CAPD SG- Flashcards
Intraperitoneal medications
sterile injections that can be provided to the patient via the PD catheter.
requires strict aseptic technique
use only sterile medication solutions
list the most common meds given during PD
Heparin
Antibiotics:
- Vancomycin
- Gentamycyin
- Tobramycyin
- Ceftazadine
What is the role of IP Heparin?
to treat and prevent the formation of fibrin which can impede catheter flow
Heparin is a ______ molecule and ______ cross the peritoneal membrane.
Heparin is a LARGE molecule and DOES NOT cross the peritoneal membrane.
Heparin only acts within the peritoneal space
What is the standard heparin dose?
500u or 1000u for every liter of dialysate given
Does heparin cross the peritoneal membrane?
No
When should heparin be avoided?
during frank bleeding
if the patient has a pork allergy
if the patient had recent surgery
if the patient has bleeding disorders
true or false
You need a doctors order to administer any IP medications?
True
When should you educate the patient at home to self administer heparin?
during times of poor catheter flow
when fibrin is present in the PD effluent
during episodes of peritonitis to minimize fibrin formation due to WBC accumulation
When peritonitis is suspected, what should you do BEFORE administering IP antibiotics?
draw cultures and fluid samples
How long should the antibiotics dwell within the peritoneum?
for a minimum of 6 hours
What are the six rights of medication administration?
- right patient
- right medication
- right dose
4 right time - right route
- right documentation
Where and when can antibiotics be ordered?
can be ordered through FMCRX during a clinic visit
abx kits can be taken home
you must teach the pt how to administer with aseptic technique and document training
review monthly during med rec. must check expiration, integrity, and review self administration skills
assess for allergies
true or false
the meds can be mixed ahead of time?
false
must be mixed and immediately exchanged
What does CAPD stand for?
continuous ambulatory peritoneal dialysis
What is peritoneal dialysis?
the removal of waste and fluid from the blood using the peritoneal membrane as a filter.
How long is the fluid left in the peritoneal cavity?
fluid is kept in the abdomen continuously except during drain.
24hours a day / 7 days a week
on rare occasions the peritoneum is left dry
The CAPD regimen consists of ______ exchanges a day, with the last exchange dwelling for _______ overnight.
4-5
9 hours average
What are the 3 steps of an exchange and what is the standard time for each one?
- drain (20 min)
flush (5 sec) - fill (10-15 min)
- dwell (4-5 hours) per prescription
What is connectology?
how the tubing is secured to the PD catheter in order to complete an exchange
What connectology can be used to do a CAPD echange?
Fresenius stay safe
Fresenius extension tubing
Baxter Ultra Bag
What does SCALE stand for?
Strength Clarity Amount Leakage Expiration
What is the CAPD exchange process?
Drain
Fill
Dwell
The drain phase takes about 15-20 min depending on the following: (6)
- amount of solution
- gravity
- use of a pump
- diameter of tubing
- position of pt and intra-abdominal pressure
- condition of the system
In which phase does the dialysis take place
dwell
before the fill, flush the system for _____ to remove the air from the tubing and to reduce the amount of air that will travel into the patient. Also shows to reduce the amount of peritonitis in the patients.
5 sec
The fill phase takes about ______ min
10-15
The fill phase is dependent on the following: (4)
- amount of solution
- solution bag height
- diameter of tubing
- intra-abdominal pressure
the dwell time is _______
prescribed
the dwell time is required for _____ and ______.
transport of solutes across the peritoneum
ultrafiltration
The CAPD usual dwell time is :
4-5 hours and 9 average at night
The fluid movement during the exchange process is controlled by
gravity
The following supplies are needed for a CAPD exchange: (12)
- dialysate solution
- PPE
- soap and hand gel
- IV pole
- spring scale
- CAPD flow sheet
- stay safe organizer
- organizer holder
- stay safe cap
10 gauze - Alcavis
- heating pad
When does the initial catheter flush take place?
1 week post insertion
wait 2 weeks if possible
If immediate use of the catheter placement is required, what modifications should take place?
decrease fill amount
protect catheter from trauma
What is a typical flush volume?
500ml
What is the typical dose for a heparin flush?
1ml or 1000u per liter of dialysate
name 3 things that you should observe the effluent for when flushing?
- fibrin ( trauma and infection can increase)
- blood
- Cloudiness (could be infection or reaction to dialysate)
list the warming PD solutions rules and guidelines (5)
- promotes patient comfort and diffusion during procedure
- use a warming pad or other approved warming device (cycler)
- never microwave
- never submerge bag or get wet
- measure temp before exchange and do not administer if over 98.6
list guidelines for PD effluent disposal in home setting for patient care partner
- care partner must utilize Full PPE
- dispose of empty effluent bags and lines in double garbage bags or per city and state regulations.
3, document training of proper effluent disposal in the medical record
Full PPE (gown shield mask gloves) is required for RN when performing exchanges?
true
sampling the PD effluent
When collecting PD effluent, use ______ to obtain _____ and ________ samples
blood culture bottles
aerobic and anaerobic
sampling the PD effluent
Use a second set of _______ bottles to collect effluent for _____ testing.
blood culture
fungi
Fungi culture take _______ to incubate.
3 weeks
Routine PD fluid cultures take _____ to incubate.
5 days
What is CCPD?
Continuous Cycling Peritoneal Dialysis
Form of PD in which the fluid is moved into the peritoneum via a controlled mechanical pump called a cycler.
This technology offers automatic delivery of the whole exchange process and provides increased fluid removal.
What is PD Plus?
When all of the exchanges are delivered via the cycler and occur during the night.
The machine delivers each exchange with a drain fill and dwell typically lasting 1.5 - 2 hours.
The last fill is in the morning and the solution is left for a long daytime dwell
An extra exchange during the day is called a PAUSE
NIPD/IPD therapy consists of:
Intermittent Peritoneal dialysis
more common during an acute or hospital setting or a skilled nursing facility.
During the “dry” period some of the solutes and fluid are reabsorbed back into the bloodstream,
Intermittent PD may be more effective for some patients due to the type of membrane they have known as high transporters.
frequent exchanges prevent the body from reabsorbing too much fluid during the dwell periods.
IP is used on urgent starts as soon as 2 hours post catheter placement
During the _____ period, dialysis is NOT occurring.
DRY
