Changing a Peritoneal dialysis catheter exit site dressing Procedure Classification: Procedure Lead Author: Joanne Martin Authors Division: Renal Services Unique ID: DDCRen1(12) Issue number: 3 Expiry Date: Contents Section Page Intro Who should read this document 2 Key practice points 2 Background/ Scope/ Definitions 2 What is new in this version 2 Policy/Procedure/Guideline 2-5 1 Use clear section headings 2 Include hyperlinks if you think they will help navigation 3 Standards 5 Explanation of terms 6 References and Supporting Documents 6 Roles and Responsibilities 6 1 2 3 Appendix Document control information (Published as separate document) Document Control 7 Policy Implementation Plan 8 Monitoring and Review 8 Endorsement 8 Equality analysis 9-10 Page 1 of 5
Who should read this document? Any clinical staff involved in preforming peritoneal catheter exit site dressings. Key Practice Points This policy recommends that all staff are trained to undertake this procedure using Aseptic-non-touch-technique (ANTT) Staff Education & Training Pathway 1. All new starters need to be trained & assessed as competent prior to patient contact. 2. Existing staff need to be informed of practice changes with a reassessment of competency. 3. All staff require an annual update & assessment Background/ Scope/ Definitions This policy outlines that all nursing and support staff (bands 2-8) require education, training and assessment and have to be deemed as competent in the ANTT before preforming peritoneal dialysis procedures. This document provides procedure guidelines for the renewal of peritoneal dialysis catheter exit site dressings. This document follows local procedure incorporating the Salford Royal Foundation Trust (SRFT) ANTT guidelines. What is new in this version? Tenckhoff catheter replaced with Peritoneal Dialysis Catheter. Standard practice now denotes 0.9% saline as a cleaning agent Policy/ Guideline/ Protocol The ANTT Procedure a) Use a non touch technique at all times handle and touch non key parts with confidence. b) Sterile packs must be opened carefully to prevent contamination of contents. c) Identify key parts (before starting any procedure) and remove equipment from the packaging carefully in preparation. d) Assemble the equipment and arrange in an organised manner within your aseptic field. e) Ensure that key parts are protected at all times. N.B. Key parts must not come into direct contact with the aseptic field (trolley) example; prepared syringes should be capped. f) Key parts should NEVER be touched as doing so will compromise the aseptic technique. g) Staff must ensure that aseptic key parts only touch other aseptic key Page 2 of 5
parts non-septic items do not come into contact with objects. h) Staff must ensure that only aseptic items come into contact with the susceptible site (key site). i) The period of time during which the procedure takes place should be kept to a minimum (Aycliffe et al 2007). j) Following completion of the procedure remove personal protective equipment i.e. gloves and apron and decontaminate hands with soap and water. k) Used equipment and waste should be dealt with according to the hospital waste management policy. l) Ensure the patient is comfortable. The principles of ANTT are simple: Always wash hands effectively. Non-touch-technique is used at all times to protect key-parts. Touch non-key parts with confidence Take appropriate infective precautions. ANTT Procedure for Peritoneal Dialysis Catheter Exit Site Dressing Pre-Procedure The following are a set of general instructions to be observed prior to commencing any procedure: Procedure Stage One Preparation 1. Wash hands with soap & water 2. Use a clean trolley, disinfect trolley with a large 70% alcohol wipe and allow to air dry (30 seconds). NB. If trolley is not clean, clean trolley with Chlorclean prior to use of alcohol wipe. 3. Gather & collect the appropriate equipment required: 0.9% saline, sterile dressing pack with gloves, small Mepore dressing, tape. Assemble equipment on lower shelf of trolley. Stage Two Aseptic Field 4. Proceed to patient. Clean hands with soap & water or alcohol gel Put on apron 5 Reassure and explain the procedure to the patient to gain verbal Rationale 2. To minimise the risk of infection drying time imperative to ensure it is aseptic To prevent cross infection by removing any contaminants. 3. Clinical procedure can be completed without interruption and reduces the risk of cross contamination 5. The health care professional has been given the authority to proceed. Page 3 of 5
consent. 6. Ensure privacy & dignity is maintained during the procedure, do not expose the patient unnecessarily and avoid draughts 6. To avoid unnecessary embarrassment to the patient and minimise airborne contamination 7. Provide adequate lighting 7. To enable clear vision & observation 8. Ensure patient s line is outside 8. To minimise risk of contamination. clothing 9. Open pack, assemble equipment using a non-touch technique and protecting key parts. 10. Attach clinical waste bag to the side of the trolley but below the level of the top shelf. 11. Open all other packs onto aseptic field. Pour Betadine into gallipot. 9. Minimise the risk of cross contamination (COSHH regulations) An organised aseptic field decreases chance of inadvertently contaminating key-parts. 10. So that contaminated material is kept below the level of aseptic field.. Stage Three Preparing Key Parts 12. Decontaminate hands again using either soap or alcogel. Put on clean non-sterile gloves. Remove old dressing, lifting towards exit site. 13. If the site appears red or is discharging, then obtain a swab for culture and sensitivity. 14. Remove gloves and discard them. Decontaminate hands using either soap or alcogel. Apply sterile gloves from dressing pack. 15. Take a gauze square dipped in the 0.9% saline, clean once around the exit site then discard. Repeat three times. Do not lift or pull the Peritoneal dialysis catheter. Dry exit site thoroughly with the two remaining gauze squares. 16. Apply the new Mepore dressing, moulding it into place so that there are no folds or creases. Secure the peritoneal dialysis catheter using tape. 12.To prevent contamination. To prevent the Peritoneal dialysis catheter being pulled. 13. To identify the presence of any pathogens. 14. To prevent contamination of exit site. 15. To prevent risk of infection from a dirty to a clean area. 16. To protect the site from contamination. To minimize irritation of the skin and maximize patient comfort. Page 4 of 5
Stage Four Environment 17. Remove all equipment & dispose accordingly. Clean trolley with 70% alcohol wipe. This should be done at the patient s bedside 18. Remove apron and gloves and wash hands. 17. To maintain a safe environment and minimize cross infection in line COSSH standards. 18. To minimise the risk of cross contamination, hands must be cleaned immediately after glove removal as organisms thrive in the warm moist environment created by gloves. Standards It is the responsibility of Department Heads/Service Manigers/Clinical Leads to ensure that policies, procedures and access to appropriate training are made available to any staff who will undertake any procedure that will breach the body s defences. Asepsis Asepsis is the method by which health care professionals can prevent microbial contamination during invasive procedures or care of breaches in the skins integrity. Aseptic techniques are methods that have been developed to ensure that only uncontaminated objects/fluids make contact with aseptic /susceptible sites (ICNA 2003). It is expected that all clinical procedures are done with strict adherence to the Trust ANTT policy Explanation of terms Peritoneal Dialysis Catheter A catheter surgically placeed through the wall of the abdomen to provide a point for dialysis solution to enter and leave the peritoneal cavity during peritoneal dialysis. References and Supporting Documents SRFT ANTT guidelines Li et al.(2010) Peritoneal dialysis International guidelines/recommendations: 2010 update Peritoneal Dialysis International, Vol. 30, pp. 393 423 Roles and responsibilities All clinical staff involved in this procedure to adhere to the principles and to document on EPR Page 5 of 5