MANITOBA RENAL PROGRAM
Contents
1. 14 15 16 17 18 19 20 21 22 23 24 Press STOP Remove dialysate solution bags from outer wrap and check for Leaks by squeezing bags Intact port caps a Clarity of dialysate solution Place one 5000mL dialysate solution bag on heater cradle Place remaining dialysate solution bags on top of heater bag or beside the cycler if space available Press GO Load cassette Attach the organizer to the front of the cycler door Clamp all 6 clamps on organizer lines Press GO Attach drain line positioned on extreme right of organizer to drain manifold and attach Y portion of drain manifold to drain bags Perform hand hygiene Attach patient Easy Lock Extension Line to the patient line if needed Remove the heater line with the red clamp from the organizer and luer lock to heater bag Luer lock remaining bags to white and blue clamp lines Open only the clamps on the lines connected to dialysate solution bags Open clamp on patient line positioned on extreme left of organizer KEY POINTS Display will read PRESS GO TO START f medications ordered add at this time See procedure 30 80 03 I nstillation of Medication into Peritoneal Dialysis Solution Ensure dialysate solution bag is positioned on top of heater sensor This will be the heater bag 500 mL above the total therapy volume is required to accommodate priming of cycler lines2. Display will read LOAD THE SET Ensure bar clamp is soft or has retracted Must be clamped during self test to avoid RELOAD SET alarm Display reads SELF TESTING When the self test is complete the display changes to CONNECT BAGS Ensure large clamps on drain bag ports are clamped if using Do not clamp small clamps on drain bag spike lines If the client has a private bathroom drain lines may be used to drain into the toilet Ensure end of line is above toilet water Secure with tape Place end of patient Easy Lock Extension Line in line organizer Maintain sterility of the exposed ends If the LAST FILL requires a different dextrose concentration or different type of solution eg icodextrin amino acid use the blue clamp line for the last fill bag No alarm on machine will occur to indicate patient line clamped and air will remain in line f using Easy Lock Extension Line the clamp will be located past the extension on patient line W P amp P Procedures 30 80 30 80 09 Manual 30 80 09 doc Page 3 of 5 PROCEDURE 25 Break seals on dialysate solution bags 26 Press GO B Patient Connection 1 Ensure the twist clamp on transfer set is closed 2 Perform hand hygiene 3 Remove patient line from organizer 4 Remove pull ring from patient line remove minicap from transfer set and connect to patient line 5 Open twist clamp on transfer set 6 Press GO 7 A
3. age 4 of 5 PROCEDURE KEY POINTS 5 Perform hand hygiene 6 Open mini cap package 7 Disconnect the patient line from the transfer Maintain sterility of exposed ends set If transfer set is contaminated apply a new minicap and refer to Decision Tree for Managing Contamination Appendix A 8 Place mini cap on end of transfer set 9 Anchor transfer set to abdomen Transfer set and catheter immobilization prevents trauma and infection to the exit site and promotes healing of the exit site 10 Remove blue organizer from outside of door and cassette from machine 11 Press GO Display reads TURN ME OFF 12 Turn machine OFF 13 Remove lines and bags and discard per facility policy 14 Wipe down machine per facility equipment cleaning practices DOCUMENTATION Automated Peritoneal Dialysis Record Appendix B treatment parameters patient outcome medications administered Medications administered in the patient health record REFERENCES Baxter Healthcare Corporation 2010 Homechoice APD Systems Trainer s Guide and Patient At Home Guide 07 19 63 294 Manual McGaw Park IL Author W P amp P Procedures 30 80 30 80 09 Manual 30 80 09 doc Page 5 of 5
4. dal Full Drain defaults to YES Change to NO a Language o Flush Defaults to YES a Reset Weight defaults to NO Change to YES a Program Locked defaults to NO a Therapy Log o Alarm Log For further information refer to the Baxter 10 4 User Manual PLEASE WAIT displays on screen followed by STANDARD MODE ON Machine beeps x2 PRESS GO TO START appears on the display DO NOT PRESS GO AT THIS TIME Wait until step 13 to press GO Verify program parameters prior to initiating setup Set the parameters for the following settings o Therapy type o Total volume a Therapy time o Fill volume o Last fill volume a Dextrose this step is skipped if LAST FILL a VOLUME 0 If using a last fill with a different dextrose concentration or a different type solution eg icodextrin enter DIFFERENT otherwise leave as SAME o Weight units lbs or kgs o Patient weight target weight Home Choice Pro will calculate and display the number of cycles and dwell time INITIAL DRAIN ALARM must never be set to OFF to avoid increased intraperitoneal volume Last manual drain defaults to yes but should be set to no It is recommended that the INITIAL DRAIN ALARM be set to 70 of the volume present in the peritoneal cavity If the last fill amount is 500ml or less the INITIAL DRAIN ALARM may be set to 0 W P amp P Procedures 30 80 30 80 09 Manual 30 80 09 doc Page 2 of 5 PROCEDURE 10 11 12 13
