PERITONEAL DIALYSIS UNIT RENAL DEPARTMENT

SGH PD WPI 097 Workplace Instruction

PERITONEAL DIALYSIS (PD) – PERITONEAL EQUILIBRATION TEST (PET)

Cross references NSW Health PD2017_013 Infection Prevention and Control Policy
NSW Health PD2017_026 Clinical and Related Waste
Management for Health Services
NHMRC Australian Guidelines for the prevention and control of
Infection in Healthcare
SGH-TSH CLIN027 Aseptic Technique - Competency and
Education Requirements
SGH-TSH CLIN411 Venepuncture And Blood Collection –
Accreditation Guidelines
SGH PD WPI 217 Continuous Ambulatory Peritoneal Dialysis
(CAPD) Freeline Solo Exchange Procedure
SGH PD WPI 216 Automated Peritoneal Dialysis (APD) Connection
And Disconnection Procedure – Claria Dialysis Machine
SGH PD WPI 143 Peritoneal Dialysis (PD) – Manual Drain With A
Drain Bag (Ultra Set)
1. Purpose To ensure the process of peritoneal equilibration testing (PET) is
performed correctly and according to best practice guidelines

2. Process
Peritoneal Equilibration Test or PET is the assessment of peritoneal membrane transport
function (of fluid and solutes) in patients on PD. This test determines solute equilibration and
peritoneal membrane transport rates through measurement of dialysate to plasma ratio at
specific times during dialysate dwell. Initial PET should be completed between 4 to 8 weeks
after commencement of maintenance PD therapy. Repeat or subsequent PETs may be
requested by the renal doctors if a change in peritoneal membrane transport function is
suspected or when clinically indicated.

2.1 DEVICES
2.1.1 Equipment
 PET form (see Appendix A)
 PET Patient Information Sheet (see Appendix B or C)
 Alcohol swabs
 Micropore tape
 Patient Labels
 Tourniquet
 Cotton Balls
 Pathology request forms
 Patient labels

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2.1.2 Key parts

 Drawing-up needle (18G)
 23 G needle
 21 G needle
 Specimen jars
 20mL syringe
 Vacutainer Needle
 Vacutainer Needle Adapter
 Biochemistry blood tube
 PD fluid
 Minicap

2.1.3 Key site

 Rubber bung on PD fluid/drain bag
 Abdominal PD catheter

2.2 PREPARATION
1. Schedule PET 4 weeks after commencement of maintenance PD. It is ideal for PET to be
completed between 4 to 8 weeks after commencement of maintenance PD therapy. The
result from PET will assist the clinician to determine the type of PD therapy best suited for a
patient.
2. Educate the patient and/or carer on the importance of and preparation for PET by
explaining and providing the following:
a. PET information sheet (for APD or CAPD patients – see Appendix B & C);
b. For APD patients – patient must accept & confirm a PET specific APD program in
Claria PD machine the day before the test
3. The day before the PET test, the patient will:
a. For APD patients:
i. Dialyse using a PET specific APD program with 2.5% PD fluid
Note: Do not combine different strength PD fluid. Use 1.5% PD fluid only for
patients unable to tolerate 2.5%
ii. Complete the APD therapy with last fill for 4 – 8 hours before PET to dwell PD
fluid for 4 – 8 hours (for) before the test
Note: Abort PET if dwell time for last fill PD fluid is < 4 hours or > 8hours
b. For CAPD patients:
i. 8 – 12 hours before PET - attend to last CAPD exchange using 2.5% PD fluid to
dwell PD fluid for 8 – 12 hours before the test
Note: Only use 1.5% PD fluid for patients unable to tolerate 2.5%
Note: Abort PET if last CAPD exchange dwell time is < 8 hours or > 12 hours

