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Peritoneal dialysis

What is it?

(Click to view larger image)

(Click to view larger image)

STAGES OF CHRONIC KIDNEY DISEASE (CKD)

Stage 1: CKD with normal renal function
Stage 2: CKD with mild renal failure
Stage 3A: CKD with mild to moderate renal impairment
Stage 3B: CKD with moderate to severe renal impairment
Stage 4: CKD with severe renal failure
Stage 5: CKD with End-Stage Renal Disease (ESRD)

 

TREATMENT OPTIONS FOR END-STAGE RENAL DISEASE (ESRD)

Dialysis

Kidney transplant

Supportive care other than dialysis (conservative/palliative care)


 

 

TYPES OF DIALYSIS

Hemodialysis

 

 

 

 

Peritoneal Dialysis (PD)


 

How does it work?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The bag with the purple pull ring contains 7.5% icodextrin which is glucose polymer.

 

SORT OF DIALYSATES

(Source: Baxter International Inc.)

Physioneal™

 

 

Specifics for the 2.5 liter format:

 

 

 

 

 

 

Specifics for the 5 liter format:

 

 

 

 

Dianeal™

 

 

 

 

 

 

 

 

Extraneal™

 

 

 

 

 


 

 

 

 

METHODS OF PERITONEAL DIALYSIS (PD)

Automated PD (APD)

Several types of programming are possible. The most frequently used are:

 

Continuous Ambulatory PD (CAPD) or Manual PD


 

AUTOMATED PERITONEAL DIALYSIS (PD) EQUIPMENT

(Source: Baxter International Inc.)

Cycler

 

 

 

 

 

Cycler set with cassette or APD set

Contains several parts:

 

 

 

 

 

5-Prong manifold set

 

 

 

 

 

 

 

 

Drainage bag

 

 

 

 

 

 

Specimen bag

 

 

 

 

 

 

Empty bag

 

 

 

 

 

 

 

Dialysis clamp

Depending on the recommendations of your healthcare team, can also be used to:


 

 

Your healthcare team is available to supervise the care provided to your child, ensure the proper functioning of equipment and make recommendations to you as needed.

Refer to your healthcare team if the equipment used for your child at home is different from what is described in this section or in the methods of care.


FAQ – Peritoneal dialysis

When to consult your healthcare team

Peritoneal catheter

Equipment for peritoneal dialysis

Peritoneal dialysis sessions

General condition

Your child’s healthcare team will use your child’s regular appointments to verify the proper functioning of the catheter and peritoneal dialysis equipment and will make adjustments to the care as required.

Do not hesitate to contact your healthcare team with any specific questions concerning your child.

 

WARNING: The information in this section is meant as a general guide for parents and caregivers of children with certain problems related to peritoneal dialysis. It is not intended to replace the recommendations of your child’s healthcare team.

Discuss your child’s unique needs with the healthcare team, including WHO and WHEN to contact when problems arise.

Problems related to the material

Discharge, redness, heat, swelling, bad odor and/or pain around the catheter insertion site

Possible cause(s):

  • Infection or inflammation caused by:
    • poor or insufficient care at the catheter insertion site,
    • insufficiently frequent dressing changes,
    • poor fixation of the catheter
  • Chronic skin irritation
  • Trauma to the site

What to do?

  • Contact your healthcare team quickly.

While waiting to reach your healthcare team:

  • Take a specimen of the flow at the insertion site, as taught.
  • If possible, take a picture of the site.
  • If you need to leave to get your smartphone or camera, cover the site with a sterile compress. After taking the photo, rewash your hands using an alcohol-based antiseptic gel (eg, Stérigel®) to the entire surface of your hands and rub until they are dry (20 to 30 seconds).
  • Clean the site, change the dressing.
  • Keep the skin clean and dry around the catheter insertion site.

Bump or red line near the catheter insertion site with redness, swelling, pain or tenderness and/or discharge

Possible cause(s)

  • Tunnel infection (catheter pathway under the skin, from the insertion site to the peritoneal cavity) caused by:
    • an infection at the catheter insertion site,
    • an abscess,
    • inadequate healing of the site

What to do?

  • Contact your healthcare team immediately.

While waiting to reach your healthcare team:

  • Take a specimen of the flow at the insertion site, as taught.
  • If possible, take a picture of the site.
  • If you need to leave to get your smartphone or camera, cover the site with a sterile compress. After taking the photo, rewash your hands using an alcohol-based antiseptic gel (eg, Stérigel®) to the entire surface of your hands and rub until they are dry (20 to 30 seconds).
  • Clean the site, change the dressing.
  • Keep the skin clean and dry around the catheter insertion site.
  • Get ready to go to the hospital.

Wet dressing

Possible cause(s)

  • Poor protection of the dressing while showering or swimming
  • Leakage from the catheter insertion site
  • Catheter breakage
  • Disconnection of the extension
  • Infection
  • Urinary incontinence or diaper overflow

What to do?

  • If the dressing was improperly protected, clean the site and change the dressing.
  • If not, try to identify the cause of the discharge.
  • Clamp the catheter with a dialysis clamp.
  • Contact your healthcare team immediately.

While waiting to reach your healthcare team:

  • Remove the wet dressing.
  • Take a specimen of the flow at the insertion site, as taught.
  • If possible, take a picture of the site.
  • If you need to leave to get your smartphone or camera, cover the site with a sterile compress. After taking the photo, rewash your hands using an alcohol-based antiseptic gel (eg, Stérigel®) to the entire surface of your hands and rub until they are dry (20 to 30 seconds).
  • Clean the site, change the dressing.
  • Keep the skin clean and dry around the catheter insertion site.
  • Change the dressing frequently.

Disconnection between patient line and extension during dialysis

Possible cause(s)

  • Accident
  • Incorrect connection technique

What to do?

  • Discontinue the dialysis session.

If complete disconnection:

  • Close the extension: the two half-moons of the white part and the light blue part must be well aligned and nested in each other.
  • Put on a MiniCap disconnect cap.
  • Contact your healthcare team immediately.

If partial disconnection:

  • Close the extension: the two half-moons of the white part and the light blue part must be well aligned and nested in each other.
  • Contact your healthcare team immediately.

Disconnection between MiniCap disconnecting cap and extension tubing

Possible cause(s)

  • Accident
  • Incorrect connection technique

What to do?

  • Stay calm.
  • Make sure the extension is closed.
  • If the MiniCap disconnect cap is loose, screw it on completely.
  • If the MiniCap has fallen off, install a new one.
  • Contact your healthcare team immediately.
  • Prepare to go to the hospital.

Disconnection between the extension and the catheter

Possible cause(s)

  • Accident
  • Damaged catheter

What to do?

  • Stay calm.
  • Immediately clamp the catheter with a dialysis clamp.

If complete disconnection:

  • Wrap the catheter in sterile compress.
  • Contact your healthcare team immediately.

If partial disconnection:

  • Tighten the extension.
  • Wrap it with a sterile compress.
  • Contact your healthcare team immediately.

Contamination of the extension tip during dialysis connection

Possible cause(s)

  • Failure to follow aseptic measures
  • Accident

What to do?

  • Put on a MiniCap disconnecting cap.
  • Contact your healthcare team immediately.

Drainage from the bag during the dialysis session

Possible cause(s)

  • Incorrect cannula breakage technique during bag preparation
  • Bag manufacturing defect
  • Perforation of the bag during the injection of the medication through the injection port

What to do?

  • Stop the dialysis session.
  • Contact your healthcare team immediately.

Cycler alarms

Possible cause(s)

  • Various

What to do?

  • Look at the message on the screen.
  • Take appropriate action.
  • If necessary, refer to the instructions in the cycler’s manual or in the alarm book available to you.
  • If you are still unable to resolve the problem, contact your healthcare team or the manufacturer’s technical support (eg, Baxter) whose number is displayed on the cycler.

Dislodgement of the catheter; catheter cuff visible outside the insertion site

Possible cause(s)

  • Catheter displacement

What to do?

  • Stay calm.
  • Contact your healthcare team immediately.

Problems related to the peritoneal dialysis session or the child's general condition

Cloudy effluent (as if milk had been added) with any of these symptoms: Constant pain in the belly; Chills; Fever (≥ 38⁰C rectal or ≥ 37.5⁰C oral or ≥ 37.5⁰C axilla); Nausea; Vomiting; Decreased effluent drainage; Headache; Loss of appetite; Fatigue; Abdominal muscle cramps or spasms (stiffness, pain)

Possible cause(s)

  • Peritonitis (infection of the peritoneum) caused by:
    • failure to follow aseptic measures during treatment
    • incorrect dialysis technique
    • catheter site infection
    • weak immune system of the child
    • untreated contamination
  • Inflammatory reaction
  • Appendicitis
  • Invasive technique
  • Movement of bacteria from the intestines to the peritoneal cavity

What to do?

