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Connecting and Disconnecting from Peritoneal Dialysis Cyclers (Adult) (3.32A)

Connecting and Disconnecting from Peritoneal Dialysis Cyclers (Adult) (3.32A) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Genitourinary

3.32A

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
July 21, 2017

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 3.32A

Original
Revision

Page
1
of 6

Title: Connecting and Disconnecting from
Peritoneal Dialysis Cyclers (Adult)

I. PURPOSE

To provide guidance for registered nurses (RNs) who have been trained to safely
connect, disconnect the patient from the Peritoneal Dialysis cyclers and perform site
care.

II. POLICY

A. Inpatients requiring peritoneal dialysis (PD) via the Cycler will be placed on the
admitting service’s unit.
B. When a patient needs to be connected or disconnected from a cycler, contact the
Clinical Support Resources listed below.
C. Registered nurses will use the following procedure to connect and disconnect
to/from the Liberty or HomeChoice Cycler. Only registered nurses who have been
trained on the Fresenius Liberty Cycler or the Baxter HomeChoice cycler, such as
PD nurses and Save Our Shift (SOS) nurses can perform this procedure. The
Peritoneal Dialysis RNs will program the cycler. The SOS nurses are only
responsible for connecting and pressing start and/or disconnecting the patient
from the Cycler. They may also troubleshoot alarms as able with the assistance
of the PD RN
D. Site care can be performed by any RN.
E. It is very important that stringent aseptic technique be used during this procedure.
Do not proceed if contamination of the patient end of catheter (transfer set) occurs
at any time. Call the PD nurse on call for further directions.
F. If patient is to have surgery or abdominal imaging, the patient’s peritoneum must
be drained.

III. CLINICAL SUPPORT RESOURCES

A. Primary Contacts: On Call Peritoneal Dialysis RN (on the paging screen, search
for PD/Home Dialysis or call paging operator and ask for PD/Home Dialysis
nurse on call).
1. Office time: 8:00am-4:30pm Monday-Friday
2. Phone number: 608-270-5643
Secondary Contact: SOS RN via paging
B. Tertiary Contact: Wisconsin Dialysis Inc. Home Dialysis Manager pager 8308 or
(608) 270-5620.




Page 2 of 6

IV. EQUIPMENT

A. Connecting Supplies:
1. Masks: yellow barrier or surgical tie behind head types
2. Clean gloves
3. Sterile 4x4 gauze
4. Alcavis solution (provided by PD RN)
B. Disconnecting Supplies
1. Masks: yellow barrier or surgical tie behind head types
2. Clean gloves
3. Sterile 4x4 gauze
4. Alcavis solution (provided by PD RN)
5. Stay-Safe Organizer attached to Liberty Cycler (provided by PD RN)
6. Stay-Safe Cap for Liberty Cycler (Central Service [CS] Item Number
4010065
7. Baxter Mini Cap for HomeChoice Cycler (Central Service [CS] Item
Number 2204129)
C. Exit Site Care
1. ExSept solution (provided by PD RN)
2. 4x4 gauze
3. 2x2 gauze
4. Antibiotic cream, per provider order
5. Paper tape
6. Grip Lock securement device (CS Item Number 4005547)

V. PROCEDURE

A. Connecting the patient to the Liberty Cycler
1. Close the door to the patient’s room.
2. Clean organizer and bedside table (if using) with hospital disinfectant.
3. Mask the patient and anyone else in the room.
4. Perform hand hygiene according to UW Health Clinical Policy 4.1.13,
Hand Hygiene.
5. Don clean gloves.
6. Ensure the transfer set (patient’s catheter) clamp is closed.
7. Scrub the catheter end for one (1) minute using a sterile 4x4 gauze
soaked in Alcavis solution (8-12 mL). Wrap the same 4x4 around
catheter and allow it to soak for one (1) minute. The cap remains on for
this procedure.
8. Remove gloves and perform hand hygiene according to UW Health
Clinical Policy 4.1.13, Hand Hygiene. Don clean gloves.
9. Place catheter in “extension” side of organizer without touching
disinfected area. Remove the clear cap on the cycler tubing located in
the white/blue organizer.
10. Twist end cap off of transfer set using aseptic technique.
11. Connect transfer set to the patient’s line of the cycler tubing using
aseptic technique. Secure the connection using a clockwise twisting
motion.
12. Open the large blue clamp on the cycler tubing and the white clamp on

Page 3 of 6

the transfer set.
13. Remove newly connected area from the organizer.
14. Press “Next” on the cycler to continue. Patient will start to drain.
15. Make sure catheter is secured to abdomen with securement device or
tape.
16. Documentation by PD or SOS RN
a. In a progress note, document start of treatment in the patient’s
clinical record.
B. Disconnecting the patient from the Liberty Cycler
1. At the end of treatment, the screen will display “Treatment Complete” in
the blue status bar at the top left corner of the screen.
2. Close door to patient’s room.
3. Mask the patient and anyone else in the room.
4. Perform hand hygiene according to UW Health Clinical Policy 4.1.13,
Hand Hygiene.
5. Place a new cap in the organizer in the slot labeled “new cap”.
6. Turn the blue trigger on the patient’s line a quarter (¼) turn clockwise to
unlock.
7. Press the blue trigger forward until it stops. This releases a pin into the
transfer set.
8. Close the white clamp on the transfer set and the large blue clamp on the
tubing.
9. Perform hand hygiene according to UW Health Clinical Policy 4.1.13,
Hand Hygiene. Don clean gloves.
10. Scrub the catheter end for one (1) minute using a sterile 4x4 gauze
soaked in Alcavis solution (8-12 mL). Then wrap the same 4x4 around
catheter and allow it to soak for one (1) minute. The cap remains on for
this procedure.
11. Remove gloves, perform hand hygiene according to UW Health Clinical
Policy 4.1.13, Hand Hygiene. Don clean gloves.
12. Place the transfer set in the organizer while still connected to cycler
tubing. Do not touch newly disinfected area.
13. Remove the white protective cover from the new Stay Safe cap.
14. Unscrew the transfer set cover from the patient line in organizer.
15. Connect the transfer set to the Stay Safe Cap. You will have to be
forceful and push in while turning because of the pin. Make sure the cap
is on tight.
16. Place the protective cap from the Stay Safe cap on the patient connector
of the cycler tubing. The PD nurse will dispose of the tubing and
effluent.
17. Turn off the cycler using the large toggle switch on the back of the
machine (To be completed by PD RN).
18. Documentation
a. PD RN
i. To obtain UF information from the cycler, push next twice.
The screen will display “Treatment Summary” in top left
corner.
ii. Chart the total UF in doc flowsheets under CCPD and
document the number in the UF column.

