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Peritoneal Dialysis Fresenius Stay-Safe CAPD Exchange (Adult) (3.22A)

Peritoneal Dialysis Fresenius Stay-Safe CAPD Exchange (Adult) (3.22A) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Genitourinary

3.22A

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
March 3, 2015

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 3.22A

Original
Revision

Page
1
of 5

Title: Peritoneal Dialysis Fresenius Stay-
Safe CAPD Exchange (Adult)

I. PURPOSE

To establish guidelines for registered nurses (RNs) who have been trained to safely
perform a peritoneal dialysis exchange using the Fresenius Stay-Safe Continuous
Ambulatory Peritoneal Dialysis (CAPD) Exchange system.

II. POLICY

A. A provider order is required for peritoneal dialysis.
B. Patients requiring peritoneal dialysis will be placed on the admitting service’s
unit. When a patient requires an exchange using the Fresenius Stay-Safe CAPD
Exchange System, contact the Clinical Support Resources listed in the next
section. Registered nurses will use the following procedure to perform CAPD
with the Stay-Safe equipment. Only registered nurses who have been trained by
Save our Shift (SOS) and D6/5 on CAPD can perform this procedure.
C. It is very important that stringent aseptic technique be used during this procedure.
Do not proceed with exchange if contamination of patient end of catheter (transfer
set) occurs at any time. Call Peritoneal Dialysis (PD) nurse on-call for further
directions. If PD solution bag tubing is contaminated, discard and obtain another
bag.
D. If patient is to have surgery or abdominal imaging, the patient’s peritoneum must
be drained.
E. Perform hand hygiene according to Hospital Administrative Policy 13.08, Hand
Hygiene. In addition, follow hand hygiene steps as described below.

III. CLINICAL SUPPORT RESOURCES
A. Primary Contacts
1. On-Call Peritoneal Dialysis RN: In paging, search Home Dialysis; or
call paging operator and ask for Home Dialysis nurse on-call
2. Wisconsin Dialysis Inc. (WDI): Home Dialysis Office, Monday-Friday,
8:00am-4:30pm, (608) 270-5643
B. Secondary Contacts
1. Save Our Shift (SOS) RN via pager and/or D6/5 at (608) 263-8220.
C. Tertiary Contact
1. WDI Home Dialysis Manager, pager 8308 or (608) 270-5620.

IV. EQUIPMENT

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A. Hospital disinfectant
B. Masks (yellow barrier or surgical tie behind head types)
C. Warmed Stay-Safe solution to 98.6 plus or minus 3 degrees
D. Stay-Safe Cap (Central Service Item Number [CS] 4010065)
E. Stay-Safe Organizer attached to an IV pole (provided by PD RN)
F. Alcavis solution (PD RNs to provide)
G. Clean gloves
H. Spring Scale (CS Item Number 4002760)
I. 4x4 sterile gauze (one [1] package)
J. 2x2 sterile gauze (one [1] package) (if adding medications)
K. 5/8 inch needle (or larger) with syringe (if adding medications)
L. Tape
M. Grip Lock Securement Device (CS Item Number 4005547)
N. Water circulating heating pad (CS Item Number 4000118)
O. Bactroban or mupirocin 2% ointment

