Peritoneal dialysis can be performed manually in the hospital or using cycler equipment at home as directed by a physician. Licensed nursing associates carry out peritoneal dialysis according to a physician's orders regarding fluid type and number of exchanges. Any changes to orders are immediately communicated to pharmacy. Nursing staff reinforce aseptic technique and infection prevention education. Intake and output are determined by weighing bags unless direct measurement is ordered.

1. Peritoneal Dialysis
Peritoneal dialysis is performed via manual exchange during
hospitalization at WCMC. Upon discharge, patients may resume use
of cycler equipment as directed by their physician.
Peritoneal dialysis is implemented by licensed nursing associates
according to physician orders regarding fluid type used for
exchange and number/frequency of exchanges.
 Any changes made regarding
type of fluid or number of
exchanges is made by
physician’s order and
immediately communicated to
materials
management/pharmacy

2. Peritoneal Dialysis (continued)
 When medication additives are ordered by the
physician, the fluid is prepared/mixed/labeled by
pharmacy and is then dispensed to nursing for
administration.
 Education regarding aseptic technique/infection
prevention is reinforced by nursing staff
 Intake and output is determined by pre and post-
treatment by bag weight unless direct fluid measurement
is ordered by the physician and this is documented in CPSI
by nursing

3. Peritoneal Dialysis (continued)
Procedure:
 Review Physician’s order, lab values, height and weight
 Educate family and patient as needed
 Close the door to the patient’s room, placing sign on door so
others know not to enter room during the procedure
 The nurse will mask self and patient, there should be no one
else in the room during the procedure
 Hand hygiene is performed and gloves donned
 Remove dialysate bag from protective pouch checking the
expiration date, strength and amount along with fluid clarity
and any leaks in the bag

4. Peritoneal Dialysis (continued)
Procedure continued:
Connect – break frangible on patient connector end and
remove pull ring from UltraBag system. Remove and discard
Minicap from transfer set and immediately connect UltraBag
system to transfer set. Be careful not to contaminate transfer
set.
Drain – Clamp the fill line with the blue outlet port calm and
break the frangible near the solution bag. Hang new solution
bag, place empty drainage bag lower than the patient with the
shiny side facing up. Open transfer set to drain observing
effluent for cloudiness. Allow 15-20 minutes to completely
drain then close the transfer set.

5. Peritoneal Dialysis (continued)
Procedure continued:
Flush – Remove the blue outlet port clamp from fill line to flush
tubing counting to five slowly watching new solution flow into the
drain bag (while the transfer set is closed). Next clamp the drain
line with the blue outlet port clamp.
Instill – Open the transfer to instill fluid regulating the flow rate by
adjusting the height of the dialysate bag. Allow bag to completely
empty, then close the transfer set and clamp the fill line with the
second blue outlet port clamp.
Disconnect – Mask, wash hands, and don gloves. Open sterile
Minicap with betadine package and have ready. Disconnect bag
system from transfer set and apply Minicap with betadine twisting
firmly to secure.

6. Peritoneal Dialysis (continued)
Procedure continued:
Dwell – Allow fluid to dwell in the
peritoneal cavity for approximately
four hours based on the physician’s
orders.
*A betadine Minicap is only used
once*

7. Peritoneal Dialysis (continued)
Documentation by nursing includes the following;
 I & O by post treatment bag weight
 Color/quality of post-treatment fluid
 Any medication added to treatment fluid
 Patient’s tolerance of the exchange
Any personal PD supplies used by the patient during admission
are reimbursed to the patient from WCMC supplies prior to
discharge.
Contact purchasing associate to order the patient’s supplies

8. Peritoneal Dialysis (continued)
When initiating, discontinuing, performing a culture, or other post
dialysis fluid collection the following PPE must be worn
 Gown
 Sterile gloves
 Mask with splash protection
Disposal
 The used bag is weighed post treatment
 The fluid is then disposed of into a toilet
 After donning proper protective equipment, the fluid is disposed of by
lowering the end of the tubing below the surface of the water prior to
opening the clamp to prevent splashing
 The bag can be hung on an IV pole while fluid is draining
 Any inadvertent spills are cleaned with expose
 The empty bag is then disposed of in a red biohazard bag