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2.3 PROCEDURE
1. Before commencing PET, weigh the patient and record on PET form (see Appendix A);
2. Ensure overnight dwell time is appropriate (8 – 12 hours for CAPD patients or 4 – 8 hours
for APD patients):
a. Note the time the last evening bag was instilled for CAPD patients or the time when the
APD therapy ended;
b. Note start time of first drain for PET;
c. Calculate overnight dwell time and record on PET form.
3. Perform a CAPD exchange as per SGH PD WPI 217 Continuous Ambulatory Peritoneal
Dialysis (CAPD) Freeline Solo Exchange Procedure. Use the same PD fluid strength used
overnight to fill the patient:
a. Drain out all PD effluent and record weight of drain bag on PD form
b. Collect PD effluent sample from drain bag using aseptic technique ensuring all the
key parts/sites are protected:
i. Wear PPE as per NSW Health PD2017_013 Infection Prevention and Control
Policy
ii. Alcohol swab the rubber bung on drain bag;
iii. Attach drawing up needle to 20 mL syringe;
iv. Push needle into the centre of the bung on drain bag;
v. Aspirate 20 mL PD effluent and transfer to patient labelled specimen jar marked
as “overnight PD fluid”
c. Patient to lie down on a bed to start filling. Record start time of fill on PET form.
d. Patient to roll from side to side every 2 minutes whilst filling.
e. Record end time of fill on PET form.
f. Collect another PD effluent sample using aseptic technique ensuring all the key
parts/sites are protected:
i. Once patient is full, drain out 200mL PD effluent into the empty PD fluid bag.
ii. Shake and invert PD fluid bag thoroughly
vi. Alcohol swab the rubber bung on PD fluid bag;
vii. Attach 23 G needle to 20 mL syringe;
viii. Push needle into the centre of the bung on drain bag;
ix. Aspirate 20 mL PD effluent and transfer to patient labelled specimen jar marked
as “0 hour PD fluid”
iii. Infuse the remaining 180 mL PD effluent back into the patient
g. Remove gloves
h. Perform hand hygiene
i. Open a new minicap
j. Perform hand hygiene
k. Don sterile gloves
l. Disconnect patient using non-touch disconnection technique
m. Apply a new minicap to catheter using non-touch technique
n. Secure the catheter in place with micropore tape

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o. Discard used equipment as per NSW Health PD2017_013 Infection Prevention and
Control Policy
p. Remove gloves and PPE
q. Perform hand hygiene
r. Dwell PD fluid for 2 hours
4. After dwelling PD fluid for 2 hours:
a. Perform hand hygiene
b. Wear PPE as per NSW Health PD2017_013 Infection Prevention and Control Policy
c. Collect patient’s blood as per SGH-TSH CLIN411 Venepuncture And Blood Collection
– Accreditation Guidelines
Note: Send patient’s blood to pathology with a patient labelled pathology request
form for serum albumin, urea, creatinine and glucose tests.
d. Collect another PD effluent sample using aseptic technique ensuring all the key
parts/sites are protected:
i. Perform hand hygiene
ii. Don sterile gloves
iii. Connect patient to a PD fluid (Freeline solo) bag
iv. Drain out 200mL PD effluent into the drain bag
v. Shake and invert drain bag thoroughly
vi. Alcohol swab the rubber bung on drain bag
vii. Attach 23 G needle to 20 mL syringe;
viii. Push needle into the centre of the bung on drain bag;
ix. Aspirate 20 mL PD effluent and transfer to patient labelled specimen jar marked
as “2 hour PD fluid”
x. Infuse the remaining 180 mL PD effluent back into the patient
xi. Remove gloves
xii. Perform hand hygiene
xiii. Open a new minicap
xiv. Perform hand hygiene
xv. Don sterile gloves
xvi. Disconnect patient using non-touch disconnection technique
xvii. Apply a new minicap to catheter using non-touch technique
xviii. Secure the catheter in place with micropore tape
xix. Discard used equipment as per NSW Health PD2017_013 Infection Prevention
and Control Policy
xx. Remove gloves and PPE
xxi. Perform hand hygiene
xxii. Dwell PD fluid for further 2 hours (making it a total of 4 hours dwell time).
5. On the 4th hour of dwell, drain out all PD effluent and collect sample using aseptic
technique ensuring all the key parts/sites are protected:
a. Wear PPE as per NSW Health PD2017_013 Infection Prevention and Control Policy
b. Perform hand hygiene