  • Contact your healthcare team immediately.

While waiting to reach your healthcare team:

  • Discontinue dialysis session, if in progress.
  • Add a specimen bag and then take a specimen of the dialysate after it has been in the peritoneal cavity for 60-90 minutes in the dwell phase.
  • Take your child’s temperature, blood pressure and pulse.

Filaments (threads) or small white pieces in the effluent

Possible cause(s)

  • Presence of fibrin (looks like partially cooked egg white) caused by:
    • normal body reaction to the presence of a foreign body, the catheter, in the peritoneal cavity,
    • infection, inflammation,
    • installation of a new catheter,
    • condition of the child

What to do?

  • Contact your healthcare team quickly.

While waiting to reach your healthcare team:

  • Continue the current dialysis session unless there are too many strands.
  • Make sure you have the heparin vial available while you wait for your healthcare team’s advice.

To prevent catheter blockage by fibrin build-up:

  • Check for it in the drainage bags at the beginning and end of treatment.
  • If present, notify your healthcare team.

Pink or red effluent

Possible cause(s)

  • Rupture of small blood vessels in the peritoneum often caused by physical exertion
  • Abdominal injury or fall during a sport activity
  • Menstruation or ovulation in adolescents
  • Forceful manipulation of the catheter

What to do?

  • If your child is unwell, contact your healthcare team immediately.
  • If your child is table, don’t worry; it’s often not serious and is usually temporary.
  • However, contact your healthcare team immediately and they will make the necessary assessment.

While waiting to reach your healthcare team:

  • Make a 2nd exchange and compare the color with the previous cycle.
  • Take your child’s blood pressure and pulse.

Slow or blocked infusion of the dialysate

Possible cause(s)

  • Clamp closure
  • Improperly prepared dialysate bags
  • Catheter obstruction caused by the presence of fibrin (normal reaction of the body to the presence of the catheter in the peritoneal cavity)
  • Internal mechanical obstruction of the catheter
  • Catheter displacement

What to do?

  • Make sure all clamps are open.
  • Make sure the dialysate bag cannulas are broken and the seals are open.
  • If the problem persists, contact your healthcare team quickly.

One and/or the other of these symptoms: Rapid increase in weight compared to your child's dry weight; Swelling of the hands, ankles, feet, around the eyes and/or face; Hypertension (high blood pressure); Difficulty breathing; Shortness of breath; Low urine output

Possible cause(s)

  • Fluid overload caused by:
    • too much fluid or sodium intake,
    • use of the wrong dialysate,
    • inadequate ultrafiltration,
    • incorrect weight reading,
    • insufficient or inadequate dialysis,
    • catheter malfunction,
    • decrease in urine production

What to do?

  • Contact your healthcare team quickly.

While waiting to reach your healthcare team:

  • Continue with your dialysis session.
  • Limit fluids and salty foods.
  • Use more concentrated dialysis solutions, as recommended by your healthcare team.

One and/or the other of these symptoms: Rapid weight loss compared to your child's dry weight; Dizziness; Less saliva, dry lips; Low blood pressure; Orthostatic low blood pressure (low blood pressure and increased pulse) when the child moves from a lying to a sitting position); Increased pulse rate; Muscle cramps, especially in the legs; Weakness; Dark eyes

Possible cause(s)

  • Dehydration caused by:
    • use of the wrong concentration of dialysate,
    • insufficient fluid intake,
    • nausea,
    • diarrhea,
    • vomiting,
    • excessive urination,
    • acute illness

What to do?

  • Have your child sit or lie down if feeling dizzy or weak.
  • Contact your healthcare team quickly.

While waiting to reach your healthcare team:

  • Discontinue dialysis session, if in progress.
  • Weigh your child.
  • Take your child’s blood pressure lying down and then sitting up (orthostatic blood pressure) unless your child unable to sit independently.
  • Give your child more fluids to drink, especially salty fluids (eg, chicken broth).
  • Use less concentrated dialysis solutions, as recommended by your healthcare team.

If your child has cramps or dizziness:

  • Give him a salty liquid (eg, broth) or saltine crackers.
  • Apply a warm compress or towel to cramped muscles.
  • Massage the muscles.

Decrease in ultrafiltration/decreased effluent

Possible cause(s)

  • Constipation
  • Peritonitis
  • Presence of fibrin
  • Change in the state of the peritoneal membrane

What to do?

  • Contact your healthcare team.

Abdominal cramps during drainage

Possible cause(s)

  • Dialysate temperature too cold
  • Effluent drainage too fast
  • Peritonitis
  • Catheter displacement

What to do?

  • Ensure that the temperature setting on the cycler is appropriate for the dialysate bag.
  • Give pain medication if recommended by your healthcare team.
  • If the problem persists, contact your healthcare team quickly.

Constipation

Possible cause(s)

  • Pressure of the dialysate on the intestines
  • Certain medications (eg, antacids, calcium carbonate, iron)
  • Diet low in fiber
  • Decreased physical activity
  • Inadequate hydration

What to do?

  • Give laxative medications, if recommended by your healthcare team.
  • Increase fluids, if your child’s diet allows it.
  • Increase fiber-rich foods, as recommended by your healthcare team.
  • Increase the amount of physical activity, if possible.
  • If the problem persists, contact your healthcare team.

One and/or the other of these symptoms: Fatigue; Muscle weakness; Decreased energy; Increased sleep

Possible cause(s)

  • Anemia
  • Hypotension (low blood pressure)
  • Dehydration
  • Inadequate nutrition (eg, lack of protein)
  • Lack of physical activity

What to do?

  • Make sure your child is eating and hydrating well, as recommended by your healthcare team.
  • Increase physical activity.
  • Be sure to follow the prescription for oral and subcutaneous medications.
  • If the problem persists, inform your healthcare team at your next visit.

Shoulder pain

Possible cause(s)

  • Irritation of the diaphragm caused by air in the peritoneal cavity

What to do?

  • Not dangerous but uncomfortable.
  • If it is only a small amount of air, it will be quickly absorbed by your child’s body.
  • If you see a lot of air in the patient line, drain the peritoneal cavity, as taught by your healthcare team.
  • Lay your child on his or her back.
  • Put pillows under his or her hips to support them.
  • If the pain persists, contact your healthcare team quickly.

Itching

Possible cause(s)

  • Dry skin
  • Electrolyte imbalance (eg, high phosphorus level)

What to do?

  • Apply a moisturizing cream or lotion to your child’s skin as recommended by your healthcare team.
  • Wash your child with a soap for dry or sensitive skin.
  • Use an unscented laundry soap formulated for sensitive skin.
  • Contact your healthcare team for other recommendations, depending on your child’s condition.

Diarrhea

Possible cause(s)

  • Viral infection
  • Peritonitis (infection of the peritoneum)
  • Too many laxatives

What to do?

  • Contact your healthcare team quickly.

While waiting to reach your healthcare team:

  • Increase fluid intake (small amounts given often) and salty foods, if recommended by your healthcare team.
  • Note the frequency and consistency of bowel movements and whether blood is present.
  • Take your child’s blood pressure and pulse and weigh your child.

Restless legs (need to move the legs at night or while lying down)

Possible cause(s)

  • Excessive or insufficient dialysis sessions
  • Lack of physical activity

What to do?

  • Contact your healthcare team.
  • Increase your child’s physical activity.

For specific advice on your child or any other questions, do not hesitate to contact your child’s healthcare team.


Everyday tips

Clothing

  • Cover the catheter with clothing.
  • Do not put the catheter in the diaper.
  • Do not attach the tip of the catheter near the gastrostomy or jejunostomy (if present) as there is a risk of contamination if there is discharge from the stoma.

Bathing and swimming

Bathing at the sink (or sponge bath):

  • Allowed at all times.
  • It is important to protect the dressing from splashing.

Shower:

  • Before the catheter site is healed (up to 6 weeks after catheter insertion) AND your healthcare team has given permission OR at any time if the skin is not intact (red, broken, etc.): no showering allowed, unless otherwise directed by your healthcare team.
  • When the site is well healed (approximately 6 weeks or more after catheter insertion) AND your healthcare team has given authorization: showering allowed once a day OR a minimum of three times a week with the catheter dressing covered with a second waterproof protective dressing (eg, transparent adhesive film such as Opsite® or Tegaderm®) OR with the catheter site exposed to the air.
  • Change the dressing when you get out of the shower.

Bathing in the tub:

  • AVOID except for infants only when the site is well healed (approximately 6 weeks or more after catheter insertion) AND your healthcare team has given permission: bathing then allowed daily OR minimum three times a week with the catheter dressing covered with a second waterproof protective dressing (eg, transparent adhesive film such as Opsite® or Tegaderm®).
  • The water level in the bathtub should NEVER touch the dressing; it is important to protect it from splashing.
  • When the bath is over, change the dressing.
  • If the catheter dressing below the protective dressing gets wet during the bath, change it immediately.

