Peritoneal Dialysis Procedure

There are three phases in one cycle of peritoneal dialysis (PD), they are: Fill, Dwell, Drain.
During each exchange the first phase is draining from the previous cycle and then filling to
begin the next cycle.

Gather Supplies:

 Bedside table
 2 surgical masks
 2 sterile towels*
 1 small sterile bowl*
 1 sterile forceps*
 2 sterile cotton swabs*
 4 squares sterile gauze*
 1 sterile 4x4 gauze*
 Lactated Ringer (LR) – ordered amount*
 D50W – ordered amount*
 1 large syringe with needle
 may be reused for 24h if sterility is maintained
 Infusion Set*
 urinary catheter bag*
 container with a lid containing 90% alcohol (change weekly)
 3 way stopcock (in open-all-ways position in 90% alcohol)
 use one NEW stopcock for each patient
 4-5cm section of suction tubing (in 90% alcohol)
 use NEW piece for each patient
 2 pairs of sterile gloves*
 non-sterile kidney basin or bowl for discarded fluid
 bucket for drained dialysate

* indicates items that are NOT reused, they are NEW with every exchange

Amy Neufeldt, RN, BscN, William J. Lawton, MD. July 2015 Mbingo Baptist Hospital
Action Rationale
1. Warm fluid and explain procedure to Part of compassionate patient-centered care
patient. is involving them in nursing actions.
2. Place surgical mask on patient and self, Infection through the PD catheter is one of the
draw curtains, and ask any caregivers to greatest risks, so minimizing possible sources
leave until exchange is finished. of infection is vital.
3. Wipe bedside table with alcohol. To prevent any contaminants from entering
the sterile field.
4. Wash hands.
5. Place sterile towel under PD catheter, Prevents contaminants near connection site.
preventing contamination of other towels and
centre of drape. Note: this towel is longer sterile after placed.
6. Place second sterile towel on bedside table Provides sterile area to prepare supplies.
(without contaminating sterile field).
7. Place sterile bowl, sterile forceps, and two
sterile cotton swabs, and gauze on sterile
towel on bedside table.
8. Open container with 90% alcohol, Allows you to retrieve necessary items
stopcock, and suction tubing piece in it without contamination
9. Use sterile forceps to remove stopcock and If placed directly on sterile field, the towel
suction tubing from alcohol and place them in would become wet and therefore
sterile bowl. contaminated.
Place forceps on edge of sterile field on table Maintaining the sterility of tip for future use,
with tips inside sterile field. though handle is not sterile.
10. Cut open the following items and use Maintaining sterility of field and items and
sterile forceps to remove them from the preparing for assembly.
package and place them in the centre of the Tearing packages increases likelihood of
sterile towel on the bedside table: contamination.
- fluid
- urinary bag
- infusion set
- syringe (if reusing syringe, use sterile
forceps to obtain it from the sterile package
and place on sterile towel on bedside table)
being careful to maintain sterility of items
and sterile field
11. Close catheter clamp, or use Kelly Clamp Prepares for disconnection and preserves
to clamp catheter. sterility of gloves later in procedure.
12. Don sterile gloves
13. Using syringe, remove from LR bag the Preparing to create a solution of the correct
same amount of fluid as the amount of D50 to concentration.
be added. Discard into non-sterile kidney
basin.
14. Using syringe, draw up ordered amount of Creating the PD solution. Glucose provides

Amy Neufeldt, RN, BscN, William J. Lawton, MD. July 2015 Mbingo Baptist Hospital
D50 and add to the bag of Lactated Ringer. the osmotic pressure for ultrafiltration.
Rotate to mix. This is the “dialysate”
15. Ensure roller clamp on infusion tubing is
closed then spike dialysate bag.
16. Attach infusion set to appropriate port of This is where dialysate will infuse through.
stopcock (see diagram).
17. Attach suction tubing to “urinary bag” port Attach as far as possible to prevent leaks.
of stopcock as far as possible and attach This may become difficult after the suction
urinary bag to suction tubing. tubing has been in the alcohol for some time
Ensure drainage port on urinary bag is and hardens. Consider replacing suction
closed. tubing if needed.
18. Turn stopcock “Off” toward the Patient. To prevent fluid from draining prematurely.
19. With one hand, use a square of sterile The catheter and cap are not sterile, so
gauze to hold PD catheter. With other hand, holding them with sterile gloves would
use one square sterile gauze to remove cap contaminate the gloves.
from PD catheter and place in alcohol.
Continue holding catheter with the same
hand – do not let go until step 20 is complete.
20. With one hand, dip cotton swab into Decrease risk of infection at port, allow to dry
alcohol and cleanse port in a circular motion. to prevent fusing to connector.
Allow to dry.
21. Attach “patient” port of stopcock to PD The catheter is not sterile, so holding it with
catheter, ensuring that it is pushed all the way sterile gloves would contaminate the gloves.
in. Must be pushed all the way in to prevent
Note: hands are no longer sterile. leakage.
22. Place urinary bag on the floor. Wrap Facilitates drainage and keeps fluid warm
dialysis fluid next to hot water bottle. while maintaining a closed system.
23. Turn stopcock “off” towards infusion set Allows dialysate to flow from abdomen into
and open catheter clamp. urinary bag.
24. Ensure dialysate is flowing into urinary Allows accurate measuring of drainage and
bag without leaks. prevents contamination of sterile towel.
25. Remove gloves and cleanse hands. Gloves are no longer sterile.
Monitor the bag often to ensure the urinary bag is emptied when it is full.
26. a. If reusing syringe, use forceps to
remove other items from sterile towel on
bedside table and place syringe in the center.
26. b. Place sterile bowl with 2 remaining
gauze squares, and 1 sterile swab on
bedside table. Cover with sterile gauze and
place forceps in bowl.
26. c. Then cover the syringe by folding the
sterile towel, keeping the center sterile.
27. Reposition patient from one side to the This promotes and ensures complete

