Addition of medication to the dialysate

Step included in the basic procedures listed in method of care Assembly of the cycler Step 6.

• Make sure that the equipment for preparing the medications is in good condition.
• Ensure that medications have:
  • the right name,
  • the right concentration.
• Make sure the expiration date has not passed.

This step ensures security for the rest of the procedure.

• Apply an antiseptic gel to the entire surface of your hands.
• Rub until your hands are dry (20-30 seconds).
• Now touch only the dialysis equipment.

This step removes most of the microbes on your hands to prevent contamination for the rest of the procedure.

• Without touching the tip of the syringe, screw the needle into it by turning clockwise about ¼ turn.
• Prepare the required number of syringes in this way.
• Leave the protective caps on the needles in place.

This step safely prepares the syringes for use.

• Remove the cap from the medication vial.
• Vigorously rub the septum (rubber top) of the vial with a disinfectant pad for 15 seconds.
• Allow to dry completely.
• Make sure nothing touches the septum to avoid contamination.
• Repeat for each vial of medication and for all vials of sterile water, if necessary.
• Change the disinfectant pad between each vial.

Disinfection is necessary to prevent bacteria or particles on the septum from entering the vial when the needle is inserted.

If the medication is already in liquid form, proceed to the next step.

• Using the directions for reconstituting the medication, pull back on the plunger to draw the same amount of air into the syringe as the amount of sterile water to be removed from the vial.
• Remove the protective cap on the syringe needle.
• Hold the syringe like a pencil with one hand and the vial of sterile water on the work surface with the other.
• Pierce the rubber septum of the vial with the syringe needle at a 45⁰ angle with the bevel of the needle (slanted part at the end of the needle) facing up.

• Quickly straighten the syringe to 90⁰.

• Invert the vial of sterile water with the needle and syringe.
• Keeping the tip of the needle submerged in the liquid, slowly withdraw the water into the syringe by pulling on the plunger.
• Push the air into the vial and withdraw the water into the syringe until you have the desired amount.

• Remove the needle and syringe from the water vial and pierce the septum of the medication vial as previously described.
• Invert the medication vial with the needle and syringe.
• Gently inject the water into the medication vial by pushing out some of the liquid and allowing the syringe to fill with air.
• Inject at the neck of the vial so that the water flows down the side.
• Once the correct amount of water has been injected into the medication vial, remove the empty syringe from the vial and replace the protective cap on the needle securely OR dispose of it in the sharps container without replacing the cap on the syringe.
• Gently shake the medication vial in a circular motion on the work table or roll the vial between your hands. Do not shake the vial vigorously.
• Repeat for each vial of medication to be diluted, as needed.

Diluting the powdered medication allows it to be injected in liquid form into the dialysate bag.

This method prevents particles of rubber from the septum from entering the solution.

Shaking the vial of reconstituted medication ensures that the contents are properly diluted.

• Disinfect the septum of the vial again with a new disinfectant pad for 15 seconds and allow to dry completely.
• Pull back the plunger to draw the same amount of air into the syringe as the amount of solution to be removed from the vial.
• Remove the protective cap from the syringe needle.
• Puncture the septum of the medication vial as previously described.
• Invert the medication vial with the needle and syringe.
• Keeping the tip of the needle submerged in the liquid, slowly withdraw the solution into the syringe by pulling on the plunger.
• Push the air into the vial and withdraw the solution into the syringe until you have the required amount.
• Remove the needle from the vial.
• If you have already disinfected the bag injection port as advised by your healthcare team, go directly to step 8.
• If not: Replace the protective cap on the needle safely.
• Repeat for each medication to be withdrawn from a vial, as needed.

This step prepares medication for safe injection into the dialysate bag.

• For a Physioneal 5 liter bag: Remove the blue pull ring from the injection port.

• Rub the injection port of the bag vigorously with a disinfectant pad for 15 seconds.
• Allow to dry completely.
• Make sure nothing touches the injection port to avoid contaminating it.
• Repeat for each bag of dialysate needed.

Disinfection is necessary to prevent bacteria or particles on the injection port from entering the bag when the needle is inserted to inject the medication.

• Remove the protective cap from the syringe needle.
• Insert the entire needle into the center of the injection port on the bag.
• Be careful not to touch the injection port with your fingers.
• Be careful not to pierce the bag with the angle of the needle.
• Inject the medication by pushing on the plunger of the syringe.
• Remove the needle from the injection port.
• Dispose of the syringe and needle in the sharps container.
• Shake the bag.
• Repeat for each drug to be injected into a dialysate bag.

This step allows the medication to be added to the dialysate bag.

Continue with the assembly of the cycler.

The addition of the medications is a step in the assembly of the cycler.