Connecting to the Baxter Cycler

I'll go step-by-step. People who love excruciating detail will appreciate this post.

After taking a shower, cleaning the exit site of the catheter on my abdomen, drying off, and getting dressed, I start the process of getting hooked into the peritoneal dialysis (PD) machine. 

Supplies

  • 1 HomeChoice Baxter PD machine
  • 1 Cassette Tubing for cycler
  • 3 Dialysis Solution Bags
    • 6L 1.5% Dextrose
    • 3L 1.5% Dextrose 
    • 2L 7.5% Icodextrin
  • 1 Mask
  • 1 15L Drain Bag
  • 1 Bottle of Alcavis 50 High Level Disinfectant
  • 2" x 2"  Clean Gauze
  • Hand Sanitizer
  • Plastic Urinal for overnight use

Procedures (Total time is about 20 minutes): 

1. Make sure my hands are clean. Since I've just taken a shower, they should be, but I'll often use hand sanitizer anyway.


2. Open the solution bags and check for "SEAL" (Strength of solution, Expiration date, Amount, and Leaks).

3. Place the 6L 1.5% Dextrose bag on the cycler machine.

4. Turn on the cycler.

5. Wait for the LCD screen to show "PRESS GO TO START"
     a. Press GO button. It'll make a loud beep sound. Sometimes you need to press the GO button twice)

6. The screen will say "LOAD THE SET"
     a. Remove the cassette tubing from its sealed bag, and close all 6 clamps on the tubes.
     b. Open the load door and place the cassette inside. Close the door.
     c. Place the blue organizer of the tubes onto the front of the closed door, fitting it on both notches.
     d. Open the drain bag and close only the large white clamp on the bag, and spike the drain line from the cassette into the bag.

7. Press the GO button. The screen will say "SELF TESTING." Wait 2-3 minutes while the machine goes through this testing of the lines. Use this time to roll up the plastic bags that held the dialysis solution bags, and put them in a box for recycling later.

8. Put on my mask and wash my hands with the hand sanitizer.

9. When the screen says "CONNECT BAGS & OPEN THE CLAMPS"
     a. Connect the tubing line with the RED clamp to the heated bag, which is the 6L bag on top of the cycler. Break the frangible on the bag. Make sure it's fully broken.
     b. Connect the line with the first WHITE clamp to the 2nd solution bag, the 3L 1.5% Dextrose. Break the frangible on this bag. Make sure it's fully broken.
     c. Connect the line with the BLUE clamp to my last bag, the 2L 7.5% Icodextrin bag. Break the frangible on this bag. Make sure it's fully broken. *
     d. Open clamps for the Solution bag lines and the patient line on organizer at the far left.

10. Press the GO button. The screen will say "PRIMING" and the machine will prime all the lines. This takes about 7 minutes, so I'll go brush my teeth, floss, put on my retainer, and trade my contact lenses for my glasses.

11. When "CONNECT PATIENT" and "CHECK PATIENT LINE" alternate appearing on the screen:
     a. Use hand sanitizer to clean my hands
     b. Take out a 2" x 2" gauze and dispense some Alcavis 50 on it.
     c. Use that gauze to scrub the still-closed minicap on the transfer set part of my PD catheter.
     d. Connect my transfer set to the patient tubing line CAREFULLY and ASEPTICALLY by removing the pull ring from the patient line, removing the minicap and then immediately connecting the transfer set to the patient line. Woohoo!! I am now connected!
     e. Press GO button. The screen will say "INITIAL DRAIN"

12. After initial drain, the treatment begins. The whole treatment for me takes about 9 hours.

Many thanks to my main nurse Suchen at Satellite Wellbound in Mountain View for writing up the guidelines which I've adapted for this post.

* I repeat and three-peat this note about checking that the frangibles are fully broken because even though, in theory, the machine should be able to detect a bag's solution not running through the tubing while the machine is working, and then sound a beeping alarm and display the problem, this was definitely not the case for me once.
     The last night of Coachella this year, I returned to my room exhausted, and neglected to fully break the frangible on the 2nd bag. The next morning, I noticed that the bag was still full and I hadn't received any of that dialysis. I spent the afternoon on the drive back to the bay area feeling quite weak and only able to do the bare minimum in terms of walking and moving around. Make sure those frangibles are broken!)