Swimming:

  • Follow your healthcare team’s instructions for swimming; they may be different depending on the child’s condition.
  • Your child can swim in a private pool or in salt water (sea, ocean).
  • It is not recommended that your child swim in a public pool, lake or river because there is a risk of infection at the catheter site and the possibility of peritonitis (infection inside the abdomen).
  • Wrap the catheter with a 4″ by 4″ sterile compress and cover the catheter dressing with a second protective waterproof dressing (eg, Opsite® or Tegaderm® type clear adhesive film).
  • Your child cannot swim if the skin around the catheter insertion site is not intact (is red, broken, etc.).
  • After swimming, change the dressing.

Sleeping

  • Maintain a regular sleep routine, appropriate to the age of your child.

Nutrition and hydration

  • Refer to your healthcare team’s recommendations for your child’s diet. Adequate nutrition is essential to maintain your child’s health.
  • Your child’s diet may require modification depending on kidney function, medications changes or other changes in your child’s health.
  • Follow your healthcare team’s recommendations for food and/or fluid restriction (eg, foods with high fluid content, high salt, potassium and phosphorus).
  • Discuss your child’s expected urination and stooling frequency (bowel movements) with your healthcare team.
  • Kidney disease can make it hard for the kidneys to properly balance fluids in the body. Your healthcare team will help you learn how to evaluate your child’s hydration (fluid balance) and to identify if your child has: tow much fluid in the body (fluid overload), too little fluid (dehydration) or the right amount (in balance). Follow your healthcare team’s recommendation to assess hydration by:
    • knowing your child’s dry weight,
    • weighing your child at the agreed upon frequency,
    • taking your child’s blood pressure and hearth rate as requested,
    • monitoring for specifics signs of fluid overload or dehydration,
    • checking how your child is feeling in general.

Activities

  • It is important that your child returns to his or her regular activities as soon as possible.
  • Healing of the catheter insertion site takes several weeks (approximately 6 to 12). Some activities are not allowed during this time (eg, strenuous activity). Follow the recommendations of your healthcare team.
  • When the site has healed and the care team allows it, your child should continue to avoid:
    • contact sports that may cause the catheter to move accidentally,
    • handling weights,
    • gymnastics,
    • parachute jumping and bungee jumping,
    • use of scissors near the catheter,
    • contact of pets with the equipment and the cycler;
    • swimming in a public pool, lake or river.
  • Your child may return to school if he or she is well enough to do so. Notify school staff of your child’s treatment and care if necessary. Discuss your child’s return to school with your healthcare team.

Travel and transportation

  • If your child requires treatment while away from home, always bring with you the necessary equipment for dialysis sessions and medication administration, including a “recovery kit” in case of complications (eg, accidental disconnection of the catheter extension). This equipment minimally contains:
    • dialysate bags,
    • the medications,
    • a cycler set with cassette,
    • drainage bags,
    • MiniCap disconnection caps,
    • a specimen bag in case of emergency,
    • the cycler in a carrying case, if necessary,
    • 4% chlorhexidine soap solution for hands,
    • alcohol-based antiseptic hand gel (eg, Stérigel®),
    • alcohol swabs or disinfectant wipes (eg, Sani-Cloth®Plus),
    • masks,
    • syringes and needles, if necessary,
    • disinfectant swabs (2% chlorhexidine and 70% alcohol or 70% alcohol only, as directed by your healthcare team),
    • dialysis clamp,
    • sterile compresses,
    • materials for changing the dressing,
    • adhesive tape,
    • table to perform dialysis (optional).
  • Always have an up-to-date list of materials and equipment needed for travel so that you can replace missing items, if necessary.
  • Have a resource list available with the names and phone numbers of the hospital, your doctor, other members of your healthcare team and your equipment and materials suppliers. Also know how to reach them after hours and during vacations.
  • Before you leave on your trip:
    • contact your healthcare team to plan ahead for equipment needs during the trip;
    • check to see if the appropriate voltage for the cycler is available at your destination, if necessary;
    • always check with your insurance company to see if out-of-country health care needs are covered;
    • make sure you have a document from your healthcare team describing your child’s medical condition and peritoneal dialysis needs, as well as a list of your child’s medications;
    • have the specifics of your child’s cycler and equipment available;
    • in collaboration with your healthcare team, find out what resources may be required during the trip or at the destination, if you run out of equipment, if there is an equipment breakdown or a special health need;
    • plan what to do in case of an emergency.
  • For travel by airplane:
    • discuss with your healthcare team the need to move the cycler or the possibility of having one at your destination;
    • discuss with the airline what equipment is allowed in the cargo hold and in the cabin of the plane;
    • keep medications and documentation from your healthcare team with you in the cabin.

Others

Monitoring the catheter site:

  • It is important to keep the catheter securely in place with minimal movement to avoid injury around the insertion site and to prevent infection.
  • Thoroughly clean the catheter insertion site as recommended by your healthcare team.
  • Check the skin around the catheter site carefully. Detecting a problem as soon as it occurs can prevent the need to change the catheter. Notify your healthcare team immediately if you notice any of these symptoms: redness, swelling, discharge and/or pain.

Monitoring weight:

  • Dry weight (or ideal “healthy weight” for the child) is the weight on the scale when your child has the right amount of water in his or her body, has normal blood pressure, no swelling, no difficulty breathing and is feeling well. Your healthcare team will help you determine your child’s dry weight at each appointment.
  • Weigh your child at the same time each day, morning and night. If he or she is receiving treatment by cycler, weigh your child each night before treatment and each morning after treatment, with comparable clothing.
  • Use a scale, specific to the nearest 0.2 kg if possible (more accurate). Record these measurements in a logbook and compare them with your child’s dry weight.
  • Rapid weight gain or loss can mean that your child has too much or too little fluid in his or her body. The healthcare team will use the results of the logbook to adjust treatment as needed. Contact your healthcare team if there is a change in weight between appointments.
  • Follow your healthcare team’s instructions if your child’s weight changes. They may recommend using more or less concentrated glucose solutions, adjusting hydration or salt intake.
  • If recommended by your your child’s healthcare team, use dialysis solutions based on a weight scale developed for your child.

Blood pressure monitoring:

  • Take your child’s blood pressure and pulse rate as instructed by your healthcare team: after the dialysis session in the morning upon waking up, three minutes afterwards in a sitting position (unless your child is an infant) and at night before the session.
  • Use the machine recommended by your healthcare team. If you are unsure of the results and if you have been taught, take a manual blood pressure. An increase in blood pressure may mean that your child has fluid overload. A decrease in blood pressure may mean that your child is dehydrated. In these circumstances, contact your healthcare team.
  • Take the blood pressure at the same time you take the weight.

Ultrafiltration:

  • Note the ultrafiltration result on the cycler screen in the register in the morning, at the end of each treatment.

Storage of dialysate bags:

  • The dialysate bag, when removed from its packaging and mixed, should be used within 24 hours. Discard any unused solution after the dialysis session.
  • Store boxes of dialysate bags anywhere in the house, in the same clean location, at a temperature between 15⁰C and 25⁰C; do not store them in an unheated area (eg, garage). Rotate; use the old ones before the new ones.

Storage of equipment:

  • Keep materials in a desk, drawers, or cabinet free of dust and dirt.

Frequency of equipment replacement: Follow your healthcare team’s recommendations on how often to change the equipment used. Here are some general recommendations:

  • Dialysate bag: discard after use;
  • Cycler set with cassette, drainage bag and specimen bag: discard after use;
  • Extension: replaced by your healthcare team every six months or more often if needed (eg, contamination, peritonitis);
  • MiniCap disconnect cap: put a new one on every morning after treatment;
  • Syringes and needles: discard after use.

Cycler care: Clean the outside of the cycler as needed with a disinfectant wipe (eg, Sani-Cloth® Plus) or a damp cloth. Do not use aerosol sprays.

Waste Management: Most waste generated in the home can be safely disposed of with the regular garbage.

  • Empty any fluid remaining in the tubing and dialysis bags into the sink, toilet or bathtub drain.
  • Empty the contents of the drainage bags into the toilet.
  • Unscrew the capped needles from the syringes. Dispose of syringe needles in a sharps container. Refer to your healthcare team for instructions on how to dispose of the container when full.
  • Place all non-recyclable materials (eg, dialysate bags, tubing, other waste) in a waste bag and seal it tightly before putting it in the trash.
  • The dialysate boxes can be recycled.

