Contamination information instructions for peritoneal dialysis patients

N.B – this procedure is only to be used by patients in situations where they are away from their usual base dialysis unit and are unable to attend the nearest alternative dialysis unit (i.e. patients on holiday).

This information is for patients undergoing peritoneal dialysis (PD) and covers the following situations that may arise where they are unable to attend their usual dialysis unit:

1. Split Miniset line or Tenckhoff catheter.
2. Titanium connector pulled out or disconnected.
3. Hole in peritoneal dialysis bag or lines.
4. Touch contamination followed by peritoneal dialysis fluid inflow.

If one of the above occurs please give yourself the following antibiotics to prevent you from getting peritonitis (these antibiotics will have already been prescribed and supplied to you as you would have pre-informed the home therapies team that you were travelling on holiday and therefore unable to attend your nearest dialysis unit).

The equipment for this procedure will be provided for you by the home therapies department or C5 ward.

Vancomycin

Equipment required

• 10 mls sterile water for injection
• One vial of vancomycin powder 500mg
• 10ml syringe
• Three Clinell wipes
• Two green needles and one orange needle
• Sharps container
• Alcohol wipes

Procedure

1. Wash your hands with soap and water and dry thoroughly.
2. Clean a surface with the alcohol wipes and gather the equipment together
3. Connect the 10ml syringe and green needle.
4. Flip the plastic top off from the vancomycin vial and clean the rubber bung on the top of the vial with a Clinell wipe.
5. Clean the twist top of the sterile water for injection with a Clinell wipe then twist the top off.
6. Draw up the 10mls of water for injection into the syringe and add this to the vancomycin powder.
7. Attach second green needle to the same 10ml syringe making sure that you do not contaminate either of them.
8. Shake the mixture gently to mix and once the liquid is clear withdraw all the mixture into the 10 ml syringe.
9. Clean the injection port with the Clinell wipe
10. Change the green needle to the orange needle and leave the filled syringe to one side
11. Safely dispose of the green needle and empty vancomycin vial into the Sharps container

Gentamicin: dose depends on your weight and will be prescribed for you

Patient’s weight: 20 to 40 kg
Dose of Gentamicin: 40mg

Patient’s weight: 41 to 60 kg
Dose of Gentamicin: 60mg

Patient’s weight: 61 to 100 kg
Dose of Gentamicin: 80mg

Patient’s weight: 101kg or more
Dose of Gentamicin: 120mg

Equipment required

• Ampoule(s) of gentamicin
• 2.5 / 5ml syringe
• Two Clinell wipes
• One green needle and one orange needle
• Sharps container

Procedure

1. Connect the green needle to a 2.5/5 ml syringe.
2. Clean the neck of the gentamicin ampoule with a Clinell wipe.
3. Snap the glass top off the gentamicin ampoule.
4. Draw up the appropriate dose of gentamicin into the syringe.
5. Clean the injection port with the Clinell wipe.
6. Change the green needle to the orange needle.
7. Safely dispose of the green needle and used gentamicin ampoule into the sharps container.

2.5/ 5ml syringe, orange needle connected containing gentamicin you need to inject them into the new dialysis fluid through the injection port:

Equipment required

• PD fluid bag
• 10ml syringe, orange needle connected containing vancomycin
• 2.5 / 5ml syringe, orange needle connected containing gentamicin
• 2 Clinell wipes
• Sharps container
• Alcohol hand wipes

Procedure

• Clean your hands with the alcohol hand wipes.
• Clean the injection port on the Peritoneal Dialysis bag with a Clinell wipe.
• Inject the vancomycin through the injection port taking care not to touch the needle with your fingers.
• Shake the PD bag to mix the antibiotic.
• Clean the injection port on the Peritoneal Dialysis bag again with a Clinell wipe.
• Inject the gentamicin through the injection port taking care not to touch the needle with your fingers.
• Shake the PD bag to mix the antibiotic.
• Ensure all the needles and glass vials are safely disposed of in the Sharps container.
• If you stick the needle through the bag by mistake, you need to throw the bag away and start the procedure again. Poor technique could result in peritonitis.
• Carry out the exchange as usual and let the bag dwell for at least six hours.
• Then continue your dialysis as normal.

Please ensure you carry out this procedure correctly within 24 hours of contamination to prevent peritonitis.

You do not have to carry the procedure out yourself. If you do not feel comfortable doing so, please take the equipment and instructions to the nearest PD unit so they can do it for you.

If you have any queries please do not hesitate to contact us:

• Monday to Friday 08:30 to 17:00 home therapies
  Tel: 01223 400184
• Evenings and Weekends
  C5 ward: 01223 217195