How To Perform Continuous Ambulatory Peritoneal Dialysis

Continuous ambulatory peritoneal dialysis (CAPD) is a procedure that filters your blood. To perform this procedure, you will need to fill your abdomen with a fluid called dialysate, and later, you will drain that fluid from your body.

While the fluid is in your abdomen, it will pull wastes, salt, and extra water through the lining of your abdomen (peritoneum) and into the fluid.

This sheet gives instructions about how to perform an exchange for CAPD. An exchange is the process of draining and refilling your abdomen.

Depending on your equipment and other factors, you may need to follow different steps. Always perform exchanges exactly as your health care provider trained you to do them.

Supplies needed:

• Mask.
• Catheter.
• Catheter cap.
• Germ-killing solution.
• Blood pressure machine.
• Fill bag (dialysate bag) with tubing.
• Dry-heat heating pad.
• IV pole.
• Drain bag.
• Y-shaped tubing.
• Sterile dialysis cap.
• Scale (to weigh the drain bag).
• Thermometer.
• Securement device.

How to prepare for an exchange

1. Close doors and windows, turn off fans, and make sure there are no drafts or air currents.
2. Before you wash your hands and handle equipment, put a mask over your nose and mouth. Keep the mask on during each exchange.
3. Wash your hands with a gel or foam. Always wash your hands before you touch any tubing. This is very important for preventing infection.
4. Make sure these things are germ-free (sterile):
   1. The small, thin tube (catheter) that goes into your body.
   1. The catheter cap.
   1. The skin area around the catheter. Use germ-killing solution on this skin.
5. Check your blood pressure if directed by your health care provider.
6. Check the dialysate:
   1. Make sure the bag is the right size and contains the correct mixture. Bag size information is on the label.
   1. Gently squeeze the bag to make sure there are no leaks.
   1. Make sure the dialysate is clear. You should be able to see any writing on the side of the bag through the solution. Do not use a cloudy solution.
   1. Check the label for the expiration date. If it is past the expiration date, throw away the bag and what is in it.
7. Warm the dialysate using a dry-heat heating pad. While you do this, leave the dialysate in the bag with the cover on. Do not use a microwave or hot water.

How to perform an exchange

1. Lie down with your head raised to a comfortable position.
2. Hang the fill bag above the level of your abdomen, on the IV pole.
3. Place a drain bag below the level of your abdomen.
4. Remove the ring of Y-shaped tubing that connects the fill bag to the drain bag.
5. Remove the sterile dialysis cap from the Y-shaped tubing.
6. Uncap the tube that is connected to your catheter (transfer set) and immediately attach it to the Y-shaped tubing.
7. Twist open the clamp on the transfer set. This will cause the fluid in your abdomen to drain through the tubing that goes to the drain bag (the drain line).
8. When the fluid has finished draining, twist-lock the clamp of the transfer set. Then clamp the drain line.
9. Break the seal (frangible) on the tubing that is connected to the fill bag.
10. Make sure your transfer set is still locked.
11. Briefly unclamp the drain line. (You will see air bubbles flow into the drain line when you do this.) Count to 5, and then clamp the drain line again.
12. Twist the transfer set clamp to open it, and allow the dialysate to flow into your abdomen.
13. When all the dialysate has filled your abdomen, twist the transfer set clamp to lock it. Then clamp the tubing that goes to your abdomen (the fill line).
14. Detach the tubing from the catheter and immediately put a sterile catheter cap on the catheter tip of the transfer set. Be careful not to touch the inside parts of the catheter tip or cap.

What to do after an exchange

1. Inspect the drainage. The fluid may look like urine, but it should be clear, not cloudy.
2. Weigh the drain bag on the scale or record the amount of fluid that drained, as directed by your health care provider.
3. If it is the first exchange of the day, check your blood pressure, take your temperature with a thermometer, and take your pulse.
4. Attach the catheter to your skin with the securement device. This prevents the catheter from being pulled.
5. Allow the solution to stay in your abdomen for as long as directed by your health care provider.

Contact a health care provider if:

• You have a fever or chills.
• You feel nauseous or you vomit.
• You have diarrhea.
• You have any problems with an exchange.
• Your blood pressure increases.
• You suddenly gain weight or feel short of breath.
• The catheter seems loose or feels like it is coming out.
• The fluid that has drained from your abdomen is pinkish or reddish. Women having their menstrual period do not need to seek medical care if the fluid is only a little pink or red.
• There are white strands in the dialysate that are large enough to get stuck in your tubing or catheter.

Get help right away if:

• The skin area around the catheter swells or becomes red, tender, or painful.
• There is pus coming from the catheter site.
• The fluid that has drained from your abdomen is cloudy.
• You feel pain or discomfort in your abdomen.

Summary

• Always wash your hands before you touch any tubing. This is very important for preventing infection.
• Contact a health care provider if you have any problems with the equipment, supplies, or process, or if you have symptoms such as fever or chills.