Medications:

  • All medications should be given to your child as directed by your healthcare team. This is especially important since his or her kidneys are no longer functioning properly.
  • Different medications may be recommended for your child:
    • phosphorus binder: prevents phosphorus from building up in the blood. Usually, healthy kidneys remove excess phosphorus in the urine. When the kidneys are not working well, phosphorus builds up in the blood. High levels of phosphorus in the blood can lead to a decrease in calcium, which can cause brittle and weak bones. Phosphorus binders bind (“stick to”) the phosphorus in food so that it is eliminated in the stool.
    • erythropoietin: helps make red blood cells. Healthy kidneys make this hormone that stimulates the bone marrow to make red blood cells. When the kidneys don’t work properly, your child doesn’t have enough red blood cells and can become anemic, which causes fatigue and lack of energy.
    • other medications: vitamin D, calcitriol (active vitamin D), laxative, iron, heparin, antihypertensive, etc.
  • Your healthcare team will recommend the type and dose of medication your child needs.
  • Some medications may be added to the dialysate bags.
  • Be sure to follow the medication schedule.
  • Never give your child over-the-counter medications without discussing first with your healthcare team.

Emergency situations:

  • Make sure you always have a MiniCap disconnect cap, dialysis catheter clamp available in case of accidental disconnection of the catheter extension.
  • Always have a phone on hand to respond to an emergency. Make sure your cell phone is charged at all times.
  • If the power goes out for more than two hours, contact your healthcare team to discuss alternative scenarios to the usual treatment.
  • Have a copy of your child’s medication list available and keep extra supplies on hand.
  • Make sure you have dialysis supplies (eg, dialysate bags, all equipment for the cycler) for at least seven days of treatment.
  • Have a resource list available with the names and phone numbers of the hospital, your doctor, other members of your healthcare team, and your equipment and materials suppliers. Also know how to reach these resources after hours and during vacations.
  • In any other emergency situation, contact your healthcare team.

Infection prevention:

  • A healthy child has a better resistance to infections. Healthy lifestyle habits (eg, good nutrition, physical activity, rest, etc.) help your child fight infections.
  • A child on peritoneal dialysis must take great care because kidney disease reduces the child’s resistance to infection.
  • The presence of a catheter in the belly can allow bacteria to enter the abdomen and cause infections, like peritonitis. It is important to keep the catheter insertion site clean and dry.
  • You can minimize infections by following aseptic measures which decrease the number of microbes (bacteria) on surfaces. These measures are:
    • Cleanliness: Personal hygiene and environmental cleanliness are the first ways you can reduce microbes (eg, wearing clean clothes, washing your hands with soapy water for at least 20 seconds, cleaning the work table, keeping the dialysis room clean, etc.). Many microbes are eliminated by cleanliness, but not all.
    • Disinfection: This action removes even more microbes. Before each dialysis treatment, you should disinfect work surfaces (eg, clean the top of the work table with an alcohol solution or a disinfectant wipe and wash your hands).
    • Sterilization: This action kills all microbes. Some items or solutions used in dialysis are packaged to ensure sterility. You do not have to sterilize anything, but you must remember that some parts of the equipment must remain sterile after you remove them from the package. You cannot touch them with your fingers, even if they are disinfected, because you will contaminate them. For example, never touch the sterile end of the catheter extension with your fingers or anything that comes in contact with the dialysis solutions (eg, syringe needle for injecting medication).
  • Specific routines, related to these aseptic measures, must be performed before each care, to minimize the risk of infection in your child. These are basic procedures to be performed, as taught by your healthcare team:
    1. Wash your hands with soapy water for at least 20 seconds.
    2. Dry your hands well with a clean paper or towel.
    3. Close the tap with the paper or towel.
    4. Close doors and windows or the ventilation system during treatment to avoid drafts.
    5. Wash your work surfaces with alcohol or a disinfectant wipe (eg, Sani-Cloth® Plus).
    6. Let the table dry.
    7. Gather and inspect materials.
    8. Put on a mask.
    9. Remove jewelry.
    10. Wash your hands with a 4% chlorhexidine soap solution for 2 minutes.
    11. Dry your hands well with a clean paper or towel.
    12. Close the tap with the paper or towel.
  • Do not touch anything after washing your hands with the chlorhexidine soap solution, except for the care equipment. If you touch something by mistake other than the dialysis equipment, apply an alcohol-based antiseptic gel (eg, Stérigel®) to the entire surface of your hands and rub until your hands are dry (20 to 30 seconds).
  • If you think you have contaminated a sterile part, don’t take a chance. Most of the equipment you use is disposable. Throw away any item that is or may have been contaminated and start over. It is safer for your child and cheaper to throw away equipment than to treat an infection.
  • If the catheter is broken or if there is contamination of the extension, contact your healthcare team immediately.
  • Keep all dialysis equipment in a clean place.
  • Do not provide care near an air conditioner and stay away from drafts.
  • Do not allow pets in the room during treatment.
  • Clean the catheter insertion site daily or at least three times a week to prevent infection.
  • Your child will need to take antibiotics before certain procedures (eg, dental work, cystoscopy, colonoscopy, etc.). These procedures can cause bleeding and give bacteria access to the bloodstream. Bacteria can contaminate the catheter and cause an infection. Notify your healthcare team of any dental appointments or invasive tests or exams.
  • Protect the venous access of your child’s non-dominant arm; this will facilitate hemodialysis treatments should he or she ever need them.

Daycare and school:

  • Your child’s healthcare team will evaluate your child’s needs and will support you in the planning of integration to daycare or to school.
  • Advise school staff of the treatment and care that your child requires.

 

Additional information and tips can be found on the following sites:

http://kidney.ca (Kidney Foundation of Canada)

https://www.agir.ca (Association générale des insuffisants rénaux): in French only


Methods of care

Methods of care : Care of the catheter insertion site

Indications

Considerations:

Frequency

Required materials

If sterile method:

Refer to your healthcare team if the materials used or the sequence of steps taught is different from what is described in the method of care.

Depending on your child’s age and condition, always encourage your child’s autonomy in carrying out the method of care.

Sterile method


Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: 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.

Step 4: Prepare the materials

  • Make sure the necessary materials are on the well-cleaned work surface.
  • Open the dressing tray in a sterile manner.

  • Open the packets of swabsticks and place the swabsticks in one of the compartments of the tray without touching the ends of the swabsticks.

  • Open the sterile compresses package and drop it into the tray without touching it.
  • If you know there is crusted skin (scabs) around the site: Open the bottle or remove the cap on the saline syringe and pour the solution into a compartment in the tray.

Why ?

This step allows you to have all the materials safely at hand for the rest of the procedure.

Step 5: Disinfect your hands

  • Wash your hands again with the alcohol-based antiseptic gel.
  • Apply a generous amount to cover the entire surface of your hands.
  • Rub until your hands are dry (20-30 seconds).
Why ?

This hand disinfection prevents contamination for the rest of the procedure.

Step 6: Remove the dressing

  • Gently remove the dressing
  • Be careful not to pull on the catheter or irritate the skin.
  • If you see scabs around the site and have not already done so: Open the bottle or remove the cap on the saline syringe and pour the solution into a compartment in the tray.
Why ?

This step allows a good view of the skin around the catheter insertion site.

Step 7: Check the catheter insertion site

  • The catheter insertion site should not change in appearance.
  • Check the site for redness, warmth, swelling, tenderness, or discharge.
  • If so, take a small specimen from the catheter insertion site with the swabstick, as instructed by your healthcare team; take a picture as well if possible.
Why ?

This step allows detection of any skin irritation or infection and allows for the analysis of the specimen if necessary.

Step 8: Check the catheter tunnel

  • Check the skin along the tunnel path for redness, swelling, tenderness or hardness.
Why ?

This step allows detection of possible irritation or infection of the catheter tunnel.

Step 9: Soften scabs, if present

  • Put on sterile gloves.
  • Soak a compress with saline solution.
  • Soften the scabs by applying the wet compress.
  • Do not pull on the scabs to avoid breaking the skin.
Why ?

This step facilitates the removal of scabs to promote healing of the site.

Step 10: Clean the catheter insertion site

  • With one hand, stabilize the catheter by holding it with a sterile compress.
  • With the other hand, use a first swabstick to clean the skin surrounding the catheter insertion site.

  • Unless otherwise instructed by your healthcare team, move back and forth repeatedly for at least 30 seconds as shown in the illustration.
  • Apply gentle pressure to the skin as you move the swabstick.
  • Make sure the skin is clean when finished this step.
Why ?

Stabilizing the catheter while cleaning the site prevents it from moving and irritating the skin and also prevents accidental dislodgement of the catheter.

This cleaning reduces the amount of microbes on the skin around the catheter insertion site and prevents infections.

Applying light pressure on the skin allows the swabstick solution to penetrate and clean the skin well.

