GUIDELINES FOR PERFORMING AN INTRAPERITONEAL UROKINASE LOCK

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1 GUIDELINES FOR PERFORMING AN INTRAPERITONEAL UROKINASE LOCK Contact Name and Job Title (author) Directorate & Speciality Jr Sr Vanessa Keill Diabetes, Infection, Renal and Cardiovascular Directorate (Renal Transplant) Date of submission Date on which guideline must be reviewed (this should be one to three years) Explicit definition of patient group to which it applies (e.g. inclusion and exclusion criteria, diagnosis) April 2018 April 2021 Applies to: All peritoneal dialysis patients under the care of the Nottingham Renal and Transplant Unit. Excludes Haemodialysis patients and patients with chronic kidney disease not yet on peritoneal dialysis. Abstract This guideline describes how perform an intraperitoneal urokianase lock. Key Words Statement of the evidence base of the guideline has the guideline been peer reviewed by colleagues? Evidence base: (1-5) 1a meta analysis of randomised controlled trials 1b at least one randomised controlled trial 2a at least one well-designed controlled study without randomisation 2b at least one other type of well-designed quasi-experimental study 3 well designed non-experimental descriptive studies (ie comparative / correlation and case studies) 4 expert committee reports or opinions and / or clinical experiences of respected authorities 5 recommended best practise based on the clinical experience of the guideline developer Consultation Process Target audience Peritoneal Dialysis. Urokianase lock Guideline has been derived based on consensus between medical and nursing staff (Grade 5) Renal Unit Senior Staff Meeting Renal Unit Nursing and Medical Staff This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date. 1

2 NOTTINGHAM UNIVERSITY HOSPITALS RENAL GUIDELINES GUIDELINES FOR PERFORMING AN INTRAPERITONEAL UROKINASE LOCK Produced in Produced in April 2018 Inclusion Criteria: All Peritoneal Dialysis patients under the care of the Inclusion Criteria: All patients under the care of the Nottingham Renal and Nottingham Renal and Transplant Unit Transplant Unit, including patients at on the Dialysis Unit at Sherwood Forest Hospital. Exclusion Criteria: Peritoneal dialysis patients with allergies/hypersensitivity to Urokinase. Any patients where the use of Urokinase is contraindicated. Exclusion Criteria: None. Local Contacts: The CAPD TEAM, Ext Local Contacts: Review Date: April 2021 Review Date: Review/consultation. These guidelines were developed in conjunction with Nursing and Medical Staff within the Renal Unit. These guidelines will be disseminated to all Ward Managers, Nursing Managers, and Nursing Medical and staff Medical within staff the Renal within Unit. the Renal The guidelines Unit. The will guidelines be ratified will and be reviewed ratified and at the reviewed Renal Unit at the senior Renal staff Unit meeting. senior staff meeting. Dissemination and availability of the guidelines. Renal specific guidelines will be available within all the Renal areas at Nottingham University Hospitals NHS Trust and the Dialysis Unit at Kings Mill Hospital. They are also available on the Renal shared area. 2

3 INDICATIONS AND CONTRA-INDICATIONS Poor drainage of peritoneal dialysis effluent and recurrent peritonitis due to coagulase negative staphylococci. Contraindicated if allergic / hypersensitive to Urokinase HAZARDS Check all IP drugs with a second registered nurse prior to starting the procedure. Possible contamination leading to peritonitis. EQUIPMENT LIST Hibiscrub Soap 1x Renal Pack 1x 10 ml syringe Alcohol Hand Rub 1x Ampoule of Urokinase 25,000units (Synerkinase R) 10ml Normal Saline 1 Minicap 2 Green needles Sharps bin ACTION RATIONALE 1. Expose catheter and ensure the miniset is turned off. Exposing the tube now will reduce the number of times needed to wash hands. The miniset should be turned off to prevent leakage. 3

4 2. Put on a plastic apron and wash hands thoroughly in hibiscrub soap. Dry hands thoroughly with paper towel. To prevent contamination and cross infection (Nottingham University Hospitals Trust 2016) Effective hand washing is a pre-requisite to effective aseptic technique (Rowley 2001) ISPD Guidelines/Recommendations Tip renal pack onto a clean trolley, ensuring that the open ends of the pack are uppermost. Open the renal pack carefully, keeping the fingers to the edge of the packs sterile field. Open minicap onto sterile field. ACTION To reduce the risks of contaminating the key parts as highlighted in Rowley (2001). RATIONALE 4. Place opened syringe & needle onto pack. Flip top off Urokinase and place on the edge of the trolley. To prevent contamination later & reduce the number of hand washes. 5 Dissolve 25,000units Urokinase (Synerkianase) with 10mls of normal saline. Discard the needle into the sharps bin. To prepare injection. To prevent needle stick injury. 6 Rub hands with alcohol rub Use a piece of gauze to lift patients peritoneal dialysis catheter & place fully opened sterile field under the catheter. 7 Remove minicap and attach syringe to catheter & open miniset. To prevent contamination. To prepare for Urokinase lock. 8 Inject 6mls of Urokinase down the PD catheter. To ensure the Urokinase reaches the end of the catheter. 9 Close miniset, remove syringe & place minicap on the end of the catheter. To prevent contamination. 4

5 10 Wait for 2 hours and then Perform CAPD exchange (as per protocol) following the relevant procedure. To see if Urokinase lock has been successful and that flow has been restored. REFERENCES Rowley, S. (2001) Aseptic Non-Touch Technique. NTPlus 97 (7) VI-VIII Strippoli P, et al Advanced Peritoneal Dialysis. 1989; 5 : ISPD Guidelines/Recommendations Peritoneal dialysis-related infections recommendations 2016 Pickering et al.urokinase for recurrent peritonitis. Lancet.1987;1: Nottingham University Hospitals NHS Trust, Infection Control Policy 2016 Nottingham University Hospitals NHS Trust, Hand Hygiene Policy 2016 Guidelines for performing a CAPD bag exchange, using the solo system. Nottingham Renal Unit FURTHER READING ISPD Position Statement on Reducing the Risks of Peritoneal Dialysis Related Infections. Nov 2011 Author: V Keill Review Date: April

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