Amy Neufeldt, RN, BscN, William J. Lawton, MD. July 2015 Mbingo Baptist Hospital
other and palpate abdomen as needed. draining.
28. When draining is finished, clean hands, This will stop draining and allow flushing of
put on clean gloves, hang fluid on IV pole, stopcock.
and turn stopcock off toward patient.
29. Open Infusion Set clamp, allowing fluid to Air will drain into urinary bag instead of
flush tubing until it enters the stopcock. Close peritoneal cavity.
Infusion Set clamp.
30. Turn stopcock off to urinary bag and open This allows new dialysate solution to enter
roller clamp again to begin “Fill” phase, peritoneal cavity in a closed system,
ensuring that filling happens in ordered time. decreasing risk of infection.
Filling too quickly can cause complications
and discomfort.
31. If using two bags, when first bag is empty: This action is one of the biggest risks as the
clean hands, put on clean gloves, close roller system is then open to contamination.
clamp, remove spike from bag and spike
second bag being extremely cautious not to
contaminate or touch spike, then resume
infusing. Remove gloves and clean hands.
32. Just before Fill phase is finished (all
ordered fluid has been infused), remove
sterile gauze from sterile bowl.
33. Use sterile forceps to remove catheter Be careful not touch the end of the cap that
cap from alcohol and place in sterile bowl. attaches to the PD catheter as this will
introduce contaminants to peritoneum
increasing risk for infection.
34. Close roller clamp on infusion set and Prevents dialysate from flowing out when
clamp PD catheter. removing exchange set-up and re-capping PD
catheter.
35. Clean hands and don sterile gloves. Prevents infection when handling the catheter
and opening the system in following steps.
36. Using remaining 2 pieces of sterile gauze. Using gauze preserves sterility of gloves and
With one hand: hold PD catheter. decreases risk of contamination of the PD
With other hand: remove stopcock assembly catheter.
from PD catheter.
Continue holding PD catheter with gauze in
one hand until re-capping is completed.
37. Dip sterile cotton swab in alcohol and Cleans port of entry, preventing risk of
swab catheter port in a circular motion. Allow infection.
to dry
38. Place catheter cap on port being Prevents infection from entering the
extremely careful not to contaminate the peritoneum.
end of the cap that attaches to the port, or
the port itself.
39. Disassemble system: If suction tubing piece remains attached or
- Place suction tubing in 90% alcohol stopcock is not placed in “open all ways”

Amy Neufeldt, RN, BscN, William J. Lawton, MD. July 2015 Mbingo Baptist Hospital
- Place stopcock in “open all ways” position position, alcohol is not able to access and
into 90% alcohol disinfect all parts of the system.
Do not leave suction tubing piece
attached to stopcock
- Discard urinary bag after measuring output
- Discard infusion set and fluid bags.
40. Remove surgical mask and allow PD system is now closed so risk for
caregivers to return. contamination is low.
41. Complete documentation including: Allows monitoring of efficacy of PD, fluid
- amount of fluid balance, and changes in patient's condition.
- colour and quality of fluid
- times of in and out
- any concerns noted, such as discomfort
- what time the syringe is replaced

References

Connell, R. (2013). Peritoneal Dialysis – Acute. Nottingham Children's Hospital, Nottingham

University Hospitals.
Preston, R.M. (2005). Aseptic technique: evidence-based approach for patient safety. British
Journal of Nursing. 14(10). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/
15928570.
Southern Alberta Renal Program. (March 2015). Transfer Set Tubing Change. Calgary,
Canada: Alberta Health Services.

Amy Neufeldt, RN, BscN, William J. Lawton, MD. July 2015 Mbingo Baptist Hospital