Step 11: Clean the catheter

  • Continue to stabilize the catheter with one hand.
  • With the other hand, use a second swabstick to clean under the catheter, starting near the insertion site and moving away from it.
  • Use the third swabstick to clean over the catheter in the same manner.
  1. Do not clean the catheter using a back and forth motion; only move the swabstick once, starting near the insertion site and moving away from it.
Why ?

Stabilizing the catheter while cleaning the site prevents it from moving and irritating the skin and also prevents accidental dislodgement of the catheter.

This step helps prevent infections by reducing the number of microbes on the catheter that could contaminate the catheter insertion site.

Step 12: Dry the catheter insertion site

  • Allow the site to air dry completely for two minutes.
Why ?

This step prevents the skin from remaining wet under the dressing, which can cause irritation or infection.

Step 13: Protect the skin around the catheter insertion site

  • Make sure the catheter is in a straight line with the insertion site.
  • Fold a dry compress in half.
  • Place it under the catheter.

  • Then cover the catheter insertion site with another compress.
  • If desired, apply the skin protector to the skin, which will be covered by a adhesive dressing.
Why ?

Proper catheter alignment and protection prevents injury to the insertion site.

Step 14: Place the dressing over the catheter insertion site

  • Remove the clear film from the adhesive dressing.
  • Apply the dressing to the catheter site as instructed by your healthcare team.
  • Make sure the dressing covers the catheter for at least 2.5 cm.
Why ?

The placement of this dressing immobilizes and protects the catheter and prevents it from moving.

The catheter is more stable if the dressing covers it for at least 2.5 cm.

Step 15: Secure and immobilize the catheter

  • Secure and immobilize the catheter on the abdomen with the device or tape recommended by your healthcare team.
  • Do not put the device or tape over the connections.
  • If necessary, apply a mesh bandage over the dressing.
  • Fold the catheter under the mesh or sweater as needed.
Why ?

A properly immobilized catheter keeps the insertion site healthy.

This step prevents the catheter from moving and irritating the insertion site.

The mesh bandage keeps the dressing in place.

Step 16: Recovery

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.

Non-sterile method


Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: 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.

Step 4: Prepare the materials

  • Make sure the necessary materials are on the well-cleaned work surface.
  • Open the packets of swabsticks and leave the swabsticks in the packets.
  • Open the sterile compresses package and leave the compresses in the opened package.
  • If you know there is crusted skin (scabs) around the site: Open the bottle or remove the cap on the saline syringe and pour some solution on the compress.
Why ?

This step allows you to have all the materials safely at hand for the rest of the procedure.

Step 5: Disinfect your hands

  • Wash your hands again with the alcohol-based antiseptic gel.
  • Apply a generous amount to cover the entire surface of your hands.
  • Rub until your hands are dry (20-30 seconds).
Why ?

This hand disinfection prevents contamination for the rest of the procedure.

Step 6: Remove the dressing

  • Gentle remove the dressing
  • Be careful not to pull on the catheter or irritate the skin.
  • If you see scabs around the site and have not already done so: Open the bottle or remove the cap on the saline syringe and pour some solution on the compresses.
Why ?

This step allows a good view of the skin around the catheter insertion site.

Step 7: Check the catheter insertion site

  • The catheter insertion site should not change in appearance.
  • Check the site for redness, warmth, swelling, tenderness, or discharge.
  • If so, take a small specimen from the catheter insertion site with the swabstick, as instructed by your healthcare team; take a picture as well if possible.
Why ?

This step allows detection of any skin irritation or infection and to allows for the analysis of the specimen if necessary.

Step 8: Check the catheter tunnel

  • Check the skin along the tunnel path for redness, swelling, tenderness or hardness.
Why ?

This step allows detection of possible irritation or infection of the tissue where the catheter lies.

Step 9: Soften scabs, if present

  • Soak a compress with saline solution.
  • Soften the scabs by applying the wet compress.
  • Do not pull on the scabs to avoid breaking the skin.
Why ?

This step facilitates the removal of scabs to promote healing of the site.

Step 10: Clean the catheter insertion site

  • With one hand, stabilize the catheter by holding it with a sterile compress.
  • With the other hand, use a first swabstick to clean the skin surrounding the catheter insertion site.

  • Unless otherwise instructed by your healthcare team, move back and forth repeatedly for at least 30 seconds as shown in the illustration.
  • Apply gentle pressure to the skin as you move the swabstick.
  • Make sure the skin is clean when finished this step.
Why ?

Stabilizing the catheter while cleaning the site prevents it from moving and irritating the skin and also prevents accidental dislodgement of the catheter.

This cleaning reduces the amount of microbes on the skin around the catheter insertion site and prevents infections.

Applying light pressure on the skin allows the swabstick solution to penetrate and clean the skin well.

Step 11: Clean the catheter

  • Continue to stabilize the catheter with one hand.
  • With the other hand, use a second swabstick to clean under the catheter, starting near the insertion site and moving away from it.
  • Use the third swabstick to clean over the catheter in the same manner.
  • Do not clean the catheter using a back and forth motion; only move the swabstick once, starting near the insertion site and moving away from it.
Why ?

Stabilizing the catheter while cleaning the site prevents it from moving and irritating the skin and also prevents accidental dislodgement of the catheter.

This step helps prevent infections by reducing the number of microbes on the catheter that could contaminate the catheter insertion site.

Step 12: Dry the catheter insertion site

  • Allow the site to air dry completely for two minutes.
Why ?

This step prevents the skin from remaining wet under the dressing, which can cause irritation or infection.

Step 13: Protect the skin around the catheter insertion site

If you are applying a Tegaderm advanced® adhesive dressing as agreed with your healthcare team, go directly to step 15.

  • Make sure the catheter is in a straight line with the insertion site.
  • Fold a dry compress in half.
  • Place it under the catheter.

  • Then cover the catheter insertion site with another compress.
  • If desired, apply the skin protector to the skin, which will be covered by an adhesive dressing.
Why ?

Proper catheter alignment and protection prevents injury to the insertion site.

Step 14: Place the dressing over the catheter insertion site

  • Remove the clear film from the adhesive dressing.
  • Apply the dressing to the catheter site as instructed by your healthcare team.
  • Make sure the dressing covers the catheter for at least 2,5 cm.
  • Go to step 16.
Why ?

The installation of this dressing immobilizes and protects the catheter and prevents it from moving.

The catheter is more stable if the dressing covers it for at least 2.5 cm.

Step 15: Apply a Tegaderm advanced® dressing to the catheter insertion site

  • Ensure that the catheter is is in a straight line with the insertion site.
  • Peel back the dressing liner to expose the adhesive surface of the adhesive dressing.

  • Place the transparent film so that the catheter insertion site is placed in the center of the dressing (Part 1).

  • Remove the remaining protective paper and attach the catheter by crossing the white wings under it.
  • Apply light pressure with your fingers all around the bandage so that it sticks to the skin without creating an opening.
  • Remove the remaining protective paper from around the bandage.
  • Take the strip with the U-shaped opening (Part 2) and stick it under the catheter so that it covers the cross of the wings with the slit facing up.
  • Take the strip (Part 3) and stick it over the catheter at the U-slot to avoid gaps; make sure to secure the strip.

Why ?

The installation of this dressing immobilizes and protects the catheter and prevents it from moving.

Step 16: Secure and immobilize the catheter

  • Secure and immobilize the catheter on the abdomen with the device or tape recommended by your healthcare team.
  • Do not put the device or tape over the connections.
  • If necessary, apply a mesh bandage over the dressing.
  • Fold the catheter under the mesh or sweater as needed.
Why ?

A properly immobilized catheter keeps the insertion site healthy.

This step prevents the catheter from moving and irritating the insertion site.

The mesh bandage keeps the dressing in place.

Step 17: Recovery

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.

Methods of care : Assembly of the cycler

Indications

Considerations:

Frequency

Before each automated peritoneal dialysis session, according to the treatment frequency agreed upon with your heathcare team.

Required materials

If needed:

Refer to your healthcare team if the materials used or the sequence of steps taught is different from what is described in the method of care.

Depending on your child’s age and condition, always encourage your child’s autonomy in carrying out the method of care.

The steps described in the method of care refer to the use of the Homechoice Pro™ cycler and compatible equipment.


Step 1: Anticipation

  • 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.
  • Announce the care and talk about it together.

Step 2: Preparation

  • Prepare the environment: Identify a place to perform the treatment.
  • 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 two work surfaces (eg, table) with alcohol or a disinfectant wipe (eg, Sani-Cloth® Plus).
  • Let the tables dry.
  • Gather and inspect materials: put materials on a work surface; pay particular attention to bags (correct names, correct concentrations, correct volumes, expiration dates not exceeded) and medications (correct names, correct concentrations, correct doses, expiration dates).
  • Put on a mask.
  • Remove jewelry.
  • Wash your hands with a 4% chlorhexidine 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.

