UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES

MEDICAL CENTER

PROCEDURE

 PROCEDURE:
138
EFFECTIVE:
1/89
REVISION:
12/93
APPROVAL:
1/08

PROCEDURE FOR HEPARINIZED SALINE FLUSH OF NEWLY INSERTED TENCKHOFF CATHETERS

PURPOSE: To maintain catheter patency with a sterile closed system while minimizing intra-abdominal pressure.

EQUIPMENT:

  1. Mask
  2. Y-set
  3. Alcohol pads, syringe-needle
  4. 250 ml. Normal Saline with 500U Heparin 1:1, 000
  5. Sterile gloves

NURSING ACTION:

PROCEDURE STEPS:

  1. Prepare Heparinized Saline Solution.
  1. Mask
  2. Wash hands. (3 minute scrub with antimicrobial soap)
  3. Scrub top of Heparin vial with alcohol pad for 10 seconds and leave covered with pad.
  4. Connect syringe and needle.
  5. Draw up 1/2cc of air with needle cap in place.
  6. Remove needle cap and alcohol pad and inject air into Heparin vial.
  7. Draw up 1/2cc of Heparin and recap syringe.
  8. Scrub medication port of saline with alcohol pad for 10 seconds and leave covered with pad.
  9. Remove needle cap and alcohol pad and inject Heparin into saline.
  10. Label saline with appropriate medication addition label.

KEYPOINT: Mask and avoid drafts. Sterile technique is a must. If even one bacterium enters the system, patient could get peritonitis.

  1. To flush with heparinized saline.
    1. Prepare supplies
      1. Clean work area & gather supplies.
      2. Make sure transfer set is unencumbered & ready for use.
      3. Mask and wash hands.
      4. Place bag of heparinized saline on work table.
      5. Remove Y set from package & place on table.
      6. Close both Y set clamps.
  1. Connect Heparinized saline to Y set
  1. Put blue outlet port clamp on heparinized saline bag.
  2. Remove tip protector from the outlet port of the saline bag.
  3. Remove the tip protector from the spike.
  4. Immediately, insert spike into saline bag.

KEYPOINT: If the spike touches any surface other than the inside of the saline outlet port, it is contaminated. Discard supplies and start over. Contamination of the spike is a key cause of gram positive peritonitis.
  1. Connect Y set to Transfer set.
  1. Check that the roller clamp on transfer set is closed.
  2. Remove tip protector from the patient connector of the Y set.
  3. Remove disconnect cap from transfer set. Discard.
  4. Immediately connect the Y set to the transfer set.
  5. Rotate and twist the connectors until fully inserted.

KEY POINT: Opening the transfer set is another break in an otherwise closed system. Care must be taken to avoid contamination of the end of the transfer set.
  1. Flush before fill.
  1. Hang saline bag on IV pole.
  2. Place drain bag in drain position.
  3. Open drain line clamp.
  4. Open new bag line clamp.
  5. Remove the blue outlet port clamp from the saline bag.
  6. Visually follow the air bubble into the drain bag.
  7. Close the saline bag clamp.

KEYPOINT: This step helps to prevent gram positive peritonitis by flushing any unknown contaminant into the drain bag. It is important to remove the blue outlet port clamp last.
  1. Drain
  1. Open the roller clamp on the transfer set and drain.
  2. Observe characteristics of effluent.
  3. Close drain bag clamp when drainage is complete.

KEYPOINT: Effluent may be blood tinged after new catheter placement but it should not be cloudy. Notify Nephrology fellow if effluent if cloudy. Chart character of effluent on the Daily Peritoneal Dialysis Record.
  1. Flush
  1. Open saline bag line clamp and allow approximately 200cc of saline to flow into peritoneum then close.
  2. Immediately open drain bag clamp to allow saline to drain.
  3. After saline has drained, infuse the final 50cc of heparinized saline by closing the drain bag clamp and opening the saline bag clamp.

KEYPOINT: This will check for inflow and outflow problems. It is not unusual for patients not to drain back all of the fluid. Document estimates of outflow. The last 50cc infusion enables fresh heparinized saline to be stored in the catheter until its’ next use.

  1. Disconnect and cap off transfer set.

  1. Open the disconnect cap package.
  2. Hold cap in upright position.
  3. Check the sponge visually for wetness.
  4. Disconnect the Y set from the transfer set.
  5. With the transfer set pointing down, point the cap up and twist on until fully inserted.
  6. Chart flush on Daily Peritoneal Dialysis Record.

REFERENCES: ANNA Core Curriculum

RESOURCE PERSON(S):  Kathy Browning, CSM; Betty Casali, CSM

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