UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
MEDICAL CENTER

PROCEDURE

1. Procedure

1. Place mask on self, patient and anyone in room prior to procedure.  Wash hands.
2. Peritoneal dialysis effluent should be disposed of in the same manner as any body fluid.
3. Record on P.D. Flow Sheet

2. Care

1. Cleanse exit site in circular motion with antibacterial soap/water.
2. Secure Tenckoff to patient's abdominal wall.
3. Dressings are optional.

3. Cell Count and Culture

1. Obtain specimen from spent exchange bag.
2. Prepare medication port of dialysate bag or random entry point by doing a 10 sec circular scrub with alcohol pad prior to puncturing with sterile syringe/needle.
3. Specimen Requirements

1. Routine Culture: 2-10 ml syringes of dialysate - one for each culture bottle
2. Cell Count:  3.5ml of dialysate in purple top tube.
3. AFT or Fungal Cultures and/or Gram Slain: 10ml of dialysate in sterile culture container.  Label all specimens as "Dialysate: for specific test.  Record on Flow Sheet.

4. To Instill Solution

KEYPOINT:  Solution is warmed prior to instilling.  Heat in designated microwave on

high for 1 minute on each side.

1. Remove cap from Tenckoff catheter and attach to Luer connector.
2. Open clamp on Tenckoff catheter.

KEYPOINT:  Some Tenckoff catheters will not have clamps.  If they do not, a port clamp must be placed on the catheter before attachment of the administration set to the catheter.

3. Open upper clamp of the administration set.

KEYPOINT:  Valve in the drip chamber will close automatically when the solution container is empty.  Premature closing of the valve can be corrected by refilling drip chamber and compressing tubing between drip chamber and closed upper clamp.  If less than the total amount of solution is to be instilled, close the upper chamber when the prescribed amount of solution has been administered.

4. Close upper clamp when desired amount of solution has been instilled.  Leave the solution in the peritoneal cavity for the prescribed time period.  If more solution is to be instilled after emptying dialysis solution, repeat procedure steps 3 and 4.  Remover the empty solution container and immediately attach new container as described below.

5. To Drain

1. Open lower clamp of administration set.
2. Allow the solution to drain a minimum of 15 minutes.  Close the lower clamp.

KEYPOINT:  Drainage line may be primed from new solution by temporarily opening the clamp if drainage is sluggish.

3. To empty drainage container, remove bottom drain from pocket, open clamp, and drain into suitable receptacle.

KEYPOINT:  Peritoneal dialysis effluent should be disposed of in the same manner as any body fluid.

4. Replace entire tubing set with every exchange.

5. Clean splashes or spills on floor with dilute bleach solution (10 cups water to 1 cup bleach).  Spray over spill and wait 5 minutes, then repeat spray and wait 5 minutes.  Wipe up and dispose in red bag.

REFERENCES:
Lippincott 7th Edition, Chapter 12

RESOURCE PERSON(S): Cathy Brothers, RN