Cut down procedure for peritoneal dialysis patients

N.B – this procedure is only to be used by patients in situations where they are away from their usual base dialysis unit and are unable to attend the nearest alternative dialysis unit (i.e. patients on holiday).

Introduction

A cut down of the Tenckhoff catheter (the tube in your stomach) is a procedure that is required if the Tenckhoff catheter has a hole in it or becomes very thin and fragile. This usually happens where the titanium connector (metal connector) and the Tenckhoff catheter join. It is a sterile procedure, which you will be shown how to do for emergencies on holiday only. If you do not feel able to, or do not want to do this yourself you can take the equipment to the nearest Peritoneal Dialysis (PD) unit and they will be able to do it for you. You will require a contamination dose of antibiotics following the cut down (these antibiotics will have already been prescribed and supplied to you before you travel on holiday). You cannot continue with your dialysis until these instructions have been carried out.

A cut down is required if:

• There is a leak / hole in the Tenckhoff catheter.
• You will also require a contamination dose of antibiotics (Patient leaflet PIN2387).

Equipment required:

• Blue clamp
• Sterile dressing pack (containing dressing towel, sterile gloves, gauze swabs, pot)
• Pack of sterile gauze
• Titanium adaptor (metal connector) which is in two parts; a collar and screw connector
• Sterile scissors or blade
• Betadine antiseptic solution
• Miniset line
• Mini Cap
• Alcohol wipes

The equipment will be provided to you by the home therapies team.

Instructions

1. Using the blue clamp, clamp your Tenckhoff catheter near to your exit site.
2. Wash your hands with soap and water and dry thoroughly.
3. Clean the work surface with the alcohol wipes.
4. Open the sterile dressing pack. Tip out the new Miniset line, Mini-cap, gauze, titanium adaptor and scissors onto sterile towel surface provided by the dressing pack. Pour some betadine antiseptic solution into the sterile pot.
5. Clean your hands with the spectrum wipes. Put on your sterile gloves.
6. Soak a piece of the sterile gauze in the Betadine solution and scrub the area of your Tenckhoff catheter that is going to be cut for two minutes.
7. Wrap a different piece of gauze soaked in the betadine solution around the area of your Tenckhoff catheter to be cut and leave to soak for two minutes.
8. Attach the screw connector section of the titanium adaptor to the new Miniset. Lay it on the sterile towel.
9. Cut the Tenckhoff catheter above the leak or weakness and drop the cut off end. Do not let go of the Tenckhoff catheter.
10. Slip the titanium collar onto Tenckhoff catheter.
11. Insert the titanium screw connector attached to the Miniset catheter into the Tenckhoff catheter.
12. Screw the two parts of the titanium adaptor together.
13. Close the white twist clamp on the Miniset.
14. Take off the blue clamp.
15. Prime the Miniset by releasing the white twist clamp. When the fluid has filled the line close the white twist clamp on your Miniset line.
16. Remove the transparent cap on the Miniset line and replace it with the white Mini cap.
17. You then need to commence the contamination procedure (patient information leaflet, PIN2387) as you require antibiotic cover to prevent peritonitis. Please ask home therapies or C5 ward if you are unsure what you need to do.
18. Return the removed titanium adaptor to the home therapies unit.
19. Inform the Home Therapies team you have performed a cut down procedure.

If you have a leak in your Tenckhoff catheter you cannot continue with your dialysis until you have completed this cut down procedure. Once you have done the cut down you must also have the antibiotics as instructed on the contamination procedure. If you do not follow these instructions correctly you could introduce germs into your catheter which could result in peritonitis.

If you do not feel able to do carry out cut down yourself, please take the enclosed equipment and instructions to the nearest PD unit.

If you have any queries please do not hesitate to contact:

• Home therapies Monday to Friday 09:00 to 17:00 Tel 01223 400184
• Evenings and Weekends C5 ward 01223 217195