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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CAPD, Exchange Replaces Existing Guideline and Procedure Yes Registration Number(s) and/or name and of HNEH GandP 10_02 Superseded Documents Related Legislation, Australian Standards, NSW Health Policy Directive, NSQHS Standard/EQuIP Criterion and/or other, HNE Health Documents,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. Version Number Month and Year Page 2 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 Version Number Month and Year Page 3 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. Version Number Month and Year Page 4 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. Version Number Month and Year Page 5