Home Choice cycler for Peritoneal Dialysis: Set up, Disconnect, & Disposal Updated 2015 1
Table of Contents Table of Contents... 2 Home Choice Cycler for Dialysis Quick Guide... 3 Have questions not answered in this guide?... 3 Dialysis Pump Set-Up... 4 Obtain your orders... 4 Supplies:... 5 Set Up... 6 Entering your Settings from the MD orders... 8 Loading the Set... 9 The Machine Will Perform a Self-Test... 11 What To Do If The Self-Test Does Not Pass... 11 If You Receive This Error Message... 11 After a successful Prime-Cycler and Self-Test... 11 Connecting Your Drainage Bags... 12 Connecting one drainage bag... 12 Connecting two drainage bags for an adult-sized patient... 13 Connecting Your Dialysate Bags... 15 Connecting one dialysate bag... 15 Connecting up to four dialysate bags... 16 Connecting more than four dialysate bags... 17 Priming... 18 Connecting your patient to the Home Choice Cycler... 19 Initiating Therapy... 21 To Remove A Patient From Therapy... 22 Supplies... 22 Discontinuing Therapy... 22 Care and Maintenance... 23 Tubing Changes... 23 Dressing Changes... 23 Documentation... 23 Troubleshooting... 24 Low Drain Alarm... 24 ULTRAFIL Alarm... 24 2
Home Choice Cycler for Dialysis Quick Guide A doctor s order needs to be in place in order to use the cycler. Keep the cycler plugged in! The cyclers are usually kept in the PICU or 3 Pavilion (3P has a total of 4.) The cycler does not typically run on lower fill volumes (<100 ml) Discharge goals for these patients include all of the following: o Minimum 100 ml fill volume o Effective drain amounts o Stable labs All cyclers should come with a white spiral book of steps called Trouble Shooting Guide for Common Alarms Sponge bathe patients with a PD catheter ONLY. Please do not put these patients in water. Parents and caregivers are taught not to perform baths in tubs. Older patients may take showers. Have questions not answered in this guide? Look at the troubleshooting guide attached to the HomeChoice cycler. Call Dialysis for troubleshooting. o Open Monday through Saturday o Dialysis nurse is on call 24/7 o Dialysis clinic : X3944 3
Dialysis Pump Set-Up The machine calculates the number of cycles and the dwell time. The total volume has to be adjusted up or down to give the correct prescription. If you can t make it work, call the dialysis nurse on-call and they will help you. Obtain your orders: Please remember to obtain your MD order with the following: - Fill volume - Number of Cycles - Fluid Concentration - Last fill (optional) - Hours to dialyze 4
Supplies: Dialysate (Obtained from pharmacy and ordered daily) Drainage Bags (Comes with 2) Standard tubing for patients > 10 kg (Obtain from Stores daily) Low recirculate tubing for patients <10 kg (Obtain from Stores daily) Betadine cap (Mini Cap with Povidone Iodine Solution from stores), Mask, clean gloves 5
Set Up: Bring cycler to the bedside. (It should be on a rolling cart. If not, it needs to be placed at the level of the patient or slightly lower.) Turn the cycler ON. (Power button is on the back right side when facing the cycler.) Cycler should say STANDARD MODE ON then the display should read PRESS GO TO START. DO NOT PRESS GO! o If the cycler doesn t say STANDARD MODE ON, call the dialysis clinic or 3P nurses after hours. This will need to be reset. Place dialysate fluid on top of the cycler in the cradle. Be sure to cover the silver disk. (The heater will warm fluid to body temperature in 10-15 minutes and will not start cycles until it is warm enough.) DO NOT PRESS GO! Arrow down instead. The machine should display CHANGE PROGRAM Instructions continued on next page. 6
Display will read CCPD/IP. o If not, press ENTER and display will begin flashing. Arrow down to correct Program and press ENTER again. Arrow down to begin entering your settings. Please see next page. 7
Entering your Settings from the MD orders: o DEXTROSE Display should say SAME. Arrow up to enter the last fill volume. o Last Fill Volume should display next. Press ENTER. Arrow up or down to select the value ordered. Usually set to 0 for infants, but it may be ordered differently. Press ENTER again. Arrow up to enter fill volume. o Fill Volume will display next. Press ENTER. Arrow up or down to enter the fill volume. Press ENTER again. Arrow up to enter therapy time. o Therapy time should display next. Press ENTER. Arrow up or down to set the therapy time. Press ENTER. Arrow up to enter total volume. o Total Volume (TV) should display. Press ENTER. TV = (ml s per cycle) X (# of cycles) Arrow up or down to enter the TV ordered and press ENTER. Arrow all the way down to enter patient weight. o Patient weight Press ENTER The number will flash. Arrow up or down to enter the patient weight. Press ENTER again to confirm the patient weight. After completing all the options, press STOP. This flash the number of cycles and the estimated dwell time very briefly and will disappear. Press GO and the cycler will display LOW FILL MODE IS OFF. 8
