CAPD
Continuous Ambulatory Peritoneal Dialysis
Green frangible
Inline seal on the Freeline Solo system which requires snapping and
separating in order to open the line
IBW
Minicap
PPE
Ideal body weight (also known as Dry Weight or Target Weight) reflecting
the euvolaemic fluid status of the patient.
The cap placed onto the end of the patient extension line which protects
the tip of the extension line.
Personal Protection Equipment
GUIDELINE
CAPD is a gravity based system of attending peritoneal dialysis. The system allows the drainage
and instillation of Peritoneal Dialysis fluid into the abdomen via a peritoneal catheter for the purpose
of filtering blood through the peritoneal membrane. Exchange of peritoneal dialysis fluid occurs at
least 4 times per day in most instances.
Prior to the commencement of each CAPD exchange a review of the patient’s observations
including blood pressure, weight changes and previous CAPD drain out volumes must occur.
If the patient is hypotensive or 2 kg above or below their dialysis dry weight the patient shall be
reviewed by an advanced practice Renal Nurse or Medical officer prior to attending the exchange.
A thermostatically controlled bag warmer or warming cabinet must be used to heat the fluid. The
fluid bag should be dated when placed on / in the warmer or cabinet and discarded if not used within
24 hours.
This Guideline does not replace the need for the application of clinical judgment in respect to each
individual patient.
PROCEDURE
This procedure requires mandatory compliance.
Patient Preparation
It is mandatory to ensure that the patient has received appropriate information to provide informed
consent and, that patient identification, correct procedure and correct site process is completed
prior to any procedure.
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Renal: Baxter Freeline Solo Continuous Ambulatory Dialysis (CAPD) Exchange Draft
Often the patient will attend their own CAPD exchange if they are well enough to do so. This offers
an excellent opportunity to assess their dialysis procedural technique. Referral for formal
reassessment by the home training team may be required.
Staff Preparation
It is mandatory for staff to follow relevant: “Five moments of hand hygiene”, infection control,
moving safely/safe manual handling, and documentation practices.
Alerts: The heating of peritoneal dialysis fluid using a microwave is obsolete.
Peritoneal dialysis bags should be heated prior to adding medication into them.
If the peritoneal dialysis fluid stock volume is greater than the required patient fill
volume the excess fluid may be run into the drain bag at step 18. Aseptically add
medications at the conclusion of this step.
Ensure that the correct Blood Glucose Monitoring is used if the patient is prescribed
Extraneal (Icodextrin) fluid via www.glucosesafety.com
Ensure that the correct strength of peritoneal dialysis fluid is on the heater pad with the lines facing
upwards. The fluid should be warm to touch.
Baxter Freeline Solo System
Drain Bag
Ring Pull
Blue Line Clamp 
Fluid Bag 
Y - Set
Green Frangible 
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Renal: Baxter Freeline Solo Continuous Ambulatory Dialysis (CAPD) Exchange Draft
Baxter Minicap and extension line
Mini-Cap 
Patient extension line
Equipment Requirements

1 x warmed Freeline Solo peritoneal dialysis fluid bag

Intavenous pole

Dressing trolley

Neutral detergent

Minicap

Alcohol based hand rub

Personal Protective Equipment
Procedure Steps
1. Wash hands
2. Weigh patient and select appropriate peritoneal dialysis fluid from the heater pad,
check the patient’s CAPD prescription and collect other equipment.

Check fluid expiry date

Check clarity of the solution
3. Expose the patient extension line from the patient’s clothing
4. Clean dressing trolley or bedside table with neutral detergent

Place the alcohol gel and minicap to the side of the cleaned work surface
5. Remove the fluid from the cover pouch and place onto the work surface, lines facing
upwards.
6. Don PPE
7. Scrub hands for 1 minute and gel
Connection and drain out
8. Separate the lines and check Freeline Solo bag for damage and leaks
9. Place the end of the “Y” set over the bag of peritoneal dialysis fluid. Turn the bag over
and secure the “Y” set with the peritoneal dialysis fluid bag.
10. Remove the ring pull from the end of the “Y” set. DO NOT TOUCH THE STERILE
END OF THE “Y” SET.
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Renal: Baxter Freeline Solo Continuous Ambulatory Dialysis (CAPD) Exchange Draft
11. Pick up the patient extension line and remove the Minicap. DO NOT RELEASE THE
EXTENSION LINE AND DO NOT TOUCH THE BLUE END OF THE LINE
12. Aseptically connect the “Y” set to the patient’s extension line
13. Hang the peritoneal dialysis fluid bag onto the IV pole
14. Place the drainage bag on the floor with the shiny side up
15. Open the roller clamp on the patient extension line and drain out for 20 – 30 minutes

Check the colour of the effluent ( it should be clear with a yellow tinge)

Check the volume in the drain bag to ensure at least 80% of the fluid has
drained out (tangible reasons why there is less than 80% include: severe
dehydration, peritonitis or a previous dry abdomen). Drainage is complete
when the drain line is cool to touch and no further fluid flow is evident upon
the patient position change
16. Close the blue clamp to the drainage bag and alcohol gel hands
Flush before fill
17. Close the roller clamp on the patient extension line. Break the green frangible by
bending it back and forth to ensure complete frangible separation
18. Release the blue drain line clamp for the count of 5 the flush the line. Re-clamp the
line.
19. Open the roller clamp on the patient extension line
20. When “fill” is completed, alcohol gel hands and close the roller clamp on the patient
extension line
21. Drop the empty bag to the floor
22. Open the new minicap
23. Alcohol gel hands
24. Pick up the patient extension line
25. Disconnect the “Y” set from the extension line, DO NOT LET GO OF THE PATIENT
EXTENSION LINE
26. Attach the new minicap to the extension line. Secure the patient extension line to the
abdomen
27. Weigh the drain bag and record the volume
28. Dispose of the drained out effluent, clear away equipment and wash hands
29. Ensure that a new peritoneal dialysis bag(s) are placed on the heater pad in readiness
for the next exchange
APPENDICES
Hand Hygiene Australia 2008: Five Moments for Hand Hygiene
REFERENCES
Baxter Health Care Procedure Manual
www.GlucoseSafety.com retrieved from website 19/04/2013
FEEDBACK
Any feedback on this document should be sent to the Contact Officer listed on the front page.
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