V. PROCEDURE

A. Ensure that Stay-Safe solution is warmed for at least two (2) hours, to 98.6
degrees Fahrenheit plus or minus 3 degrees. Check temperature by folding the bag
of solution over a thermometer. DO NOT MICROWAVE SOLUTION OR
PLACE IN A WARM WATER BATH.
B. Ensure that the solution is the correct percentage of dextrose and volume. Check
expiration date.
C. Take equipment to the patient’s bedside and close the door.
D. Completing an exchange (the correct order for an exchange is drain, fill, dwell)
1. Perform hand hygiene using gel for 30 seconds.
2. Remove transfer set (patient’s catheter) from patient’s clothing and
make sure the transfer set clamp is closed.
3. Clean bedside table and organizer with hospital disinfectant.
4. Mask patient, self and anyone else in the room. Masks need to be worn
during connecting and disconnecting only
5. Wash hands for one minute using antibacterial soap.
6. Don clean gloves.
7. Open the Stay-Safe solution bag by tearing down from a notched edge of
the package overwrap and place on cleaned bedside table.
8. Wipe off any moisture on the bag and check to make sure the solution is
clear.
9. Squeeze the bag to check for leaks. Verify again the correct dextrose
concentration and volume ordered, as well as expiration date.
10. Add medications to the Stay-Safe solution bag IF ORDERED.
a. Gather medication supplies and verify dose.
b. Disinfect the top of the medication port on the dialysate bag with
an Alcavis soaked 2x2 gauze, and. allow to stay in place for one
(1) minute by securing with tape or a plastic hemostat DO NOT
USE ALCOHOL OR CHLORAPREP WIPES.
c. Using stringent aseptic technique, insert medication into the
medication port of the dialysate bag using a 5/8 inch long needle.

Page 3 of 5

d. Gently rotate bag to mix the medication with the dialysate. Label
bag with the medication and dose inserted.
11. Place IV pole with organizer next to the patient.
12. Find the Stay-Safe disc with its colored plastic cover on the dialysate
tubing. Turn the blue dial on the disc counterclockwise until it fits into
the cut-out portion of the plastic cover.
13. Remove the plastic cover after the dial is in the cut-out portion. The blue
dial will be at Position 1.
14. Place the disc into the organizer with the tubing threaded into the drain.
Flush channels respectively.
15. Hang the dialysate bag on the IV pole. Place the drain bag on the floor,
clear side up.
16. Break the cone in the dialysate bag outlet port.
17. Remove the Stay-Safe cap from its package. Place the cap in the “New
Cap” notch on the organizer.
18. Perform hand hygiene using gel for 30 seconds.
19. Don clean gloves.
20. Pour 8-12 mL of Alcavis solution onto a 4x4 sterile gauze pad. Wrap the
end of the transfer set in the gauze. Scrub capped area of transfer set for
one (1) minute. Wrap the 4x4 gauze around and allow to soak for one (1)
minute.
21. Perform hand hygiene using gel for 30 seconds.
22. Don clean gloves.
23. Place the end of the transfer set in the “Extension” notch on the
organizer without touching the disinfected area. Perform hand hygiene
using gel for 30 seconds.
24. Don clean gloves.
25. Remove the protective cap from the outlet in the middle of the Stay-Safe
disc and discard the cap. KEEP THIS PORT STERILE.
26. Unscrew the transfer set from its cap. The cap will remain in the
organizer for now, but will not be used again.
27. Immediately connect the transfer set to the Stay-Safe disc using stringent
aseptic technique.
28. Open transfer set clamp to begin draining the peritoneum. (If
experiencing difficulty draining, encourage the patient to roll side to
side, sit, or stand.) DO NOT DRAIN FOR MORE THAN 30
MINUTES.
29. When the drain is complete, turn the dial to Position #2. This will start
the flush from the dialysate bag to remove air in the system.
30. After about 3 seconds, when fluid from the dialysate bag reaches the
drain bag, turn the dial to Position #3. This will start the fill to the
peritoneum and usually takes about 10 minutes.
31. When the patient fill is complete and dialysate bag is empty, turn the
dial to the very end of Position #4. You will feel a “click” when you get
to the last position. This will insert the closure pin from the disc into the
end of the transfer set.
32. Close the clamp on the transfer set. (Closing the transfer set clamp
before pinning adds too much pressure and the pin will not set
correctly.)