Loading the Set: LOAD SET will display next. Do not attempt to open the door on the pump unless this is displayed! Choose the appropriate tubing for your patient based on their weight. Open the cassette door. Insert the tubing cassette. It is only made to go in one way. Do not force it. 9
Shut the cassette door. The blue cartridge is for holding. Attach to the door as shown with the tubing up. Clamp all tubing other than the ones you are attaching bags to except for the patient line. The patient line should be open to the patient. Press GO. The machine will now perform a self-test. See next page for details on the self-test. 10
The Machine Will Perform a Self-Test: The pump will do a self-test at this point. What To Do If The Self-Test Does Not Pass: If the self-test on the pump does not pass, open and close the cassette door and press GO again or turn the machine off and on. If it does not pass for a second time, call the Dialysis Clinic (X53944) If You Receive This Error Message: System Error 2240: System has detected air in the cassette. This can be resolved by pressing STOP, turn the cycler OFF, wait 10 seconds, and turn the cycler back ON and reload the cassette. After a successful Prime-Cycler and Self-Test: The cycler should display CONNECT BAGS and OPEN CLAMPS. 11
Connecting Your Drainage Bags You will be connecting your drainage bags first. See next page to connect two drainage bags. Connecting one drainage bag Remove one of the drainage bags from the package. Clamp the big clamp on the drainage bag. If you don t clamp it, you will have a huge mess! Connect the drainage bag to the tubing on the far right of your blue cartridge. Remove the clear cap and spike your drainage bag. Your drainage bag is now connected. 12
Connecting two drainage bags for an adult-sized patient Remove both of the drainage bags from the package and have an APD Drain Manifold ready. Clamp the big clamps on each drainage bag. If you don t clamp it, you will have a huge mess! 13
Connect one side of the APD Drain Manifold to the drainage bag by spiking it. Repeat the previous step with the second drainage bag. They will now both be connected via the manifold. Locate the tubing on the far right of your blue cartridge. Remove the clear cap and spike the remaining end of the manifold to connect your two drainage bags. Once your drainage bag(s) are connected, make sure to open the clamps that will allow effluent and dialysate to flow to your bags. You will be connecting your dialysate bags next. 14
Connecting Your Dialysate Bags Wash your hands and put on clean gloves. The cycler will still display CONNECT BAGS and OPEN CLAMPS Regardless of how many bags of dialysate you have, the solution with the highest concentration will sit on the heater. Connecting one dialysate bag Connect to dialysate bag on heater next. Locate the tubing that is now on the far right of your blue cartridge. Still Open! Take the clear cap off of the tubing and connect it to the dialysate bag that is to sit on the heater. Open the clamp. 15
Connecting up to four dialysate bags If the patient uses more than one dialysate bag, connect any extra bags (up to four) to the extra tubing remaining on your cartridge. The fluid with the highest concentration will be placed on the heater. 16
Connecting more than four dialysate bags Obtain a 5-prong manifold. You should have one remaining tubing set on your blue cartridge. Attach the 5-prong manifold to one of the remaining tubing sets on your blue cartridge. Attach any additional dialysate bags at this time. Remember to break the frange on your dialysate tubing. Be sure to open all clamps on tubing connected to bags. Always leave any tubing clamped that is not being used. 17
Priming Press GO after all of the clamps are open and the machine will start priming. This may take a few minutes. Machine will say PRIMING 18