Step 3: 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.

Step 4: Turn on the cycler

  • Press the ON/OFF button on the back of the unit.

  • The message “Press Go to start” appears on the screen.
Why ?

This step opens the cycler and resets the internal functions.

Step 5: Check the dialysate bags

  • Remove all bags from their packaging.
  • Place them on the second well-cleaned work surface.
  • Place the 5L Physioneal bags so that the injection ports are on top and the connectors are pointing up.
  • Each bag should be in good condition, clean and dry.
  • Make sure that:
    • the solution in the bag or each bag chamber is clear (not discolored or cloudy and without small particles),
    • there are no leaks when you lightly squeeze the bag or the large bag chamber,
    • the seals are intact, if any,
    • the pull ring is in place,
    • the fins are in the correct position, if any,
    • the injection port protective cap is in place.

Why ?

This step ensures that the bags are in good condition for the safety of the rest of the procedure.

Step 6: Add medication to the bags, if necessary

Proceed to the next step if you do not have any medication to add.

Refer to the method of care Addition of medication to the dialysate.

Why ?

It is necessary to add the medication to the bags before mixing the solution.

Step 7: Prepare dialysate bags

If you are using only Dianeal or Extraneal bags, go directly to step 11.

If you are using 5 liter bags of Physioneal, go to the next step. 

If you are using 2.5 liter bags of Physioneal:

  • Break the cannula between the two chambers of the 2.5 liter Physioneal bag.

  • Hang the bags on a hook or rolling pole to allow the dialysate to mix well.
  • Wait until the top solution is completely drained into the bottom chamber. It may take a few minutes to mix the solutions.
  • Be careful that the bag connector does not touch the roller pole.
  • Go to step 11.
Why ?

The break of the cannula between the two chambers of the 2.5 liter Physioneal bags allows the solutions to mix.

Step 8: Prepare the 5 liter Physioneal bags - Open the long seal

Go to step 11 if you are not using 5 liter Physioneal bags.

  • Hold each side of the large chamber firmly with your hands facing out.

  • Push the solution toward the center of the long seal.
  • Finish opening the long seal in either of these ways:
    • apply pressure to the large chamber from the corner, or
    • press down on the large chamber with both hands.

  • Make sure that the solution in the large chamber is completely emptied into the small chamber.
  • Gently mix the solution by pressing both hands against the walls of the large chamber.
Why ?

The opening of the long seal between the two chambers allows the mixing of the solutions.

Step 9: Prepare the 5 liter Physioneal bags - Open the short seal

  • Lift the large chamber by holding the bag firmly with both hands.

  • Roll the bag toward the connector.
  • Apply pressure by leaning over the bag.
  • This pushes the solution towards the short seal to open it.
Why ?

Breaking the short seal between the small chamber and the connector allows the solution to flow into the connector.

Step 10: Prepare the 5 liter Physioneal bags - Check the contour of the bag

  • Look carefully all around the bag for leaks.
  • Pay particular attention to the connector area.

Why ?

This check ensures that the bag is watertight after handling.

Step 11: Place the bag on the heater

  • Place the appropriate bag on the cycler heater as directed by your healthcare team.
  • If your child is receiving dialysate of the same concentration throughout the session: place one bag on the warmer.
  • If your child is receiving dialysate of more than one concentration and large volumes per cycle: place the bag with the highest concentration on the heater, as directed by your healthcare team.
  • If your child is receiving a mixture of dialysates of different concentrations and small volumes per cycle: place the empty bag on the heater. Make sure the bag clamp is securely closed.
Why ?

Placing the appropriate bag on the heater to start the treatment allows it to be warmed up beforehand.

The dialysate should be administered at the temperature determined in the cycler programming for your child’s comfort.

Step 12: Prepare the cycler set with cassette

  • Open the packages of the remaining materials.
  • Place the materials on the second well-cleaned work surface.
  • Close the six tubing clamps.
  • Close the clamps of the 5-prong manifold set, if used.
Why ?

This step secures the set with cassette and the rest of the materials, if used.

Step 13: Prepare the drainage bag and specimen bag (if needed)

  • Close both clamps on the drainage bag (the tubing and the drainage port clamp).
  • If recommended by your healthcare team, add another clamp on the drainage port tubing.
  • If you need the specimen bag, make sure the clamp on its tubing is closed.

Why ?

Closing the clamps prevents the flow of effluent through the tubing of these bags during treatment.

Step 14: Start the cycler

  • Start the cycler by pressing the green GO button on the front of the unit.

  • The message “Load the set” appears on the screen.
Why ?

This is the first step in setting up the cycler.

Step 15: Open the cycler door

  • Push the handle on the front of the cycler up; the door will open.
  • Never force the door open.
Why ?

Pulling the handle unlocks and opens the cycler door so that the cassette set can be installed.

Step 16: Install the cassette of the cycler set

  • Install the cassette in the only way possible: horizontally, with the lines pointing to the right of the unit.
  • Press the lower portion of the cassette in before pressing the upper portion.
  • Hold the specimen bag tubing in your hand as it is not attached to the organizer.
Why ?

The installation of the cassette in the cycler allows the dialysis treatment to be performed.

Step 17: Close the cycler door

  • Close the door and push the handle down.
  • Make sure the cassette tubing is not bent or compressed where it exits the device.
Why ?

This step locks the door and secures the cassette in the cycler.

Step 18: Install the organizer of the cycler set

  • Always hold the specimen bag tubing in your hand.
  • Install the organizer on the front of the door by attaching the top then the bottom sections.
  • Place the specimen bag tubing on the hook on the side of the cycler table.
Why ?

This step secures the organizer on the cycler.

Step 19: Disinfect your hands

  • Disinfect your hands with an antiseptic gel.
  • Apply a generous amount to cover the entire surface of your hands.
  • Rub until your hands are dry (20-30 seconds).
  • Now touch only the dialysis equipment.
Why ?

This hand disinfection prevents contamination for the rest of the procedure.

Step 20: Connect the specimen bag (if needed)

  • Remove the protective cap from the specimen line and the tubing from the specimen bag.
  • Connect the specimen line to the tubing of the specimen bag.

  • Hang the specimen bag on the hook on the side of the cart or place it on the table.
  • Leave the tubing clamp closed until the specimen bag is used.
Why ?

This step allows the bag to be connected securely.

Step 21: Connect the drainage bag

  • Remove the rightmost clampless line from the organizer (drain line) and remove its protective cap.
  • Remove the protective cap from the drainage bag tubing.
  • Connect the drain line to this tubing.

  • Open the drain line clamp.
  • Be careful not to touch the ends of the lines and connectors while connecting.
  • Place the drainage bag on the table at the back of the cycler or on another clean surface. Do not place the bag on the floor until all connections are complete.
Why ?

This step allows the bag to be connected securely.

Step 22: Prepare the connection of the bags

  • Press the green GO button on the front of the unit.

  • The message “Self testing” appears on the screen.

  • When the automatic test of the cycler is completed, “Connect bags” appears on the screen.
Why ?

This step allows you to perform the automatic test of the cycler before connecting the bags to check the correct operation of the cassette.

Step 23: Disinfect your hands

  • Disinfect your hands with an antiseptic gel.
  • Apply a generous amount to cover the entire surface of your hands.
  • Rub until your hands are dry (20-30 seconds).
  • Now touch only the dialysis equipment.
Why ?

This hand disinfection prevents contamination for the rest of the procedure.

Step 24: Connect the bag to the heater

  • Connect the bags to the other lines on the organizer, following the sequence from right to left.
  • Remove the line with the red clamp from the organizer (heater line) and remove its protective cap.

If the bag on the heater is a 5 liter Physioneal bag: go to the next step.

If the bag on the heater is empty:

  • Remove the protective cap from the empty bag tubing.
  • Connect the heater line to the empty bag tubing.
  • Open the clamp on the heater line and empty bag tubing.
  • Go to step 24.

If the bag on the heater is a Physioneal 2.5 liter or Dianeal bag:

  • Remove the pull ring from the bag.
  • Connect the heater line to the bag connector.
  • Open the clamp on the heater line.
  • Break off the cannula in the bag connector.
  • Go to step 24.

 

  • Be careful not to touch the ends of the line and the connector or tubing during connection.
  • Make sure the connector or tubing on the bag is secure.
Why ?

This step allows the bag to be connected securely and ensures that the dialysate can flow through the system.

Removing the pull ring allows the bag to be connected to the heater line.

Step 25: Connect the Physioneal 5 liter bag to the heater

If you are not using a 5 liter Physioneal bag, go to the next step.

  • Hold the connector with one hand and pull the pull ring with the other to remove it.

  • Connect the heater line to the bag connector by turning until you feel resistance.
  • Open the red clamp on the heater line.
  • Close the wings of the bag connector with one hand; you will hear a “click”.

