What Is An Exchange?

On peritoneal dialysis, I do four exchanges a day and they are usually 4 to 6 hours apart.  Some of you have asked what an exchange consists of so I thought I would share it with all of you.  This will be long, so please feel free to skip this post if you are not interested.  An exchange can be broken down in 3 parts:  drain, fill, and dwell.  Here are the steps I take:

Step one -  preparation.  The first thing I do is rinse and dry my hands and then take a paper towel and wet it with a bleach/water solution.  With that I wipe down my prep cart, the fronts and handles of my supply drawers and the IV pole.  After discarding that, I wash my hands normally with soap and water (not the big scrub).  Now, with clean hands, I am ready to lay out my supplies:  4×4 gauze pad, 2 clamps, tape, mini cap and mask.  When the supplies are ready, I put my mask on, set my timer for 3 minutes and do a big scrub on my hands; my nurse says if you don’t scrub for at least 3 minutes, your hands aren’t clean.  I dry my hands, turn off the faucet with a paper towel and throw it away, being careful to not touch the sink or anything else.

I take my dialysis solution bag (there is a better name but it escapes me) from the cooler where it is keeping warm with a heating pad and check it (SEAL) for Strength, Expiration, Amount and Leaks and hang it on the IV pole, being careful not to touch the connecting end.

Step two – connect.  This is where I take a 4×4, open it up and tape the outside wrapper part to my thigh.  At this point I have already untaped the end of my catheter so I pull it from my waist band and lay it on the 4×4.  Next I loosen the connecter end of my catheter and grab the connector end of the IV bag, pull the mini cap off my catheter, pull the connector off the IV bag and connect up being very careful not to touch any of the ends where germs might enter my body.

Step three – drain.  Before I drain, I have to flush air from the lines (one from the IV bag and one to the drain bag which is connected to the IV bag); the way I do this is to break the little cannula on the IV bag, count to five and clamp the line, break the cannula to the drain line and then unclamp my roller clamp that is attached to the catheter – this causes the fluids in my abdomen to drain into the drain bag.

It usually takes me about 12 minutes or so to drain and I know I am about empty when I start to feel a tugging inside, comparable to mild cramps (and sometimes not so mild!).  When I am empty, I close the roller clamp on the catheter and take the clamp off the fill line and put it on the drain line. 

Step four – fill.  Now I open the roller clamp again and I am filling back up.  This takes another 12-15 minutes.  When the bag is empty, it is time to disconnect after I take a second clamp and clamp the fill line. Now I am clamped in three places:  fill line, drain line and rollerclamp (catheter).

Step five – disconnect.  During the drain and fill time I have probably been reading our moving my hair out of my face or touching something so I need to use hand sanitizer on my hands.  When they are dry I take a mini cap and open it up and check to make sure there is a betadine sponge inside it and that it is not dried out.  Now I take the unconnect from the catheter, making sure I hold it pointing down towards the 4×4 making sure not to touch it to anything and place a mini cap on it.  Now I am through and can take off the mask.

Step six – dwell.  The dwell time is the how long the fluid is in my abdomen, passing through the peritoneum and collecting the toxins, usually 4 to six hours.

From this point I have various tasks.  The first exchange of the morning I have to take my blood pressure, weight, temperature and blood sugar.  I also have to take the drain bag and hang it over the toilet to drain and then discard.  I also have to clean up the floor because that is where I have thrown the old mini cap, the IV bag outer wrapper and other trash.  They tell you to throw it in the floor because they don’t want you to try and hit the garbage can and chance touching it – all these habits are extremely important since I can get peritonitis if any germs enter my body through the catheter.  We do not want peritonitis!  Now I roll the empty IV bag up and discard it and get a new IV bag for the cooler, rotating the warmer ones around for the next exchange.

Any questions? 

Tagged as:  exchanges · peritoneal dialysis