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     Good Morning, when training patients our nursing team has always taught the learners to do a 20 second hand wash with antibacterial soap and water and drying with clean paper towel, before gathering supplies and proceeding with their capd exchange or setting up their cycler. During the exchange procedure and cycler set up we instruct the patients to reinforce the cleanliness of their hands by using sanitizer (after masking) before any sterile connection or disconnection moments. I spoke to a Nurse yesterday who was teaching a patient that if the patient thought her hands weren't soiled, she didn't need to wash with soap and water before gathering her supplies, but to just use sanitizer. My colleague's rational was that our hospital policy stated sanitizer is the superior choice over antibacterial soap and water for "unsoiled hands" and that as this is hospital policy, this should apply to PD patients as well. Is there a best practice guideline for performing PD exchanges that clarifies hand hygiene methods and procedure?
    ANSWEREDKaren A. answered March 8, 2023
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     In order for the patient to start their PD therapy at home, it is requested that they have a safe area; however, the imprecision of the term has given rise to a great variety of criteria, where the remodeling of the space (walls, floors and furniture) has been requested. This situation sometimes delays the start of home therapy, because patients do not have the support or resources for such modifications and during that time intermittent dialysis is performed in the hospital, with the risks that this represents. So, is there any guide or evidence that specifies the minimum conditions to consider a safe space for home PD?
    ANSWEREDAna Miriam Cabrera Delgado answered February 13, 2023
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     I'm an educator at a providence hospital in Portland, Oregon and am looking for best practices/procedure for instilling alteplase in PD catheters for obstructions. From our own personal literature review, we've notice most of the literature is for the early 2000s. Does anyone have more current resources we can utilize to understand best practice for this intervention as we review our current process?Thanks!Allison Young MSN, RN, CMSRN
    ANSWEREDallison young answered December 11, 2022
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     I have a new PD patient keep having negative UF 24H urine output <500mL and became fluid overloaded after5 days had to do 1 time back up hemodialysis (he still has a fistula/had been on ICHD for 2 years) , days after I check and did an initial membrane test and resulted to high transport type (cant do PET yet he barely started) , decreased dwell time around 1.5 hours 2 days after changes reviewed treatment still every cycle he has about 3/5 cycles still negative UFs, I had removed last fill on the second prescription change that I did because that made this pt overloaded and absorbs it after long day dwell, what prescription would you recommend?
    ANSWEREDKimberly Flores answered April 22, 2022
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     In our home program, we have been practicing IP antibiotics administration for treatment for peritonitis on our PD patients. We have a new supervisor that is saying that we are not allowed as nurses to mix Abx with dianeal solutions and should be done by pharmacist. She has minimal experience with PD– performing exchanges for patients in an acute setting in the hospital. Has anyone ran into any of these issues before? Where can we find the answer and or source to show her that this is allowed practice?
    ANSWEREDMary C answered April 6, 2022
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     Baxter Healthcare recently sent out an Urgent Medical Device Correction notification (Jan 2022) regarding the MiniCap Extended Life PD transfer sets and the use of cleaning products causing damage if come into direct contact (hand sanitizer, hydrogen peroxide, bleach, alcohol, or antiseptic agents, solvents used to remove adhesive residue). It has been our policy to cleanse the exterior portion of the transfer set prior to connection and disconnection with Alcavis. Due to the recent notification we have stopped this practice but are hoping to find out what others are doing in replace of this practice. We have been told Povidone Iodine or soap and water are both acceptable to clean the transfer set and catheter. Patients that shower daily, this can take place while in the shower but what about the patients that are not bathing daily, what would be an alternative to cleaning the transfer set and catheter? Any thoughts or suggestions would be greatly appreciated.
    ANSWEREDCarla M. answered February 1, 2022
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     Hi, I have a patient with severe intellectual impairment who has ESRF and embarking on RRT. Swimming is enjoyable activity for this young man . His mum will be doing his dialysis and thought of doing HD is very overwhelming for mum. I wanted to know what are the recommendations around swimming and PD, once the exit site has healed. he will be swimming in both public and private pools. Is it an absolute contraindication? Can it be pursued with use of colostomy bags and meticulous exit site cares. Thanks for letting me know. Reshma
    ANSWEREDReshma Shettigar answered August 24, 2021
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