Page 4 of 6

b. SOS RN
i. In a progress note, document catheter disconnection.
19. Complete exit site care daily if indicated (see below).
C. Connecting the patient to the HomeChoice Cycler
1. Close door to patient room.
2. Mask patient, self and anyone else in the room.
3. Perform hand hygiene according to UW Health Clinical Policy 4.1.13,
Hand Hygiene.
4. Don clean gloves.
5. Ensure transfer set (patient’s catheter) clamp is closed.
6. Scrub the catheter end for 1 min. using sterile 4X4 gauze soaked in 8-12
ml of Alcavis Solution. Then wrap the same 4X4 around catheter and soak
for 1 min. The cap remains on for this procedure.
7. Remove gloves and perform hand hygiene according to UW Health
Clinical Policy 4.1.13, Hand Hygiene. Don clean gloves.
8. Remove the patient line from the cycler organizer.
9. Remove the pull ring from patient line connector.
10. Remove cap from transfer set. Immediately connect to the patient line
connector.
11. Open the transfer set by twisting clockwise the light blue part located on
the transfer set, just above the end.
12. Make sure the patient line clamp on the machine tubing is open .
13. Press “GO” to continue. Patient will start to drain.
14. Document start of treatment in progress note (can be done by PD or SOS
RN).
D. Disconnecting the patient from the HomeChoice cycler:
1. At the end of treatment, the screen will display “END OF THERAPY”.
2. Press the down arrow to view summary information (initial drain, cycle by
cycle UF, total UF, average dwell time). Record the above information.
3. Press “GO” and then close the patient line clamp on the cycler tubing and
the twist clockwise on the light blue part located on the transfer set.
4. Close the door to patient room. Mask patient, self and anyone else in the
room
5. Perform hand hygiene according to UW Health Clinical Policy 4.1.13,
Hand Hygiene.
6. Put on clean gloves.
7. Scrub the catheter end for 1 min. using sterile 4X4 gauze soaked in 8-12
ml of Alcavis solution. Then wrap the same 4X4 around the catheter and
soak for 1 min. The cap remains on for this procedure.
8. Perform hand hygiene according to UW Health Clinical Policy 4.1.13,
Hand Hygiene. Don clean gloves.
9. Open a new minicap (disconnect cap), keep sterile.
10. Disconnect the transfer set from the patient line using aseptic technique.
11. Connect the minicap to the transfer set using aseptic technique.
12. Documentation
a. PD RN
i. Chart the total UF in doc flowsheets under CCPD and
document the number in the UF column. At this point you

Page 5 of 6

may turn off the cycler using the large toggle switch.
b. SOS RN
i. In a progress note, document catheter disconnection.
E. Exit Site Care
1. Complete once a day (usually done when patient is being disconnected
from the cycler) or whenever the exit site becomes wet or dirty.
2. Gather supplies.
3. Perform hand hygiene according to UW Health Clinical Policy 4.1.13,
Hand Hygiene. Put on clean gloves.
4. Remove dressing if present, taking care not to pull or tug on catheter.
5. Perform hand hygiene according to UW Health Clinical Policy 4.1.13,
Hand Hygiene. 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 two (2) inches beyond using gauze soaked in
ExSept solution. Allow to dry for two (2) minutes. If ExSept is not
available, use a chloraprep sponge and clean in the same manner.
9. Using a sterile cotton tipped applicator, apply a small amount of antibiotic
cream as ordered to exit site. Do not apply ointment of any kind to the
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 in the patient’s clinical record.
13. Note: Non sterile exit site care may be performed by the floor nurses,
SOS nurses or PD nurses. Exit site care for newly placed PD catheters
with a sterile dressing in place, will only be performed by PD nurses.

VI. UW HEALTH CROSS REFERENCES

A. Nursing Patient Care Policy 3.22A, Peritoneal Dialysis CAPD Exchange (Adult)
B. UW Health Clinical Policy 4.1.13, Hand Hygiene

VII. REFERENCES

A. Funes, I., Nash, K., & Moran, J. (2009). A Simple Technique to Decrease
Peritonitis Rates. Peritoneal Dialysis International, 29.
B. Lew, S. & Gruia, A. (2007). Disinfection of lines and transfer set in peritoneal
dialysis. Nephrology, 154, 129-38.
C. Baxter Healthcare Corporation (2012). HomeChoice APD Systems, Patient at
Home Guide.
D. Fresenius Medical Care North America, (2015) Liberty Cycler User’s Guide.
E. World Health Organization (2009). WHO Guidelines on Hand Hygiene in Health
Care.


Page 6 of 6


VIII. REVIEWED BY

Nurse Manager, Infusion Center and SOS
Manager, Wisconsin Dialysis Inc.
Nursing Patient Care Policy and Procedure Committee, July 2017

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive