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Peritoneal Dialysis Catheter Care – Adult/Pediatric ‐ Ambulatory [158]

Peritoneal Dialysis Catheter Care – Adult/Pediatric ‐ Ambulatory [158] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


Delegation Protocol Number: 158
Delegation Protocol Title:
Peritoneal Dialysis Catheter Care - Adult/Pediatric - Ambulatory

Delegation Protocol Applies To:
UW Health Kidney Clinic and Pediatric Nephrology

Target Patient Population:
Adult and pediatric patients with peritoneal dialysis catheters

Delegation Protocol Champions:
Sana Waheed, MD - Department of Medicine - Nephrology
Allison Redpath Mahon, MD, MPH -Department of Pediatrics - Nephrology

Delegation Protocol Reviewer:
Karen Schlageter, RN - Clinic Manager Kidney Clinic

Responsible Departments:
Department of Medicine - Nephrology
Department of Pediatrics - Nephrology

Purpose Statement:
This protocol delegates authority from the nephrology provider ordering placement of the peritoneal
dialysis catheter to registered nurses (RNs) to place orders for peritoneal dialysis catheter-related care.

Who May Carry Out This Delegation Protocol:
Peritoneal Dialysis Registered Nurses (RN’s) trained in the use of this protocol.

Guidelines for Implementation:
1. This protocol is initiated when a patient presents after initial placement of a peritoneal dialysis
catheter. The RN will enter an order into Health Link under “Request for Procedure” for peritoneal
dialysis (PD) catheter flush and dressing change weekly. The patient will be entered on Kidney Clinic
Nursing schedule in Health Link for PD catheter flush and dressing change appointment.
2. The patient will be seen weekly or more often as needed by RN for PD catheter flush and sterile
dressing change to PD exit site. After the PD catheter exit site is set in tunnel and no longer needs
weekly sterile dressing changes, the PD catheter may be flushed every other week at RN’s
discretion. Factors included in this decision are ease of flushing, smooth flow and presence or
absence of fibrin. Adult patient will continue to be seen in Kidney Clinic for scheduled appointments
and lab work. Pediatric patient will continue to be seen at AFCH for monthly clinic visits.
3. Catheter Care
3.1. For adult patients, the RN will flush the PD catheter initially with 500 mL of peritoneal dialysis
solution 1.5% dextrose x 2 or until clear. The RN will increase flushing volume by 250 mL weekly
or as tolerated by patient. Maximum volume for a flush is 2 L. The RN may leave 200-250 mL
dialysate in peritoneum after flushing for comfort.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

3.2. For adult or pediatric patients being flushed after a kidney transplant or abdominal surgery
other than PD catheter placement, please contact nephrology provider and/or surgeon for
specific flushing orders.
3.3. For pediatric patients, the RN will initially flush the PD catheter with 10-15mL/kg of peritoneal
dialysis solution 1.5% dextrose until clear. The RN may increase flushing volume by 5 mL/kg
weekly as tolerated, with a maximum increase weekly of 250 mL. The maximum flushing
volume is 30 mL/kg up to 1.5 L
3.4. The RN will add heparin 500 units/liter to dialysate on the initial flush as needed for clots to
dialysate unless the patient is allergic to heparin or has a known history of heparin-induced
thrombocytopenia. The heparin will be omitted if the patient is allergic to heparin.
3.5. The RN will perform sterile PD exit site dressing changes per Wisconsin Dialysis Inc procedure
#37 (see Appendix).
4. Management of Complications
4.1. If the patient experiences any changes in condition that may indicate a need for more
immediate dialysis, such as edema, hypertension, fatigue, loss of appetite, or nausea/vomiting,
the RN will notify the primary nephrology provider.
4.2. If the patient experiences drain/fill pain or difficulty with flushing the RN will order a KUB
(Abdomen AP vw XR) for catheter placement and will notify the appropriate nephrology
provider.
4.3. If the patient develops abdominal pain or PD fluid appears cloudy the RN will enter orders in
Health Link for PD fluid cell count with differential, gram stain, culture and sensitivity and notify
appropriate nephrology provider.
5. The RN will document the PD catheter flush and dressing change in Health Link and enter nursing
time in charge log book.

Order Mode:
Laboratory: Cosign Required, Protocol/Policy
Medications: Protocol/Policy, Without Cosign

References:
1. Li PK, Szeto CC, Piraino B, et al. ISPD Peritonitis Recommendations: 2016 Update on Prevention and
Treatment. Perit Dial Int 2016;36(5);481-508. 10.3747/pdi.2016.00078
2. Warady BA, Bakkaloglu S, Newland J, et al. Consensus guidelines for the prevention and treatment
of catheter related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012
update. Perit Dial Int 2012;33(Suppl 2);S32-86. 10.3747/pdi.2011.00091
3. Daugirdas JT, Blake PG, Ing TS, eds. Handbook of Dialysis. 5
th
ed. Philadelphia, PA: Lippincott
Williams & Wilkins; 2015.
4. Alexander S, Firanek C. Peritoneal Dialysis Catheter and Complications Management for Children.
Deerfield, IL: Baxter Healthcare Corporation; 2001

Collateral Documents/Tools:
Wisconsin Dialysis Inc. Procedure #37 Care of Peritoneal Dialysis Catheters





Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Approved By:
UW Health Ambulatory Protocol Committee: January 2017
UWHC Pharmacy & Therapeutics Committee: April 2017
UWHC Medical Board: May 2017
UW Health Chief Medical Officer: May 2017

Effective Date: May 2017

Scheduled for Review: May 2020
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org