GUIDELINE FOR PERFORMING A BAXTER CAPD SET CHANGE Contact Name and Job Title (author) Directorate & Speciality Jr Sr Vanessa Keill Diabetes, Infection, Renal and Cardiovascular Directorate (Renal Transplant) Date of submission July 2015 Date on which guideline must be reviewed (this July 2018 should be one to three years) Explicit definition of patient group to which it applies Applies to: All peritoneal dialysis patients under the (e.g. inclusion and exclusion criteria, diagnosis) care of the Nottingham Renal and Transplant Unit. Excludes Haemodialysis patients and patients with chronic kidney disease not yet on peritoneal dialysis. Abstract Key Words Statement of the evidence base of the guideline has the guideline been peer reviewed by colleagues? Evidence base: (1-5) 1a meta analysis of randomised controlled trials 1b at least one randomised controlled trial 2a at least one well-designed controlled study without randomisation 2b at least one other type of well-designed quasi-experimental study 3 well designed non-experimental descriptive studies (ie comparative / correlation and case studies) 4 expert committee reports or opinions and / or clinical experiences of respected authorities 5 recommended best practise based on the clinical experience of the guideline developer Consultation Process Target audience This guideline describes how to perform a Baxter CAPD set change. CAPD, Set change Guideline has been derived based on consensus between medical and nursing staff (Grade 5) And expert committee reports or opinions and / or clinical experiences of respected authorities (Grade 4) Renal Unit Senior Staff Meeting Renal Unit Nursing and Medical Staff This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date. 1
NOTTINGHAM UNIVERSITY HOSPITALS RENAL GUIDELINES GUIDELINES FOR PERFORMING A BAXTER CAPD SET CHANGE Produced in in July 2015 Inclusion Criteria: All Peritoneal Dialysis patients under the care of the Inclusion Criteria: All Nottingham patients under Renal the and care Transplant of the Nottingham Unit. Renal and Transplant Unit, including patients at on the Dialysis Unit at Exclusion Criteria: Sherwood NONE Forest Hospital. Exclusion Local Contacts: Criteria: The None. CAPD TEAM, Ext 56705 Local Contacts: Review Date: July 2018 Review Date: Review/consultation. These guidelines were developed in conjunction with Nursing and Medical Staff within the Renal Unit. These guidelines will be disseminated to all Ward Managers, Nursing Managers, and Nursing Medical and staff Medical within staff the Renal within Unit. the Renal The guidelines Unit. The will guidelines be ratified will and be reviewed ratified and at the reviewed Renal Unit at the senior Renal staff Unit meeting. senior staff meeting. Dissemination and availability of the guidelines. Renal specific guidelines will be available within all the Renal areas at Nottingham University Hospitals NHS Trust and the Dialysis Unit at Kings Mill Hospital. They are also available on the Renal shared area. Http://nuhnet/nuh_documents/Guidelines/Forms?Guidelines.aspex. This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date. 2
INDICATIONS AND CONTRA-INDICATIONS A set change is required routinely on each patient every 6 months with the Baxter minicap system. It is also necessary if the line splits or becomes disconnected. HAZARDS It is possible to cause contamination to the line during the procedure, which could lead to a peritonitis episode. It is therefore essential that routine set changes should not be undertaken by a member of staff with a cold or sore throat, and if possible avoid if the patient has either of the above. During the procedure the connection is referred to as the titanium connection. It can be a plastic connector but will still be referred to as the titanium. EQUIPMENT LIST Hibiscrub soap Alcohol hand rub Methylated spirit (Hard surface spray) 1 Blue clamp Renal pack 1 Miniset 1 Minicap 1 White connection K shield Paper Towel 3
ACTION RATIONALE 1. 2. 3. 4. Ensure set change is taking place in a suitable environment with as little chance of disturbance as possible. Ideally in a treatment room with a no entry sign on. Expose the patients PD catheter. Apply the blue clamp to the catheter, above the titanium connector. Put on a plastic apron and wash hands thoroughly in hibiscrub. Clean dressing trolley with methylated spirits. Open renal pack on to cleaned surface. Use alcohol rub on hands, wait for hands to dry. Reducing opening & closing of doors & passage of people will reduce disturbance of airborne particles & hopefully reduce the risk of infection. Prevent fluid draining out during the set change. To prevent cross contamination and cross infection (Nottingham University Hospitals NHS Trust 2015) Effective hand washing is a pre-requisite to effective aseptic technique (Rowley 2001) To reduce the risk of contaminating the key parts as highlighted in Rowley (2001) Reducing the risk of infection (Nottingham University Hospitals NHS Truest Hand Hygiene policy 2013) 5 Place dressing towel under the patients PD catheter. To act as a sterile field. 4
6 Place white K shield around titanium connector, and use to clean the area. Leave the shield around the connection until ready for set change. 7 Return to trolley. Attach minicap to miniset line and turn off roller clamp. Pull the end off miniset connection. Place gauze around the exposed connection end of miniset line. To clean the connection as the k shield has betadine soaked sponges in them. To reduce the risk of infection. To prevent the open end of miniset becoming contaminated during set change. Thus reducing the risk of infection. 8 Remove K shield from patient s line. 9 Using 2 nd piece of gauze hold on to titanium remove old line and attach new line as quickly as possible. Speed is necessary to reduce infection risk. Using gauze helps to grip ends securely and prevents hands touching the ends of the lines. 10 Remove blue clamp 11 Ensure CAPD staff are informed of what has happened to this patient. To ensure that follow-up can be organised. REFERENCES Rowley, S. (2001) Aseptic Non-Touch Technique. NT Plus 97 (7) VII-VII Nottingham University Hospitals NHS Trust, Aseptic Non Touch Technique Policy 2015 Nottingham University Hospitals NHS Trust, Infection Prevention and Control Policy, Hand Hygiene. 2013 5
FURTHER READING ISPD Guidelines/Recommendations. Peritoneal dialysis- related infections recommendations: 2010 update ISPD Position Statement on Reducing the Risks of Peritoneal Dialysis Related Infections. Nov 2011 Author : V Keill Review Date : July 2018 6