  • Never put one hand on the connector and the other on the wings to close them.

  • Make sure the wings are tightly closed.

  • Be careful not to touch the ends of the line and connector while connecting.
  • Make sure the bag connector is secure.
Why ?

This step allows the bag to be connected securely and ensures that the dialysate can flow through the system.

Removing the pull ring allows the bag to be connected to the heater line.

Closing the bag wings advances the connector cannula to puncture the bag and allow solution to flow into the tubing for treatment.

Step 26: Connect the dialysate bags

The Extraneal bag must always be connected to the line with the blue clamp (see next step).

  • Remove the line with a white clamp from the rightmost organizer (bag line) and remove its protective protective cap.

  • Remove the pull ring from the bag.
  • Connect the bag line to the bag connector.
  • Open the bag line clamp.
  • For the 5 liter Physioneal bag: Close the bag connector wings with one hand.
  • For all other dialysate bags: Break the cannula in the bag connector.
  • Repeat with the other bag line with a white clamp to connect a second bag.
  • If you run out of lines, add the 5-prongs manifold set to this other bag line and connect the necessary bags.

 

  • Be careful not to touch the ends of the line and connector while connecting.
  • Make sure the bag connector is secure.
Why ?

This step allows the bag to be connected securely and ensures that the dialysate can flow through the system.

Removing the pull ring allows the bag to be connected to the bag line.
Closing the wings on the Physioneal 5 liter bag advances the connector cannula to puncture the bag and allow solution to flow into the tubing for treatment.

Step 27: Connect the last injection bag, if needed

If you are not using a different concentration of dialysate for the last injection, go to the next step.

The Extraneal bag must always be connected to the line with the blue clamp.

The tubing with the blue clamp can also be used to connect an additional dialysate bag if you use the same solutions for the entire dialysis session.

  • Remove the line with the blue clamp from the organizer (last fill line) and remove its protective cap.

  • Remove the pull ring from the bag.
  • Connect the last fill line to the bag connector.
  • Open the last fill line clamp.
  • For Physioneal 5 liter bag: Close the bag connector wings with one hand.
  • For all other dialysate bags: Break the cannula in the bag connector.

 

  • Be careful not to touch the ends of the line and connector while connecting.
  • Make sure the bag connector is secure.
Why ?

This step allows the bag to be connected securely and ensures that the dialysate can flow through the system.

Step 28: Check the connections

  • Make sure that only the clamps on lines connected to a dialysate bag are open and that the others are closed.
  • If recommended by your healthcare team, clamp the extension branches and unused bag lines with a dialysis clamp.
  • If a specimen bag is connected, make sure its tubing clamp and the specimen line clamp remain closed until the specimen is collected.
  • Check that the connections between tubing and bags are tight (not leaking).
Why ?

This step verifies that all connections are secure.

Step 29: Place the bags

  • Hang the bags on the side of the cycler or leave them on the work surface.
  • Place the drainage bag under the cycle table or on the floor on a pad.
Why ?

This step allows the bags to be placed in the most appropriate location during treatment and ensures that the dialysate flows well.

Step 30: Priming the lines

  • Put a compress left in its package on the end of the patient line, if recommended by your healthcare team.

  • Open the patient line clamp.
  • Press the green GO button on the front of the unit.
  • The message “Priming…” appears on the screen.
  • When the vacuum is complete (takes about 10 minutes), the message “Connect yourself” appears on the screen alternating with “Check patient line”.

  • Disinfect your hands with an antiseptic gel (eg, Stérigel®) and rub until your hands are dry (20-30 seconds).

  • Close the patient line clamp.
Why ?

The compress protects the end of the patient line.

The opening of the clamp allows the air to be removed from the lines (“priming” the lines).

Step 31: Check the dialysate level in the patient line

If the patient line is not primed properly (if there is still air in the patient line):

  • Make sure the patient line clamp is open properly.

  • Make sure the patient line is properly positioned on the set.
  • Press the STOP button on the front of the cycler.
  • Press the down arrow on the front of the cycler until “Reprime patient line” appears on the screen.
  • Press the ENTER button on the front of the cycler.
  • Press the ENTER button again. The cycler will ask you if you want to reprime the patient line.
  • Repeat this step until the line is primed.
  • Close the patient line clamp.
Why ?

This step allows to check if the air vacuum is well done in the patient line (if the line is well “primed”).

Step 32: Connect your child to the cycler, if desired

After assembling the cycler, connect the system to your child within four hours.

Why ?

Connecting the system to your child allows the peritoneal dialysis treatment to begin.

Step 33: Recovery

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.

Methods of care : Addition of medication to the dialysate

Indications

Considerations:

Frequency

During the preparation of dialysate bags, if necessary.

Required materials

If needed:

Refer to your healthcare team if the materials used or the sequence of steps taught is different from what is described in the method of care.

Depending on your child’s age and condition, always encourage your child’s autonomy in carrying out the method of care.


Step 1: Inspect the equipment

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.
Why ?

This step ensures security for the rest of the procedure.

Step 2: Disinfect your hands

  • 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.
Why ?

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

Step 3: Prepare the syringes

  • 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.
Why ?

This step safely prepares the syringes for use.

Step 4: Disinfect the septum of the vial

  • 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.
Why ?

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

Step 5: Dilute the powdered medication, if applicable

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.
Why ?

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.

Step 6: Remove the medication from the vial

  • 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.
Why ?

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

Step 7: Disinfect bag injection port

  • 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.
Why ?

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.

Step 8: Inject the medication into the bag

  • 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.
Why ?

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

Step 9: Continue assembling the cycler

Continue with the assembly of the cycler.

Why ?

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

Methods of care : Connection to the cycler

Indications

Considerations:

Frequency

Within a maximum of 4 hours after assembly of the cycler, depending on the frequency of automated peritoneal dialysis treatment agreed upon with your healthcare team.

Required materials

If needed:

Refer to your healthcare team if the materials used or the sequence of steps taught is different from what is described in the method of care.

Depending on your child’s age and condition, always encourage your child’s autonomy in carrying out the method of care.


Step 1: Anticipation

  • 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.

Step 2: Preparation

  • 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.

Step 3: 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.

Step 4: Check the closure of the catheter extension

  • Make sure that the cycler and cassette assembly is complete and that there is no air in the patient line.
  • 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.

Why ?

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

Step 5: Disinfect the junction of the extension with the MiniCap

  • Open the sterile compresses package.
  • Open the disinfectant pad package.
  • Take the white part of the extension with one hand.
  • With the other hand, wipe the outside of the extension at the MiniCap junction with the disinfectant pad for 15 seconds.
  • Let dry.
  • Do not remove the MiniCap to clean underneath (the dark blue end of the extension).
Why ?

Disinfection removes most bacteria from this area before making the connection to the patient line.

Step 6: Protect the extension

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

This step avoids contamination of the extension.

Step 7: Connect the patient line (with pediatric set)

If your child has an adult set, move on to the next step.

  • Remove the protective cap from the patient line without touching the end of the line.
  • Remove the MiniCap by unscrewing it without touching the dark blue end of the extension.

  • Insert the ends into each other and screw firmly.

  • Check that the connection between the extension and the patient line is secure.
  • Go to step 10.
Why ?

This step connects the patient line to the catheter extension to enable treatment.

Step 8: Connect the patient line (with adult set)

  • Open the connection shield package, if used.
  • Remove the protective cap from the patient line without touching the end of the line.
  • Remove the MiniCap by unscrewing it without touching the dark blue end of the extension.

  • Insert the ends into each other and screw firmly.

  • Check that the connection between the extension and the patient line is secure.
Why ?

This step connects the patient line to the catheter extension to enable treatment.

Step 9: Put on the connection shield (if adult set)

  • Install a connection shield around the connection, if recommended by your healthcare team.

Why ?

The connection shield protects the exposed part of the catheter extension.

Step 10: Open the catheter extension

  • With one hand, turn the white part of the catheter extension counterclockwise.
  • With the other hand, turn the light blue part clockwise.
  • The two half-moons are no longer interlocked.

Why ?

This step allows the automated peritoneal dialysis to start.

Step 11: Check the system

  • Open the patient line clamp.
  • Make sure that the clamps on all bags are open.
  • Check for kinked, bent, or jammed tubing.
  • If your child is in diapers or has a gastrostomy/jejunostomy, wrap a protective pad around the connection.
Why ?

These checks ensure the proper flow of solutions through the system.

Installing a protective pad around the connection protects it from leaks.

Step 12: Start the treatment

  • Press the green GO button on the front of the unit.
  • The message “Initial drain” with the programmed volume appears on the screen.
  • If the drainage volume displayed is correct, press the GO button again.
  • If the drainage volume displayed is incorrect, modify according to the recommendation of your healthcare team
  • The message “Initial drain” appears on the screen and the treatment begins.
Why ?

