PURPOSE
- Aids the removal of Toxic substance and Metabolic Wastes.
- Establishes electrolyte balance.
- Removes excessive body fluid.
- Assisting in regulating the fluid balance of the body.
- Controls blood pressure.
- Controls server intractable heart failure, when diuretics no longer promote elimination of water and sodium.
POLICY
1. A skilled Nurse or a trained person performs this procedure.
2. Strict aseptic technique should be maintained through out procedure.
3. Hand washing technique should be performed prior to the procedure according to P & P of Royal Hospital.
4. The catheter should be kept in position according to the comfort of the patient.
EQUIPMENT
1. Trolley cleaned with soap and water.
2. Surgical Mask
3. Sterile Gauze.
4. Dialysis Fluid (according to Physicians order)
5. Minicap with povidine.
6. Blue clamps (2 No.)
7. Hibisol with dispenser
8. Incopad.
PROCEDURE
| SN | Nursing Action | Rationale |
| 01 | Explain the procedure to the patient. | To gain patient confidence and co-operation. |
| 02 | Bring the prepared Trolley beside the patient. | |
| 03 | Screen the patient. | To provide privacy to avoid unnecessary embarrassment to the patient during procedure. |
| SN | Nursing Action | Rationale |
| 04 | Wear apron and mask. | To prevent droplet infection. |
| 05 | Wash and dry hands. | Asepsis is essential to prevent infection. |
| 06 | Clean the top shelf of the trolley with gauze soaked in spirit. | |
| 07 | Pen the Titanium adapter and gently insert into the Tenckhoff catheter and connect the Transfer set under aseptic technique. | To avid Contamination (Change the Transfer set once in 6 months). |
Bag Exchange
| SN | Nursing Action | Rationale |
| 01 | Check the Doctors order. | To obtain specific instruction and information. |
| 02 | Explain the procedure to the patient. | To gain Patients confidence and co operation. |
| 03 | Bring the prepared Trolley with all the Equipment to the patient’s bedside. | To gain time and easy handling of equipment. |
| 04 | Screen the patient to provide privacy and encourage the patient or relative to observe the procedure. | To avoid unnecessary embarrassment to the patient during the procedure. |
| 05 | Wash and dry hands. | To minimize the risk of infection. |
| 06 | Wear surgical mask. | To avoid droplet infection. |
| 07 | Wipe the top shelf of the trolley with soaked spirit gauze. | To avoid droplet infection |
| 08 | Arrange Hibisol, sterile gauze, and minicap. | |
| 09 | Open sterile Gauze pack with aseptic technique. Tear the outer cover of the Fluid and keep. | To avoid contamination on the sterile gauze and packet. |
| 10 | Check the fluid for Clarity, leakage amount and % Type and Expiry date and colour. Place at one corner of the Trolley. | Do not attempt to start exchange if fluid is cloudy, leak, or wet. |
| SN | Nursing Action | Rationale |
| 11 | Place IV stand near to the patient Place an Incopad on the floor near to the patient Wash and dry hands. Keep the Drainage bag on the floor. | To obtain good flow of the patient from peritoneum. |
| 12 | Hang the new bag on IV stand and clamp the Tube With blue clamp. | |
| 13 | Remove the protective cap and discard, clean with sterile gauze and connect to the fluid Release the clamp from the catheter Allow to drain the fluid into the drain bag. | As the fluid flows out the tubing will be warm, If no flow check the tubing to see whether it is kinked, check the patient’s position. Encourage the patient to turn side to side or stand up (if sitting) Ones the fluid has drained out the tubing will be cool. |
| 14 | Clamp the Drainage tube and Catheter. | |
| 15 | Break the corn of the dialysate fluid, remove the clamp count 1-5 allow to drain the fluid into the peritoneum usually take 10- 20 Mts. If the patient experience pain slow to the patient, disconnect the tube and clamp the catheter and cover with minicap. Place the catheter and tubing on the patient abdomen. | To remove air from the line and clear the fluid line. |
| 16 | Check the drainage bag by holding it under direct light for clarity (turbid or clear Fibrin, Blood) | If the fluid is turbid, with blood and fibrin inform doctor for immediate action. Send the specimen for culture and Sensitivity. Reserve the bag for Doctor to see. |
| 17 | Arrange the items back on the bottom shelf of the trolley and clean the top shelf, and keep the trolley in the corner of the room. | Trolley should be kept ready for the next exchange with all equipment. |
| 18 | Remove mask. Mask the patient comfortable Measure the drainage fluid in dirty utility Room. Wash and dry hands. | Record uneventful Exchange and note if there is any new order from the doctor for The next exchange. |
| 19 | Record the CAPD chart and Nursing notes. |
| SN | Nursing Action | Rationale |
| 20 | Warm a new CAPD fluid bag under the light for next exchange. | Introducing a cold fluid into peritoneum will mask the patient uncomfortable and will experience abdominal pain. |