How to Add Antibiotics to the PD Solution Bags

Gather these supplies and place them on a clean surface:

• Antibiotic
• Sterile Water vials if needed
• Syringes and needles
• Alcohol swabs
• Mask and gloves
• Dialysate bags – 2 L (liter) cycler, 3L cycler, 5 L cycler, 1.5 L Ultrabag, 2.5 L Ultrabag

Check the bag(s) of dialysate for:

• Solution (dextrose concentration)
• Expiration date
• Amount and appearance (Is there anything floating in the solution?)
• Leaks

Check medicine and sterile water vials for:

• Expiration date
• Flip top securely in place and vial intact (means it has not been tampered with)

There may be times you will need to mix a powder antibiotic with sterile water to turn the medication into a liquid form. This liquid form will allow you to add the antibiotic to the dialysate bags.

1. Put on a mask.
2. Wash your hands and wear gloves.
3. Scrub the top of the sterile water vial with an alcohol swab for 15 seconds, let dry for 15 seconds.
4. While the sterile water vial is drying, scrub the top of the antibiotic vial with an alcohol swab for 15 seconds. Let dry for 15 seconds.
5. Add about 5 mLs of air to the sterile water vial.
6. Draw 10 mLs of sterile water into the syringe and add it to the powdered antibiotic vial.
7. Gently mix by rolling the vial between your hands or using a “swirling” motion. It must become clear.
8. Draw antibiotic into the syringe to be added to the dialysate bag(s). See the Pharmacy Medication Label for the right dose (amount) of antibiotic to add to each bag.

Some antibiotics are in premixed vials (already in liquid form).

1. Put on a mask.
2. Wash your hands and wear gloves.
3. Scrub the top of the liquid antibiotic vial with an alcohol swab for 15 seconds, let dry for 15 seconds.
4. Add about 1 mL of air to the premixed vial
5. Draw antibiotic into the syringe to be added to the dialysate bag(s). See the Pharmacy Medication Label for the right dose (amount) of antibiotic to add to each bag.

1. Put on a mask.
2. Wash your hands and wear gloves.
3. Line up all the bags on the clean surface.
4. Scrub each medicine port on the bags with an alcohol swab for 15 seconds, let dry for 15 seconds.
5. Insert the needle of the syringe into the medicine port at the inner circle mark (looks like a bullseye). If it feels hard to push the needle in, then pull back and gently try again. Be sure not to push the needle through the side of the medicine port.
6. Once the needle is in place, push on the syringe plunger to add the antibiotic to the bag.
7. Remove the needle from the bag and throw the whole syringe in the appropriate sharp’s container.

Use one syringe for each antibiotic/medicine for each bag of dialysate. (For example, if you are using 5 bags, you will need 5 syringes for each antibiotic.)

1. Put on a mask.
2. Wash your hands and wear gloves.
3. Set up as you normally do. Remember to gently shake the bags to mix the antibiotics.
4. Start your dialysis routine no sooner than 3 to 6 hours after giving the loading dose of antibiotics.
5. Take antibiotics with each dialysis as instructed—do not miss a dose.
6. Finish all days of antibiotic therapy even if your child is feeling better.
7. Your child may also be instructed to take an antifungal medicine orally (by mouth) while on the antibiotics.

1. Put on a mask.
2. Wash your hands and wear gloves.
3. Prepare antibiotics following “How to Add Antibiotics to the PD Solution Bags.” You will be using an Ultrabag for a loading dose. Do Not Use a cycler bag.
4. Flush your child’s peritoneal cavity.
5. If connected to the cycler, disconnect from cycler then connect to the Ultrabag with no antibiotics added and do some in and out flushes.
6. If not connected to cycler, then connect to the Ultrabag with no antibiotics added and do some in and out flushes.
7. Disconnect from the Ultrabag used to flush.
8. Connect to the Ultrabag containing the antibiotics.
9. Drain any leftover flush solution.
10. Then using normal fill volume, instill dialysate solution with antibiotics.
11. Clamp.
12. Disconnect and cap PD (peritoneal dialysis) catheter with MiniCap.
13. Antibiotic needs to dwell for 3 to 6 hours or per instructions from Nephrologist.

Gather these supplies and place them on a clean surface:

• Heparin vials
• Syringes and needles
• Alcohol swabs
• Mask and gloves
• Dialysate bags – 2 L (liter) cycler, 3L cycler, 5 L cycler, 1.5 L Ultrabag, 2.5 L Ultrabag

Check the bag(s) of dialysate for:

• Solution (dextrose concentration)
• Expiration date
• Amount and appearance (Is there anything floating in the solution?)
• Leaks

Check medicine and sterile water vials for:

• Expiration date
• Flip top securely in place and vial intact (means it has not been tampered with)

The heparin vial is premixed.

1. Scrub the top of the heparin vial with an alcohol swab for 15 seconds, let it dry for 15 seconds.
2. Add about 1 mL of air to the heparin vial and then draw heparin into the syringe to be added to the dialysate solution bag. See the Pharmacy Medication Label for the right dose (amount) of heparin to add to each bag.

1. Put on a mask.
2. Wash your hands and wear gloves.
3. Line up all of the bags on the clean surface.
4. Scrub each medicine port on the bags with an alcohol swab for 15 seconds, let dry for 15 seconds.
5. Insert the needle of the syringe into the medicine port at the inner circle mark (looks like a bullseye). If it feels hard to push the needle in, then pull back and gently try again. Be sure not to push the needle through the side of the medicine port.
6. Once the needle is in place, push on the syringe plunger to add the heparin to the bag.
7. Remove the needle from the bag and throw the whole syringe in the appropriate sharps container.

1. Set up as you normally do. Remember to gently shake the bags to mix the heparin.
2. Start your dialysis routine as you normally do.
3. When therapy is complete, discontinue as you normally do.

1. Put on a mask.
2. Wash your hands and wear gloves.
3. Flush your child’s peritoneal cavity. This can be done one of two ways:
4. If connected to the cycler, leave connected and bypass the dwells.
5. If not connected to cycler, then connect to the Ultrabag and do some in and out flushes.
6. Disconnect from the cycler or Ultrabag used to flush.
7. Connect to the Ultrabag containing the antibiotics.
8. Drain.
9. Use normal fill volume. Clamp.
10. Disconnect and cap PD (peritoneal dialysis) catheter. Needs to dwell for 3 to 6 hours.