This step begins the automated peritoneal dialysis treatment with the initial drainage of your child’s peritoneal cavity.

Step 13: Recovery

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.

Methods of care : Disconnection of the cycler

Indications

Considerations:

Frequency

At the end of the automated peritoneal dialysis treatment.

Required materials

If needed:

Refer to your healthcare team if the materials used or the sequence of steps taught is different from what is described in the method of care.

Depending on your child’s age and condition, always encourage your child’s autonomy in carrying out the method of care.


Step 1: Anticipation

  • 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.

Step 2: Preparation

  • 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.

Step 3: 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.

Step 4: Check the closure of the catheter extension

  • 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.
Why ?

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

Step 5: Prepare the MiniCap

  • 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.
Why ?

This step prepares the MiniCap for use and avoid contamination.

Step 6: Disinfect your hands

  • 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.
Why ?

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

Step 7: Disinfect the junction of the extension with the patient line

  • 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.
Why ?

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.

Step 8: Protect the extension

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

This step avoids contamination of the extension.

Step 9: Disconnect the patient line

  • 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.
Why ?

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.

Step 10: Close the cycler

  • 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.
Why ?

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

This step completes the procedure.

Step 11: Recovery

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.
.Reviser : NR .Version : 1.0

Methods of care : Effluent specimen collection

Indications

Considerations:

Frequency

Required materials

Method by specimen bag:

Refer to your healthcare team if the materials used or the sequence of steps taught is different from what is described in the method of care.

Depending on your child’s age and condition, always encourage your child’s autonomy in carrying out the method of care.

Per specimen bag for cell count and culture


Step 1: Anticipation

  • You and your child are a team. Encourage autonomy by making realistic choices about what they can do to help you.

Step 2: Preparation

  • 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 work surface (eg, table) with alcohol or a disinfectant wipe (eg, Sani-Cloth®  Plus).
    • Let the table dry.
    • Gather and inspect the materials.
    • Put on a mask.
    • Remove jewelry.
    • Wash your hands with a 4% chlorhexidine ssoap 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.

Step 3: 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.

Step 4: Check the connection of the specimen bag

  • Make sure that the tubing of the specimen bag is connected to the specimen line.
  • If the specimen bag is not already installed:
    • Open the specimen bag packaging.
    • Disinfect your hands with an antiseptic gel and rub until your hands are dry. Now touch only the dialysis equipment.

    • If the cycler has been assembled for more than one hour, disinfect the outside of the specimen line protective cap with a disinfectant pad.
    • Remove the cap from the specimen line and specimen bag tubing.
    • Connect the specimen line to the specimen bag tubing.
  • Install the specimen bag on the hook on the side of the cart.
  • Check that the tubing clamp is securely closed.

Why ?

The specimen bag is used to collect the effluent required for analysis.

Step 5: Let some effluent drain into the drainage bag

  • On the last drainage, let some effluent drain into the drainage bag:
  • 20 ml if your child has a pediatric set,
  • 40 ml if your child has an adult set.
  • Press the STOP button on the front of the cycler.
  • The message “Stopped: Drain” appears on the screen.
  • Close the clamp on the open drainage bag tubing.
Why ?

This step avoids collecting dialysate that remains in the patient line rather than effluent from the abdomen.

Collection of specimen for “routine” cell count and culture is always done at the beginning of the last drainage of the peritoneal dialysis treatment, unless there is an emergency or your healthcare team indicates otherwise.

Step 6: Fill the specimen bag

  • Open the clamp on the specimen bag tubing and the clamp on the specimen line.
  • Press the GO button on the front of the cycler.
  • The message “Drain x from y” appears on the screen.
  • Allow effluent to flow into the specimen bag until it is full (approximately 100 ml).
  • Press the STOP button again.
  • The message “Stopped: Drain” appears on the screen.
  • Close the clamp on the specimen bag tubing and the clamp on the specimen line.
Why ?

This step allows the effluent to collect in the specimen bag.

Step 7: Complete the drainage

  • Open the tubing clamp on the drainage bag.
  • Press the GO button on the front of the cycler again.
  • The message “Drain x of y” appears on the screen.
  • Make sure that the drainage continues.
Why ?

This step completes rest of the drainage.

Step 8: Continue treatment, if indicated

  • If the specimen was collected “routinely”: complete the dialysis treatment.
  • If the specimen was collected on an emergency basis: follow the instructions of your healthcare team (to continue or not to continue the treatment).
Why ?

This step completes the dialysis treatment if the specimen is collected “routinely”.

If the collection is done in an emergency situation, your healthcare team will give the appropriate instructions, depending on your child’s condition (whether to continue treatment or not).

Step 9: Disconnect the specimen bag

Why ?

This step allows easy access to the collected specimen of effluent.

Step 10: Prepare the syringe

  • Without touching the tip of the syringe, screw the needle into it by turning clockwise, about ¼ turn.
  • Leave the protective cap in place on the needle.
Why ?

This step prepares the needle and syringe safely for the next step.

Step 11: Disinfect your hands

  • Disinfect your hands with an antiseptic gel.
  • Apply a generous amount to cover the entire surface of your hands.
  • Rub until your hands are dry (20-30 seconds).
  • Now touch only the dialysis equipment.
Why ?

This hand disinfection prevents contamination for the rest of the procedure.

Step 12: Disinfect the specimen bag port

  • Disinfect your hands with an antiseptic gel and rub until your hands are dry. Now touch only the dialysis equipment.
  • Scrub the specimen port vigorously with a disinfectant pad for 15 seconds.
  • Allow to dry completely.
  • Make sure nothing touches the specimen port to avoid contamination.
Why ?

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

Step 13: Collect the specimen in a syringe

  • Remove the protective cap from the syringe needle.
  • Insert the entire needle into the center of the injection port of the bag.
    Be careful of the angle of the needle so as not to puncture the bag.
  • Pull back the plunger and withdraw the required amount of effluent (60 ml).
Why ?

This step allows safe collection of the effluent specimen.

Step 14: Transfer the specimen to the containers

  • Remove the lids from the containers and place them upright on a clean surface.

  • Transfer the effluent to the containers, avoiding touching the rims, in the amount recommended by your healthcare team (10 ml for a cell count and 50 ml for a culture).
Why ?

Transferring the specimen to a sterile container prevents contamination before analysis.

Step 15: Close the containers

  • Put the lids back on the containers.
  • Make sure the lids are tightly screwed on.
Why ?

This step ensures that the containers are sealed and secure.

Step 16: Dispose of the material

  • Dispose of the remaining effluent in the toilet.
  • Dispose of the syringe with its needle in the sharps container.
Why ?

Effluent is a waste product that must be disposed of in a sanitary manner.

Needles must be disposed of safely.

Step 17: Identify the container

  • Label the 10 ml container that the specimen collected is for cell counting. The container can be stored at room temperature.
  • Label the 50 ml container that the specimen collected is for culture. The container should be kept cold (in the refrigerator or on an ice pack) if transport to the laboratory is not immediate.
Why ?

This step ensures that the correct volumes are saved for each type of analysis.

Step 18: Recovery

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.

Per drainage bag for creatinine clearance


Step 1: Anticipation

  • You and your child are a team. Encourage autonomy by making realistic choices about what they can do to help you.

Step 2: Preparation

  • Prepare the environment: Identify a place to perform the treatment.
  • Prepare your child:
    • Get help if needed.
    • Make sure your child is properly positioned to perform the treatment.
  • Prepare yourself: Choose a time when you are ready to do the treatment. Review the method.

Step 3: 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.

Step 4: Check the disconnection of the cycler

  • Make sure your child is disconnected from the cycler (that the patient line is disconnected from the catheter extension).
Why ?

“Routine” creatinine clearance specimen collection is always performed at the end of peritoneal dialysis treatment.

Step 5: Prepare the container

  • Remove the lid from the container and place it face up on a clean surface.
Why ?

The specimen will be poured into a clean container for analysis.

Step 6: Prepare the drainage bag

  • Shake the drainage bag.
  • Remove the protective cap from the end of the drainage port.
Why ?

Shaking the bag distributes the content of the effluent so that the specimen will be accurate.

Step 7: Collect the specimen

  • Open the drainage port clamp(s).

  • Allow the amount of effluent recommended by your healthcare team to drain (minimum 50 ml). Try to fill the container.
  • Close the drain port clamp(s).
  • Replace the protective cap on the end of the drainage port.
Why ?

Once the specimen is collected, it is ready to be analyzed.

Step 8: Close the container

  • Put the lid back on the container.
  • Make sure the lid is screwed on tightly.
Why ?

This step seals the container and secure the specimen.

Step 9: Recovery

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.
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