Dialysis - Peritoneal (CAPD - Continuous Ambulatory Peritoneal Dialysis)

Dialysis - Peritoneal (CAPD - Continuous Ambulatory Peritoneal Dialysis)

Effective Date: [Original NPP Date]
Revised Date: [Current Date]

Goal

To remove toxic substances from the body by perfusing specific warm sterile chemical solutions through the peritoneal cavity.

Policy

Continuous ambulatory peritoneal dialysis (CAPD) is performed only by licensed nurses who have been properly trained in the procedures. Dialysis is provided per MD Order for the type of dialysate solution, amount of exchange, and dwell time.

All equipment for infusing the dialysate and discontinuing the procedure must be sterile. Commercially prepared closed system kits are utilized.

Prior to the first exchange each day, the resident will be weighed and have blood pressure and pulse taken. Blood pressure and pulse will also be taken prior to the initiation of each additional exchange and after the last exchange of the day.

The skin around the PD catheter is cleansed daily as part of routine bathing unless otherwise ordered by the physician. If the site is infected, obtain an MD Order for treatment.

Residents may shower. If tub baths are necessary, keep the water level below the exit site. After leaving the tub, wash the exit site with water and antimicrobial soap.

Observe residents and fluid during the drain phase of the dialysis exchange for signs of infection. If present, notify the MD. If the exchange fluid is cloudy, save and refrigerate the bag for possible laboratory testing. Notify the Dialysis Center.

Any patient requiring the removal of the P.D. catheter will have that procedure done at the hospital.

Troubleshooting:

• Fluid Drainage Around Catheter/Tenderness/Pain in Abdomen:

  • Do not proceed with the infusion.
  • Notify the physician immediately and obtain further orders.

• Severe Respiratory Distress During Dwell Phase:

  • Drain the peritoneal cavity immediately.
  • Notify the physician.
  • Take vital signs and perform an assessment.

• Slow or Absent Inflow/Outflow:

  • Check for kinks in the tubing.
  • Raise the solution bag or reposition the resident.
  • Apply manual pressure to the lateral aspects of the resident’s abdomen.
  • Notify the physician if these maneuvers fail.

• Resident Transfer Set Disconnection:

  • Close catheter ASAP.
  • Apply a new minicap to the catheter.
  • Notify MD/Dialysis Center for further instructions.

Adding Medications

• Use sterile technique to avoid contamination.
• Medications added to dianeal solutions typically include antibiotics and heparin.
• Antibiotics should be added to the solution with the longest dwell time (overnight bag).

Equipment

• Mask
• Dianeal solution
• Medication to be added
• Sterile syringe/needle
• Alcohol swabs
• 2 Betadine caps (mini CAD with povidone-iodine solution)
• 2 clamps

Procedure for Adding Medications

1. Ensure to drain effluent and flush fill line before adding medication.
2. Gather supplies.
3. Put on a mask and wash hands with antimicrobial soap.
4. Clean vial tops with iodine wipes for 5 minutes.
5. Draw up the prescribed medication.
6. Clean the medication port on the dianeal solution bag with iodine caps for 5 minutes.
7. Inject medication slowly into the center of the medication port.
8. Shake the bag to mix the medication.
9. Continue with the fill procedure of the exchange.
10. Dispose of the used syringe.
11. Document medication on the Medication Administration Record and Peritoneal Dialysis Flow Sheet.

Ultra Bag Exchange Procedure

1. Prepare Supplies:

   • Warm the solution using a heating pad. Check the temperature (94-98 degrees Fahrenheit).
   • Gather two clamps, mask, mini caps, IV pole, and inspect the ultrabag.

2. Connecting:

   • Remove the transfer set from clothing and check if closed.
   • Mask and wash hands.
   • Break the blue frangible on the resident connector line.
   • Remove the pull ring and mini cap.
   • Immediately connect the transfer set to the ultrabag.

3. Drain:

   • Clamp the fill line.
   • Break the green frangible near the solution bag.
   • Hang the solution bag on the IV pole.
   • Place the drain bag on the floor.
   • Open the transfer set and check for fluid clarity.

4. Flush:

   • Remove the clamp from the fill line.
   • Count to 5 to prime the fill line with the solution.
   • Clamp the drain line.

5. Fill:

   • Open the transfer set and fill for 10 minutes.
   • Close the transfer set and clamp the fill line.

6. Disconnect:

   • Mask and wash hands.
   • Open the mini cap package.
   • Disconnect the ultrabag from the transfer set.
   • Apply the mini cap to the transfer set.
   • Weigh the drain bag and record it on the flow sheet.

Resident Problems Associated with Peritoneal Dialysis

A table will list various problems (e.g., Weakness, Shakiness, Bleeding from Exit Site, etc.), possible causes, and the appropriate actions to take.

CAPD Flow Sheet

A flow sheet is provided to document all pertinent information related to CAPD procedures, including observations of untoward signs and symptoms and resident response. This includes date, time, weight, blood pressure, pulse, description of catheter site, time, amount and type of fluid instilled, medication, time and amount of returned fluid, description of returned fluid, comments, and nurse's signature.

References:

• Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. [Link to current CMS SOM]
• CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]