Page 4 of 5

33. Perform hand hygiene using gel for 30 seconds.
34. Don clean gloves.
35. Unscrew the protective cover from the new Stay-Safe cap. Save this cap
and set aside.
36. Unscrew the transfer set from the disc and immediately attach the
transfer set to the new Stay-Safe cap. You will have to push forcefully
because of the pin.
37. Remove the capped transfer set from the organizer and secure it to the
abdomen using tape or the Grip Lock Securement Device.
38. Place the protective cover from the new Stay-Safe cap that you saved, on
the white end of the outlet in middle of the disc to prevent drips.
39. Inspect the drain fluid. It should be transparent. If not, notify the PD RN
40. Zero the spring scale. Weigh the drain bag with the spring scale.
41. Document in the CAPD flowsheet in patient’s clinical record:
a. Characteristics of drain fluid (i.e., color, clarity and presence of
fibrin)
b. Record weight of drain bag
42. To dispose of fluid, follow Hospital Administrative Policy 8.89,
Preventing Occupational Exposure to Hazardous Drugs. If patient is not
on a medication that requires hazardous drug precautions, wear clean
gloves, gown and face shield. Cut the bag and drain the contents into the
toilet. Dispose of the used tubing and old cap into a red garbage bag.
43. Complete exit site care daily (see section E below).
E. Exit Site Care (this is a clean procedure)
1. Complete once a day or whenever the exit site becomes wet or dirty.
2. Gather supplies.
3. Wash hands with antibacterial soap for 1 minute. Put on clean gloves.
4. Remove dressing if present, taking care not to pull or tug on catheter.
5. Remove gloves and use hand gel for 30 seconds and put on clean gloves.
6. Inspect exit site for erythema, drainage, pain, swelling (contact PD RN if
any is noted).
7. Inspect transfer set for cracks, slits or holes. If present, call PD RN.
8. Clean from the exit site and 2 inches beyond using gauze soaked in
ExSept solution. Allow to dry for two minutes. If ExSept not available
use a chloraprep sponge and clean in the same manner.
9. Using a sterile cotton tipped applicator, apply a small amount of double
antibiotic ointment to exit site.
10. Dress the catheter site with a 2X2 gauze and tape.
11. Tape transfer set to the abdomen allowing some slack in catheter or
secure with the Grip Lock securement device.
12. Document exit site care on the CAPD flowsheet in patient’s clinical
record.

VI. UWHC CROSS REFERENCES

A. D6/5 & SOS Checklist: Completing a Peritoneal Dialysis Drain (see Related
section on U-Connect)
B. D6/5 & SOS Checklist: Completing a Peritoneal Dialysis Manual Exchange (see
Related section on U-Connect)

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C. D6/5 & SOS Checklist: Connecting to the Liberty Peritoneal Dialysis Cycler (see
Related section on U-Connect)
D. D6/5 & SOS Checklist: Disconnecting from the Liberty Peritoneal Dialysis
Cycler (see Related section on U-Connect)
E. D6/5 & SOS Checklist: Peritoneal Dialysis Exit Site Care (see Related section on
U-Connect)
F. Hospital Administrative Policy 8.89, Preventing Occupational Exposure to
Hazardous Drugs
G. Hospital Administrative Policy 13.08, Hand Hygiene
H. Nursing Patient Care Policy 3.32A, Connecting and Disconnecting from a
Peritoneal Dialysis Liberty Cycler (Adult)

VII. REFERENCES

A. American Nephrology Nurses’ Association (2010). Peritoneal dialysis fact sheet.
http://www.annanurse.org/download/reference/practice/pd_fact.pdf
B. Fresenius Medical Care North America (10/2010). CAPD Exchange Procedure
Stay Safe. Retrieved from http://www.fmcna.com
C. National Kidney Foundation (2006). Dialysis Outcomes Quality Initiative (DOQI)
Clinical Practice Guidelines for Peritoneal Dialysis.
http://www.kidney.org/professionals/kdoqi/guideline_uphd_pd_va/index.htm
D. U.S. Department of Health and Human Services, National Institutes of Health,
National Institute of Diabetes and Digestive and Kidney Diseases (2006).
Treatment methods for kidney failure: Peritoneal Dialysis. No. 06-4688, 1-19.
http://kidney.niddk.nih.gov/kudiseases/pubs/pdf/peritoneal.pdf

VIII. REVIEWED BY

Clinical Nurse Specialist, Critical Care
Clinical Nurse Specialist, Medical Nursing
Wisconsin Dialysis Inc. Representative
Save Our Shift Representative
Nursing Patient Care Policy and Procedure Committee, February 2015

SIGNED BY

Beth Houlahan, MSN, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer