PURPOSE
1. To provide guidelines for appropriate bag exchange.
POLICY
1. The procedure should be performed by a physician or a C.A.P.D. trained Nurse.
2. A strict aseptic technique should be maintained throughout the procedure in accordance with the policy and procedure of aseptic technique.
3. Number of exchanges to be done daily should be ordered by the physician.
4. The type of C.A.P.D. fluid and drugs to be given should be prescribed by the physician.
5. Wash and dry hand should be performed according to the policy and procedure on hand washing.
6. If it is the 1st exchange of the day, the weight and blood pressure of the patient should be taken and recorded in the C.A.P.D. chart.
7. The exit site dressing should be changed every morning after taking bath.
EQUIPMENT
1. Trolley washed with soap and water with 70% spirit
2. C.A.P.D. fluid (type as required)
3. Frekasept or Hibiscrub
4. Frekaderm
5. Betadine antiseptic
6. Hibiscrub
7. Spirit / spirit swabs
8. Sterile gauze packs
9. Mepore dressing 9 x 15 cm
10. Surgical mask
11. Clean sheet / tray
12. Scissors
13. Non-sterile gauze 4 x 4
14. Drugs / sterile syringe with needles (if required)
15. Un-sterile receiver for soiled dressing
16. Drip stand with Dr Block clamp
17. Weighing scale – hanging
18. Plastic apron
19. Amuchina solution
20. Three (3) blue clamps
21. Two (2) small sterile containers
PROCEDURE
1. Wash and dry hands.
2. Bring the prepared trolley with all equipment to the patient’s bedside.
3. Screen the bed to provide privacy. Encourage the patient to observe the procedure.
4. Wear surgical mask.
5. Wash and dry hands with hibiscrub.
6. Wipe the top shelf of the trolley and the sides with non-sterile gauze soaked in spirit.
7. Arrange Frekaderm, Frekasept and Amuchina solution on top shelf at one corner.
8. Open a sterile gauze pack with aseptic technique and place the pack near the edge of the top shelf with the gauze exposed.
9. Check the new C.A.P.D. fluid bag for
* leakage
* correct type
* amount
* expiry date
* clarity
* colour
and place it at one corner of the trolley.
10. Place the drip stand near the patient.
11. Place the clean tray on the floor near the patient.
12. Place small disposal bin near the patient.
13. Place the patient in a comfortable position – sitting or recumbent and expose Tenchkoff catheter site.
14. Wash and dry hands.
15. Remove empty drainage bag from the patient and spray all around the connecting site with Frekaderm and place the bag on the tray below the level of the patient.
16. Release both Tenchkoff catheter clamp and transfer set clamp and allow fluid to drain into the bag.
Note
As the fluid flows out the tubing will be warm. If no flow, check the tubing to see whether it is kinked or not. Check the position of the patient. Encourage the patient to turn gently from side to side (if lying) or stand up (if sitting. Once the fluid has drained out the tubing will be cool and drainage bag will be filled.
17. While the fluid is drained out, check the new C.A.P.D. fluid bag again for volume, type, clarity, expiry date and leakage.
18. Remove the outer pack using aseptic technique (Do not touch the connecting tube site. Place back on top shelf near the edge with the connecting site hanging freely).
19. Place the drainage bag beside the new bag in the same way.
20. Disinfect hands with Frekasept (away from the trolley).
21. Place one piece of sterile dry gauze on the clean surface of the opened gauze pack and pour some Betadine antiseptic on it.
22. Disinfect hands again with Frekasept.
23. Wrap the betadine soaked gauze around the connecting site of the drainage bag and leave it for at least 3 minutes.
24. Clean and dry fingers with gauze and discard gauze into the dustbin.
25. After 3 minutes, discard Betadine soaked gauze into the dust bin.
26. Disinfect hands again with Frekasept.
27. Remove the cap of the connecting site of the new bag and spray all around the exposed site with Frekaderm (Avoid spraying the lumen). Disinfect hands.
28. Wipe Betadine soaked site of the old bag with sterile dry gauze.
29. Disconnect transfer set from the old bag holding the connecting site of the drainage bag with the thumb and forefingers (rest of the fingers facing the bag to prevent contamination) and quickly connect transfer set to the connecting site of the new C.A.P.D. bag using the same non touch technique.
Note
Do not hesitate to change the new bag if the exposed connecting site of the new bag has been accidentally touched by the hands or any other objects.
30. Break the cone of the new C.A.P.D. bag and hang the bag on the drip stand.
31. Release both clamps and allow fluid to flow in.
32. When the fluid has completely drained in, clamp both clamps.
33. Fold the empty bag and coil the tubing around it and place with the patient.
34. Check the filled drainage bag by holding it up under direct light for:
* clarity
* fibrin
* blood
35. Arrange all items back on the bottom shelf of the trolley. Clean top shelf with spirit and leave it in one corner of the room.
36. Remove mask.
37. Make the patient as comfortable as possible.
38. Measure the drained out fluid in the dirty utility room using gloves.
39. Wash and dry hands.
40. Document the procedure in the C.A.P.D. chart and patients file.
41. Warm a new C.A.P.D. fluid bag under the tight of the patient for the next exchange.
Note
If drained out fluid is cloudy, turbid, or with blood or fibrin, inform the physician first and send a specimen for culture and sensitivity and cell count. Reserve the bag of fluid for the physician to see before measuring the amount.