Disconnection of the cycler

• You and your child are a team. Encourage autonomy by making realistic choices about what they can do to help you.
• Make the care part of a routine.

• Prepare the environment: Identify a place to perform the treatment.
• Prepare your child:
  • Get help if needed.
  • Position your child to safely assess the catheter insertion site in one of the positions discussed with your healthcare team, based on your child’s comfort, age and ability to cooperate.
  • Begin distraction strategies. 
• Prepare yourself: Choose a time when you are ready to do the treatment. Review the method.
• Perform basic procedures, as taught by your healthcare team:
  • Wash your hands with soapy water for at least 20 seconds.
  • Dry your hands well with a clean paper or towel.
  • Close the tap with the paper or towel.
  • Close doors and windows or ventilation system.
  • Wash your working surface (eg, table) with alcohol or a disinfectant wipe (eg, Sani-Cloth® Plus).
  • Let the table dry.
  • Gather and inspect materials.
  • Put on a mask.
  • Remove jewelry.
  • Wash your hands with a 4% chlorhexidine soap solution for 2 minutes.
  • Dry your hands well with a clean paper or towel.
  • Close the tap with the paper or towel.
• Now touch only the dialysis equipment.
• Now that you are ready to begin the treatment, take the opportunity to congratulate your child and offer encouragement during the rest of the procedure.

See the full description here

Summary 3 key concepts:

• Safety: Carefully follow the care practice steps as you have been taught.
• Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
• Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

• Make sure that the catheter extension is properly closed: the two half-moons of the white part and the light blue part must be well aligned and nested in each other.

• Close the clamp on the patient line of the cycler.

This step prevents contamination with air and fluid in the patient line.

• Open the sterile compresses package, if used.
• Open the MiniCap package.
• Leave the MiniCap resting inside sterile package.
• Be careful not to touch the MiniCap.

This step prepares the MiniCap for use and avoid contamination.

• 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.

• Open the sterile compresses package, if used.
• Open the disinfectant pad package.
• Take the white part of the extension or patient line with one hand.
• If your child has a pediatric set: With the other hand, wipe the outside of the extension where it is connected to the patient line with the disinfectant pad for 15 seconds and let it dry.
• If your child has an adult set with a connection shield in place: there is nothing to disinfect.

Disinfection at the junction between the extension and the patient line of the pediatric set avoids contamination of this area before disconnecting the patient line.

The connection shield put in place with the adult set already protects the exposed part of the catheter extension.

• Place the extension on a sterile compress or keep it in your hands.

This step avoids contamination of the extension.

• Remove the connection shield, if present.
• Disconnect the patient line without touching the dark blue end of the catheter extension.
• Immediately put the MiniCap on the extension tip.

• Make sure the MiniCap is tight.

• If your child is in diapers or has a gastrostomy/jejunostomy, wrap a protective pad around the MiniCap.

This step disconnects the child from the system.

The MiniCap protects the end of the extension.

Installing a protective pad around the MiniCap helps prevent contamination from the diaper or a feeding tube.
Pulling the lever unlocks and opens the cycler door to access the cassette.

This step completes the procedure.

• Press the green GO button on the front of the unit.
• The message on the screen alternates between “Close all clamps” and “Disconnect yourself”.
• Push the lever on the front of the cycler up to open the door.

• Remove the cassette from the set.

• Press the GO button again.
• The message “Turn me off” appears on the screen.
• Press the ON/OFF button on the back of the cycler to turn it off.
• Discard the set with cassette and bags.

Pulling the lever unlocks and opens the cycler door to access the cassette.

This step completes the procedure.

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

• Listen to what your child says about the parts of the procedure that were difficult or painful.
• Comfort your child and recognize your child’s collaboration with positive feedback.
• Highlight your child’s  specific strengths that helped make the procedure positive.
• Discuss with your child what might be done the same or differently the next time the care is needed.
• Keep your promises if you have promised a reward, follow through.
• Reward yourself too.