CHECKLIST ON
CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD)
Name: Group:
Date: Date Inclusive:
Preparation 4 3 2 1 0
1. Switch on the light switch off the fan and AC
2. Close door and window
Materials needed – Items before the therapy
Hand disinfectant
CAPD record book
Blood pressure monitor
Weighing scale
Alcohol wipe
Dialysis solution with drain bag attached
Mini cap (x2)
Surgical mask
Basin
PROCEDURE 4 3 2 1 0
1. Measure your blood pressure and pulse rate, weight
2. Record your blood pressure and pulse rate in the CAPD record book
3. Put on surgical mask
4. Wash your hands thoroughly with soap
5. Dry your hands completely with a clean paper towel
6. Clean the table with an alcohol wipe
7. Clean the drip stand and weighing scale with an alcohol wipe
8. Check the following on the dialysis solution
Check the concentration – Dianeal Low Calcium (2.5 meq/L)
- Peritoneal dialysis solution with 1.5 dextrose hydrose
USP
Check the expiry date
Check the volume of the dialysis solution – 200ml
9. Check for leaks in the dialysis solution
10. Check for ring
Green pull-ring
Frangible seal
Clamps
11. Perform the 7 steps handwashing
12. Dry your hands completely with a clean paper towel
13. Tear the outer part of the dialysis solution
14. Hang the dialysis solution in the drip stand
15. Separate the attached drain bag from the dialysis solution
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16. Separate the lines and hang the patient connected end on the drip stand
17. Pull both the blue and white clamps down and close them
18. Check that the green pull-ring and frangible seal are intact
19. Check that the dialysis solution is clear
20. Squeeze both sides of the dialysis solution to check for leaks
CONNECTION
1. Take out your transfer act from your waist pouch
2. Perform the 7-step hand washing
3. Dry your hands completely
4. Remove the green pull-ring by pulling it outwards and dropping it
5. Remove the mini cap from your transfer set carefully and drop it
6. Connect the patient connector to your transfer set securely
7. Place the drain bag into a basin
DRAINING
1. Open the twist clamp on your transfer set in an anti-clockwise direction
2. Open the white clamp on the drain line
3. Draining takes about 20 minutes to complete
4. While the draining is taking place, record the following in the CAPD record book-
Time and percentage of dialysis solution
5. After 20 minutes, draining is complete
6. Lose the twist clamp on your transfer set in a clockwise direction
7. Close the white clamp on the drain line
8. Weigh the amount of the drainage
9. Check the clarity of the drainage
10. Record the following in the CAPD record book
Amount of drainage
Time taken to drain
Clarity of drainage
Balance calculation
FLUSHING AND FILLING
1. Break green frangible seal on the dialysis solution
2. Open the white and blue clamps and do a count from 1-5
3. Close the white and blue clamps after the connecting ends
4. Open twist clamp on your transfer set in an anti-clockwise direction
5. Open the blue clamp on the fill line
6. Filling of the new dialysis solution takes about 8-10 minutes is completed
7. Once the filling is completed
Close the twist clamp on your transfer set in a clockwise direction
8. Close the blue clamp on the fill line
9. Record the following in the CAPD record book
Volume in
Time taken to fill
DISCONNECTION
1. Place 2 mini caps on the table
2. Check the expiry date of the both mini caps
3. If you are performing therapy yourself
Perform a double 7-step hand rub using the hand disinfectant
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4. If you are a caregiver: Perform the 7-steps of hand washing
Dry your hands with a clear paper hand towel
Open mini cap package
Check for presence of iodine sponge
The other mini cap will only be used if the 1st mini cap is contaminated in a way
Remove the patient connector from your transfer set
Close your transfer set with the new mini cap securely
Put your transfer set back into your waist pouch
Empty the contents in the drain bag and flush it down to the toilet
END OF THERAPY
1. You have completed your therapy
_______________________________ ________________________
Student’s name and signature CI’s Signature
Grading system:
4 – very satisfactory 3 – satisfactory 2 – good 1 – needs improvement 0 – not performed
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