How To Perform Continuous Cycling Peritoneal Dialysis

How To Perform Continuous Cycling Peritoneal Dialysis

Continuous cycling peritoneal dialysis (CCPD) is a procedure that cleans your blood.

Continuous Cycling Peritoneal Dialysis (CCPD) is a form of peritoneal dialysis (PD) used to treat patients with end-stage renal disease (ESRD) or chronic kidney failure. It is one of the modalities of peritoneal dialysis, along with continuous ambulatory peritoneal dialysis (CAPD).

In CCPD, a machine called a cycler is used to perform automated exchanges of dialysis fluid (dialysate) during the night while the patient sleeps. The cycler controls the inflow, dwell time, and drainage of the dialysate, which allows for more frequent exchanges compared to CAPD. The treatment typically involves multiple cycles throughout the night, providing continuous dialysis and effective removal of waste products and excess fluids from the body.

To do this procedure, you will need to set up a machine. While you sleep, the machine will fill your belly (abdomen) with a fluid called dialysate.

Later, the machine will drain the fluid from your belly.

Continuous cyclic peritoneal dialysis (CCPD) is based on the concept of continuous equilibration dialysis proposed by Popovich et al., but incorporates the automation provided by a cycler.

CCPD uses multiple short nocturnal exchanges, while the patient is connected to the cycler and a long diurnal exchange with the patient ambulatory.

Thus, it is a virtual reversal of the CAPD schedule.

The primary objective of CCPD is to provide automated, continuous peritoneal dialysis in a convenient manner, freeing the daytime hours from all procedures. The secondary goal is to reduce the rate of peritonitis.

This article gives you instructions for how to do CCPD.

Always do this procedure exactly as you were told by your doctor.

Why is Continuous cyclic peritoneal dialysis done? What are the indications?

Continuous cyclic peritoneal dialysis (CCPD) was designed to reduce the high incidence of peritonitis and eliminate the multiple interruption created by dialysis exchanges during the day needed for CAPD, while maintaining the quality of dialysis.

Three nocturnal cycles with 2 liters of dialysate lasting 3 hours each are provided by an automated cycler while the patient sleeps.

What are the Supplies needed for Continuous cycling peritoneal dialysis?

• Mask.
• A thin tube that goes into your body (catheter).
• Germ-free (sterile) catheter cap.
• Germ-killing solution.
• Blood pressure machine.
• Bags of dialysate.
• Cassette and tubing.
• Dry-heat heating pad.
• CCPD machine (cycler).
• Drain line.
• Thermometer.
• Tape to attach the catheter to your skin.

How to get ready

1. Close doors and windows. Turn off any fans. Make sure there is no air leaking into the room (draft).
2. Put a mask over your nose and mouth.
3. Wash your hands with a gel or foam. Always wash your hands before you touch any tubing.
4. Make sure these things are free of germs:
   1. The thin tube that goes into your body (catheter).
   1. The cap for your catheter.
   1. The device that attaches the fluid bag and tubing to the catheter (adapter).
   1. The skin area around the catheter. Use a germ-killing solution to wash that skin.
5. Check your blood pressure if told by your doctor.
6. Check each bag of dialysate.
   1. Gently squeeze the bag to check for leaks.
   1. Look at the color of the fluid. It should be clear. Do not use cloudy fluid.
   1. Check the label to make sure that:
      1. The bag has the right mixture.
      1. The bag is the right size.
      1. The dialysate is not old (expired). Do not use the bag if the date on it (expiration date) is older than today’s date. If it is old, throw away the full bag.
7. Make the bag warm.
   1. Do not use a microwave or hot water to make the bag warm.
   1. Use the dry-heat heating pad. Leave the cover on the bag while you make it warm.
8. Make sure the machine is set up and programmed with your settings. Follow the instructions on the machine.

How to start a cycle

1. When you are ready for bed, attach the bags to the machine. Use exactly the number of bags your doctor told you to use.
2. Find the cassette. The cassette has tubing that connects to:
   1. Each bag.
   1. The tube that goes to your body (patient line).
3. Attach a tube from the cassette to each bag that you will be using for the night. If there are extra tubes on the cassette, clamp them.
4. Put the cassette with tubing into the front of the machine.
5. For each dialysate bag that you need for the night:
   1. Put the bag on the warming pad of the machine.
   1. Take the bag off of the warming pad. Pull the ring on its tubing.
   1. Attach the bag to a tube of the cassette.
      1. Connect the first tube to the first bag.
      1. Connect the second tube to the second bag.
      1. Keep putting bags together with tubes until each bag is connected to a tube.
   1. Break the seal (frangible) on the tubing of the bag.
6. Connect the drain tubing to the drainage system on the machine.
7. Make sure the tubing that drains fluid from your body (the drain line) can reach the toilet. Waste fluid will flow into the toilet during the cycle.
   1. Do not let the open end (tip) of the drain line touch the water in the toilet.
   1. Lay the tip of the drain line on the edge of the toilet seat.
8. Lie down with your head raised to a comfortable position.
9. Start the machine.
10. Connect yourself when the machine tells you to do that.
11. Use one hand to remove the pull ring from the tube that goes to your body (patient line).
12. Take the cap off the tube that is connected to your catheter (transfer set). Connect it to the tube that goes to your body.
13. Twist open the clamp on the tube that is connected to your catheter.
14. Press “GO” on the machine.

How to finish a cycle

1. In the morning, record all volumes and times that are shown on the machine.
2. Press “GO” on the machine.
3. Close all the clamps when the machine tells you to do that.
4. Close the twist clamp on the tube that is connected to your catheter.
5. Clamp all the tubes that go to the machine.
6. The machine will tell you:
   1. To disconnect the tube that goes to your body from the tube that goes to your catheter.
   1. To put the cap on the tube that goes to your catheter. Do not touch the inside parts of the cap or the catheter tip.
7. Use catheter-holding tape to attach the catheter to your skin.
8. Check your blood pressure, temperature, and heartbeat.
9. Throw away the empty bags and tubing as told by your doctor.

Contact a doctor if:

• You have a fever or chills.
• You feel sick to your stomach (nauseous).
• You throw up (vomit).
• You have watery poop (diarrhea).
• Your blood pressure goes up.
• You suddenly gain weight.
• You suddenly feel short of breath.
• The catheter seems loose, or feels like it is coming out.
• The fluid from your belly is pink or red. (Women in their period do not need to tell the doctor if the fluid is only a little bit red or pink.)
• You see some things in the catheter or tubing that look like white strings.
• You have any problems with the machine.

Get help right away if:

• You have belly pain.
• The fluid that drained from your belly is cloudy.
• You have any of these problems in the catheter area:
  • Pain, redness, or soreness.
  • Swelling.
  • Pus.