Connecting your patient to the Home Choice Cycler: After priming the patient will be ready to be connected to the Home Choice Cycler and will display CONNECT YOURSELF. CHECK PATIENT LINE. Discard your old gloves. Put on your mask, wash your hands, and put on a set of new, clean gloves. Locate the tubing that goes from the cassette to the patient that is on the far left of the blue cartridge. Place this in the bed. Locate the patient transfer set. Hold the transfer set in one hand and the machine s patient line tubing in the other. Do NOT let go of either during the procedure. Pull the tab off of the machine s tubing without touching the end of the connection. Remove the Mini-Cap (betadine cap) that is on the patient s transfer set. 19
Connect the machine s tubing to the patient catheter with a screwing motion. You should also feel a click. Open the white roller clamp. Press GO. 20
Initiating Therapy: Display should say INITIAL DRAIN This is the initial drain and the cycler is attempting to remove any fluid remaining in the patient prior to initiating the fill volume. During this time, you may reposition patient for optimal draining, check tubing, etc. You might not have drainage at this time. Wait 7 minutes. The pump may read a negative number and attempt to put fluid in to see if it can initiate drainage (similar to irrigation ). The cycler will do this independently. You do not need to do anything but reposition if it helps. When the patient is empty, you will have to wait until the cycler alarms to be able to arrow down to bypass the initial drain. If you attempt to do this before, it will restart the cycle and you will be unable to bypass. It will attempt to drain again for 7 minutes. Display will now read FILL 1 OF X The number of fills will vary depending on what the MD ordered. You may also get a message that the fluid is still warming. If so, just wait and the fill will start automatically. The cycler will start on its own. Once the cycler is finished with the fill cycle amount, the display will read DWELL 1 OF X The number of dwell cycles will vary based on the MD order. The cycler will continue to FILL/DWELL/DRAIN until dialysis is complete. The cycler only alarms when it can t complete the functions. If you experience any alarms, please refer to the troubleshooting manual connected to the cycler or later on in this reference. 21
To Remove A Patient From Therapy: Supplies: Mask New Mini-Cap (betadine cap) Non-sterile, clean gloves Discontinuing Therapy: At the end of treatment, the display will read END OF THERAPY. 1. Mask and wash your hands. Apply clean gloves. 2. Twist white roller clamp on tubing. 3. The cycler will read TREATMENT COMPLETE. 4. Press GO on the cycler. Walk through the steps dictated by the machine until it says DISCONNECT YOURSELF. 5. Disconnect the tubing from the patient catheter. a. Do NOT clean around the connection before or after unhooking. b. Keep the tubing and catheter sterile by holding it and placing the betadine cap to maintain clean technique. 6. Place the new Mini-Cap (betadine cap) by screwing it on until it is flush with the transfer set. 7. The cycler will read TURN ME OFF. 8. Remove the cassette prior to turning the cycler off and then turn the cycler off using the power button. 9. Throw away all used supplies. (Refer to Policy #IN-32) 22
Care and Maintenance Tubing Changes: Dressing Changes: All lines, fluid, and tubing used on the Home Choice cycler are new every day or for every treatment. (Refer to Policy #IN- 32) For new catheters, it is ideal to leave dressings undisturbed for 5-7 days. If it is visibly soiled or wet, it may need to be changed sooner. Do not apply a Biopatch and do not use Chloraprep. Use Shur- Clens. Dressings are changed every 24-48 hours to assess the site, regardless of visibility (soiled). For dressing change procedures, please refer to policy number PS 654. Documentation While the patient is on the cycler, it keeps a running total of the ultrafiltrate. On the flowsheet- Level 1 Column UF Record final out. At the end of the last cycle, record your totals. 23
Troubleshooting Low Drain Alarm The machine attempts to get at least 85% of the fill volume back. If it is unable to, this message will appear. To fix: Press STOP then GO and the cycler will attempt to drain again. Check for kinks. The patient may need to be repositioned. If it continues, arrow down to bypass and the cycler will move on to a fill cycle. This may take a few times before it responds. You are able to bypass lo drain alarms until you reach negative 50% of the fill volume. Then the machine will not let you continue with treatment. It will give you a Negative UF Alarm. ULTRAFIL Alarm If the above alarm continues with the next cycle and/or the drainage number becomes negative greater than 50% of the fill amount, the machine will display ULTRAFIL 3 and the display buttons will freeze and you will be unable to bypass any longer. 24