Policy on draining Peritoneal Dialysis to toilet?

[miss_vtRN]

We have a patient at work right now on overnight peritoneal dialysis, something we do not routinely see on my floor. The patient complained that one nurse had him drain into the toilet instead of a collection bag! Always leery of germs and according to the patient's preferance, I set him up to drain into the bag...but the oncoming nurse c/o having to lift the heavy bag in the a.m. and seemed surpirsed that he wasn't draining into the toilet. So I'm confused...What is common practice among those of you with experience in this area? What is your hospital policy on draining peritoneal dialysis? Any EBP/research on this? thanks!

[Eastcoast24]

hmmmm....

I'm not a dialysis nurse, never have been, but aren't you supposed to measure the amount of fluid drained? Kinda hard if you're draining directly into the toilet...

[running_nurse]

I work in Peds and we don't have many PD patients. HOWEVER. When we a PD patient in the hospital (usually a new PD patient), we come in and do the set up and take down. Not sure what system they are using, but the PD machine should measure the Is/Os for you. (Eastcoast24, there is a TON of PD fluid after a night, way too much to measure in a hat...the collection bag is HUGE).

The biggest thing about PD is the risk for INFECTION, ie Peritonitis. Anything we do with our PD patients is sterile sterile sterile. So...when I go in to change a collection bag, I will clamp everything first. I wash my hands for about 5 minutes, sterile glove, mask myself and the patient. Scrub the cath site and the connection site for a few minutes. Connect the new collection bag and put together a new setup if needed.

The old collection bag gets taken care of AFTER I have taken care of everything with the patient in the most sterile environment possible and make sure the system is CLOSED. Then, I take the old bag to the hopper room and flush it down the BIG sink. I would never ever lead a patient to a bathroom and drain their PD fluid. As finicky as dialysis patients are, I'm surprised this patient even let that happen.

Not that cleanliness isn't important in all aspects of medicine, but PD does seem to have a higher risk of infection vs. HD. Only a small percentage of our patients do PD - the rest are HD for one reason or another - and the ones who have been denied PD are the ones who don't live in a clean and stable environment. My boss will make a home visit and determine if PD is suitable or not.

[tony55!]

I am a dialysis nurse, and we do this a my hospital. Just make sure the line is not touching the water in the toilet. it does help the nurse that is discarding the set up not to lift heavy drain bags. The machine calculates the amount of effluent.