5. fter draining about 200 300 ml check effluent for clarity C End of Therapy 1 Scroll down to obtain therapy information using the down arrow 2 Press GO 3 Close twist clamp on the transfer set the clamps on the disposable set and the small clamps on the drain bags Or the clamp on the drain line extension if using 4 Press GO KEY POINTS Display will read PRIMING Priming takes approximately 10 minutes When priming complete display will flash CONNECT YOURSELF and CHECK PATIENT LINE If air is noted in patient line reprime patient line as follows zi Press STOP o Arrow down to REPRIME PATIENT LINE 5 Press ENTER o Machine reads VERIFY LINE IN ORGANIZER o Press ENTER again Verify patient line is primed If line is not primed refer to step A 26 key point Maintain sterility of patient line and transfer set If patient line is contaminated discard set up If transfer set is contaminated apply a new minicap and refer to Decision Tree for Managing Contamination Appendix A Display screen will read INITIAL DRAIN If cloudy effluent noted take a sample using the sample minibags Refer to 60 30 14 Peritonitis Protocol Display reads END OF THERAPY Post therapy information o Initial Drain o Total Ultrafiltration o Dwell Time a Added Lost Dwell Display reads CLOSE ALL CLAMPS Display will read DISCONNECT YOURSELF W P amp P Procedures 30 80 30 80 09 Manual 30 80 09 doc P
6. sure correct solution volume dextrose concentration solution type and expiry date before opening outer wrap of dialysate solution bags 3 Plug the power cord into the back of the machine Plug the other end into a grounded outlet WAP amp P Procedures 30 80 30 80 09 Manual 30 80 09 doc Page 1 of 5 PROCEDURE Nurse s Menu 7 Access the Nurse s Menu by pressing and holding the hidden button to the leftofGO when turning ON the Home Choice Pro Confirm default settings To exit nurse s menu turn machine OFF Turn machine ON n Select program parameters Press down arrow until CHANGE PROGRAM is displayed Press ENTER Select Program Parameters a Press ENTER to make the screen blink Use the up and down arrows to change the parameter to the desired level a Press ENTER again to stop the blinking and save the parameter a Use the down arrow to advance to the next parameter Press STOP n Make Adjustments 7 Press down arrow until MAKE ADJUSTMENTS is displayed on screen a Press ENTER Scroll to INITIAL DRAIN ALARM Ensure n that INITIAL DRAIN ALARM is set appropriately KEY POINTS ON OFF button is located at the back of the machine The Nurse s Menu allows the nurse to tailor the Home Choice Pro to meet a patient s particular needs o Nurse s Menu o Mode Standard Low Fill a Min drain Vol 85 o Smart Dwells defaults to YES o Heater Bag Empty NO o Ti
7. v Winnipeg Regional Office r gional de la k d h Ith Health Authority sant de Winnipeg I ne ea Ca manitoba renal program Caring for Health A l coute de notre sant ni renal prog MANITOBA RENAL PROGRAM SUBJECT SECTION 30 80 Peritoneal Dialysis Home Choice Pro Cycler Set Up Initiation of Cycling and End of Treatment utilizing a luer lock cycler set software version 10 4 AUTHORIZATION EFFECTIVE DATE November 2002 Professional Advisory Committee Manitoba Renal Program Nursing Practice Council St Boniface Hospital REVISION DATE September 2006 May 2012 CODE 30 80 09 PURPOSE 1 To provide peritoneal dialysis using the Home Choice Pro automated peritoneal dialysis cycler POLICY 1 The Nephrologist will prescribe the total therapy time total therapy volume fill volume last fill volume and dialysate solutions 2 All Registered Nurses RN and Licensed Practical Nurses LPN who have received education and training and who are competent may perform this procedure EQUIPMENT KEY POINTS Home Choice Pro automated cycler Disposable Cycler 4 Prong Cassette Prescribed dialysate solution Disconnect mini cap x 2 check expiry date Second mini cap in case of contamination Drain bag s Drain manifold Drain line optional May use up to 2 drain lines Easy lock patient line extension optional PROCEDURE KEY POINTS Set up 1 Perform hand hygiene 2 Gather supplies En
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