Obtaining an effluent sample of peritoneal dialysis fluid Procedure for. Contents

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1 Obtaining an effluent sample of peritoneal Procedure for Classification: Procedure Lead Author; Joanne Martin Authors Division: Renal Services Unique ID TC51(05) Issue number: 4 Expiry Date: April 2019 Contents Section Page Intro Who should read this document 2 Key practice points 2 Background/ Scope/ Definitions 2 What is new in this version 3 Policy/Procedure/Guideline Use clear section headings 2 Include hyperlinks if you think they will help navigation 3 etc Standards 5 Explanation of terms 5 References and Supporting Documents 5 Roles and Responsibilities Appendix Document control information (Published as separate document) 6 Document Control 6 Policy Implementation Plan 7 Monitoring and Review 7 Endorsement 7 Equality analysis 8-9 Page 1 of 5

2 Who should read this document? Any Clinical Staff involved in collecting samples of peritoneal dialysis effluent for analysis. Key Practice Points This document provides details of how to correctly obtain a sample of peritoneal dialysis effluent. Background/ Scope/ Definitions Peritoneal dialysis (PD) is the use of the peritoneal membrane for dialysis. Dialysis fluid is drained into the peritoneal cavity via peritoneal dialysis catheter. PD uses the peritoneal membrane as it has a rich supply of blood vessels and many small microscopic holes that allow for the passage of waste fluid from the blood system into the. The dialysis solution contains varying strengths of dextrose. The dialysate fluid is instilled into the peritoneal cavity via a sterile pathway and allowed to dwell for a period of approximately 4 6 hours, or as prescribed. During this time the fluid bathes the peritoneum and attracts into it the waste products and fluid from the blood system, by the processes of osmosis and diffusion. Peritoneal dialysis is a continuous process and requires the fluid inside the patient to be changed at intervals over a 24 hour period. This change is called a dialysis exchange and is a procedure that patients carry out in their own home. These exchanges of fluid can be performed in one of two ways: CONTINUOUS AMBULATORY PERITONEAL DIALYSIS This type of PD requires that the patients carry out their own dialysis at home. Most patients will require 4 dialysis exchanges each day. Each exchange will take approximately 30 minutes to perform. AUTOMATED PERITONEAL DIALYSIS This type of PD involves the patient having a machine at home that performs the patient s dialysis exchanges overnight for approximately 7 12 hours. Peritonitis Peritonitis denotes inflammation of the peritoneum with a resultant increase in the number of white blood cells, leading to cloudiness of the PD fluid when drained out of the peritoneum. This cloudiness, which is almost invariably present, should be seen as the earliest detector of infection; the majority of patients will also complain of abdominal pain or tenderness. Other accompanying symptoms may include nausea, vomiting, constipation, fever and chills. An elevated dialysate count of white blood cells of more than 100/mm3, of which at least 50% are polymorphonuclear neutrophils, is supportive of the diagnosis of microbial-induced peritonitis, and calls for immediate initiation of antimicrobial therapy, Pirano et al (2002). Page 2 of 5

3 What is new in this version? The size of syringe from 20mls luer lock to 50mls luer lock. The sample volume from 20mls to 50mls. The removal of the word Tenckhoff catheter and replaced with Peritoneal dialysis catheter Policy/ Guideline/ Protocol Equipment Sterile 50mls Luer Lock Syringe Sterile 21 gauge Green needle Sanicloth x 2 Universal sterile specimen pot Microbiology form Procedure 1. Explain procedure to patient. To reduce anxiety and gain informed consent. To comply with the Code of Professional Conduct, Patients Charter and local standards of service. 2. Assemble all equipment. If the patient has not brought in a Pd drained bag containing dialysis effluent, ask them to perform an exchange. Appropriate supplies can be found on H3 ( /4 ) To ensure time is not wasted and the procedure runs smoothly. To obtain Pd fluid to send to the Laboratory for analysis. 3. Observe the clarity of the in the drainage bag and not this. Cloudy fluid may indicate Pd peritonitis. 4. The practitioner should wear gloves, a plastic apron. Universal precautions are taken in order to prevent the practitioner coming into contact with patient s body fluids. 5. Wash and dry hands with soap and water followed by an alcohol rub. Clean the area (flat surface e.g. dressing trolley/plastic tray) with a sanicloth and place drainage bag onto the cleaned area. To minimise the risk of sample contamination. 6. Clean the sample port of the drainage bag with a sanicloth using a scrubbing action and allow to dry for 30 seconds. To minimise the risk of sample contamination. 7. Draw back 50mls of Pd fluid and instil into the universal container. Page 3 of 5

4 To maintain a sterile environment for the specimen. 8. Dispose of the drainage bag in the dirty utility area. Wash hands thoroughly with soap and water. Hand washing is the single most important procedure for prevention of hospital acquired infections in the clinical setting. Hands have been shown to be an important route of transmission of infection. 9. If peritonitis is suspected the specimen should be sent to the laboratory in the microbiology bag marked for white cell count, culture and sensitivity and gram stain. In order to determine if peritonitis is present and any organism that could of caused the Pd peritonitis. 10. If a new Pd peritonitis is suspected the specimen should be marked URGENT, and at night/weekends/out of hours the on-call microbiologist should be bleeped. The patient needs to wait until the results from the fluid are obtained. To ensure the correct diagnosis and treatment are established as promptly as possible. 11. While analysis of the sample is taking place, the patients vital signs/early warning score should be obtained and the exit site should be examined for signs of redness, exudate or soreness. To detect any signs of infection. Exit site infections can lead to Pd peritonitis. 12. Once results are obtained, if the white cell count is greater than 100 follow the Pd peritonitis protocol. PLEASE NOTE THAT THE Pd STAFF CAN BE CONTACTED MONDAY FRIDAY 8.30am 16.30pm Ext OUT OF HOURS/WEEKENDS CONTACT WARD H /4 Standards If a new peritonitis is suspected the specimen should be marked URGENT and at night /weekends/ out of hours the on call microbiologist should be bleeped. The patient needs to wait until the results from the Pd effluent are obtained. Explanation of terms Peritoneal Dialysis Catheter Page 4 of 5

5 A catheter surgically/medically inserted 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 To be read in conjunction with the following document: Bacterial Peritonitis Protocol. References Li et al.(2010) Peritoneal dialysis International guidelines/recommendations: 2010 update Peritoneal Dialysis International, Vol. 30, pp Piraino B, Bailie GR, Bernardini J. (2005) Peritoneal dialysis related infections recommendations: Update. Peritoneal Dialysis International 25: Roles and responsibilities All Clinical Staff involved in this procedure to adhere to the principles and document on EPR Page 5 of 5