Intraperitoneal Medications when on Home Peritoneal Dialysis

Important information:

These instructions will help you safely give antibiotics and heparin through IP administration when needed.

Heparin may be needed for:

• Fibrin is a protein that may appear white, pink, or red and can cause problems with catheter drainage. Use heparin for at least one treatment or until fibrin is cleared.

• Peritonitis is an infection in the abdomen. There is a higher risk of fibrin developing when a patient has peritonitis.

Antibiotics may be needed for these reasons:

• Peritonitis: If there is a suspected infection, antibiotics may be started at home. Diagnosis is confirmed with a cell count and culture. The length of antibiotic treatment depends on the type of infection.

• Contamination: Contact your dialysis team to confirm if antibiotics are needed for possible contamination.

Standard dosing per bag in table below, please contact your dialysis team for any questions.

Instructions for giving medication:

Prepare for the procedure 

1. Wash your hands before touching any of your supplies:

   • Turn on the water.

   • Wet your hands and wrists.

   • Use liquid soap from a pump dispenser. Work up a lather.

   • Scrub your hands thoroughly for at least 20 seconds.

   • Rinse your hands, keeping your fingers pointed downward toward the drain.

   • Dry your hands with a clean paper towel. Use this paper towel to turn off the faucet.

   • Once you have washed your hands, be careful only to touch your supplies. You must wash your hands again if you touch anything else, such as furniture or your clothes.

   • If you prefer, clean your hands using an alcohol-based hand sanitizer.

2. Gather supplies. Check expiration dates of supplies prior to using.

   • Alcohol pads

   • Syringe with needle attached. Use a 10 ml syringe for antibiotics or a 3 ml for heparin

   • 21-gauge needle for flush (1 needle per flush if diluting medication)

   • Use one syringe for each medication, for each bag of dialysate, if applicable.

   • 10 ml normal saline flush (1 flush per vial if diluting medication)

   • Bottles (vials) of medicine, as prescribed

   • A sharps container to throw out the used needle and syringe

   • Trash can

   • Clean exam gloves

   • Dialysate bag(s) for PD treatment

     Antibiotic supplies Cefepime vial 10 ml normal saline flush (dilutant) 21-gauge needle 10 ml syringe with needle attached

     Heparin supplies Heparin vial 3 ml syringe with needle attached

3. Clean your work area

   • Keep pets and other children out of your work area.

   • Don't work in the bathroom. There are too many germs.

   • Clean washable surfaces with soap and water. Dry with a paper towel.

   • Wipe down non-washable surfaces (such as fabric or wood) to remove dust.

   • Spread a clean cloth, paper towel or blue chuck over your work surface.

   • Place your supplies on the clean, dry, covered work surface.

   • Put on a mask and wash your hands again, using step 1 above.

   • If you feel the need to sneeze or cough, turn away from your work surface.

Prepare the medicine

1. Check the label on the bottle to make sure it is the correct medicine and dose. Also check the expiration date.

   • You may have a multi-dose vial or a vial with powder that you mix with liquid.

   • If you will use the medicine more than once, write the date on the vial so you remember when you opened it.

   • Heparin is a multi-dose vial and can be used for 30 days after opening.

2. Remove the protective cap from the bottle. Wipe the rubber top of the bottle with an alcohol pad.

3. Dilute the medication if necessary

   • Remove white cap from 10 ml normal saline syringe and twist on a 21-gauge needle on the end of the syringe.

   • Keep the vial on the surface and inject the needle into the rubber top.

   • For cefepime: Inject the full 10 ml of normal saline into the vial. Remove and discard needle and syringe in sharps container. Swirl the vial until the powder is dissolved.

   • For other medications requiring dilution, contact your dialysis team for instructions.

   • Wipe the rubber top of the bottle again with an alcohol pad.

4. Carefully remove the cover from your other syringe with needle attached.

5. Draw air into the syringe by pulling back the plunger. The amount of air should be the same as the amount of medicine you need to get from the bottle. For example, if you need 10 mL of medicine, draw in 10 mL of air.

6. Insert the needle into the rubber top of the bottle. Push down on the plunger to inject all of the air into the bottle.

7. With the needle still in the bottle, turn the bottle upside down.

8. Keep the needle tip below the fluid level in the bottle.

9. Drawing up medicine Level of medicine Keep the bevel of needle below level of medicine.

   Pull back the plunger slowly until you have drawn up the correct amount of medicine.

10. Keep the syringe tip in the medicine.

11. Tap the barrel of the syringe to check for air bubbles. Push out any air or extra fluid.

12. If you have a lot of bubbles, push the plunger to return the medicine back to the vial. Draw medicine out again slowly and tap air bubbles out. Double check that you still have the right amount of medicine.

13. Remove the needle from the vial.

14. Carefully replace the cap on the needle, being careful not to stick yourself.

15. Repeat for each syringe: One syringe of each medication is needed for EACH dialysate bag. Example: When using 3 dialysate bags, draw up 3 separate syringes of heparin with prescribed dose in each syringe.

Inject the medicine into dialysate bag

• Injecting medicine Needle inserted into dialysate bag med port

  Gather the correct size and number of dialysate bag(s) for nightly PD treatment.

• Clean hands as instructed in step 1 and put on clean gloves.

• Use an alcohol pad to scrub the medication port for 15 seconds, then allow to dry.

• Carefully remove cap from the syringe needle.

• Inject each dialysate bag with the prescribed dose of medication per dialysate bag using the medication syringe with needle attached.

• Gently shake each dialysate bag to mix the medicine evenly.

• Repeat for each dose of medication.

Discard your materials

• Do not re-cap the needle after use.

• Place the syringe and needle in your sharps container. If the needle is attached, point it downward. Follow the instructions for disposing of the container when it is full.

• Throw any other materials in the trash.

Contact your CHOP dialysis team with questions or concerns.

• 8:30am-5:00pm, Monday-Friday call 215-590-2449

• Outside of those hours, and on holidays, call 215-590-1000, ask the hospital operator for the nephrology fellow or nephrology PD RN

Reviewed December 2024 by Rebecca Deady BSN, RN, CDN