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c. Don sterile gloves

d. Connect patient to a CAPD Freeline solo bag (for CAPD patients or APD patients with
day dwell) or Ultraset bag (for APD patients without day dwell) as per SGH PD WPI
217 Continuous Ambulatory Peritoneal Dialysis (CAPD) Freeline Solo Exchange
Procedure or SGH PD WPI 143 Peritoneal Dialysis (PD) – Manual Drain With A
Drain Bag (Ultra Set)
Note: For patient connecting to CAPD – use PD fluid strength as per patient’s regular
PD regimen
e. Record start time of drain on PET form
f. Drain out all PD effluent and record weight of drain bag on PD form
g. Record end time of drain on PET form
h. Shake drain bag thoroughly
i. Alcohol swab the rubber bung on drain bag
j. Attach 21 G needle to 20 mL syringe;
k. Push needle into the centre of the bung on drain bag;
l. Aspirate 20 mL PD effluent and transfer to patient labelled specimen jar marked as “4
hour PD fluid”
m. For CAPD patients or APD patients with day dwell – run PD fluid into the patient as
required. When fill is complete, twist close the catheter valve until it clicks
n. Open a new minicap
o. Perform hand hygiene
p. Don sterile gloves
q. Disconnect patient using non-touch disconnection technique
r. Apply a new minicap to catheter using non-touch technique
s. Secure the catheter in place with micropore tape
t. Discard used equipment as per NSW Health PD2017_013 Infection Prevention and
Control Policy
u. Remove gloves and PPE
v. Perform hand hygiene
6. Send all 4 x patient labelled specimen jars containing varying times of PD effluent sample
(marked as: overnight, 0 hour, 2 hour and 4 hour PD fluid) with a patient labelled pathology
request form for urea, creatinine and glucose tests.
7. The day after PET, the nurse will:
a. Record blood and PD fluid test results on PET form (Appendix A)
b. Enter results in Adequest (in Sharesource Remote Monitoring platform) to calculate
the PET result i.e. peritoneal membrane transport type & rate of the patient
c. Document PET result in RISC, eMR and patient notes
d. Analyse PET result against patient’s current PD regimen
e. Inform Nephrologist of PET result and determine the optimal PD regimen for patient
f. Educate and inform patient of PET result and of any recommendation for PD regimen
change or update

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3. Network file Renal, Peritoneal Dialysis

4. External references / Blake, P. G., Bargman, J. M., Brimble, K. S., Davison, S. N., Hirsch, D.,
further reading McCormick, B. B., . . . Tonelli, M. (2011). Clinical Practice Guidelines and
Recommendations on Peritoneal Dialysis Adequacy 2011. Peritoneal
Dialysis International, 31(2), 218-239. doi: 10.3747/pdi.2011.00026
Brown, E. A., Blake, P. G., Boudville, N., Davies, S., de Arteaga, J., Dong,
J., . . . Warady, B. (2020). International Society for Peritoneal Dialysis
practice recommendations: Prescribing high-quality goal-directed
peritoneal dialysis. 40(3), 244-253. doi:10.1177/0896860819895364
Boudville, N., & de Moraes, T. P. (2020). 2005 Guidelines on targets for
solute and fluid removal in adults being treated with chronic peritoneal
dialysis: 2019 Update of the literature and revision of recommendations.
Perit Dial Int, 40(3), 254-260. doi:10.1177/0896860819898307
Dombros, N., Dratwa, M., Feriani, M., Gokal, R., Heimburger, O., Krediet,
R., . . . Verger, C. (2005). European best practice guidelines for peritoneal
dialysis. 7 Adequacy of peritoneal dialysis. Nephrology, Dialysis and
Transplantation, 20 Suppl 9, ix24-ix27. doi: 10.1093/ndt/gfi1121
Gokal, R., & Chan, C. K. (2004). Adequacy targets in peritoneal dialysis.
Journal of Nephrology, 17 Suppl 8, S55-67
K/DOQI Clinical practice guidelines for peritoneal adequacy, update 2006.
(2006). American Journal of Kidney Disease, 48 Suppl 1, S91-97. doi:
10.1053/j.ajkd.2006.05.016
Johnson, D., Brown, F., Lammi, H., & Walker, R. (2005). The CARI
guidelines. Dialysis adequacy (PD) guidelines. Nephrology (Carlton), 10
Suppl 4, S81-107. doi: 10.1111/j.1440-1797.2005.00465_1.x
Lo, W. K., Bargman, J. M., Burkart, J., Krediet, R. T., Pollock, C.,
Kawanishi, H., & Blake, P. G. (2006). Guideline on targets for solute and
fluid removal in adult patients on chronic peritoneal dialysis. Peritoneal
Dialysis International, 26(5), 520-522
Mehrotra, R., Ravel, V., Streja, E., Kuttykrishnan, S., Adams, S. V., Katz,
R., . . . Kalantar-Zadeh, K. (2015). Peritoneal Equilibration Test and
Patient Outcomes. Clin J Am Soc Nephrol, 10(11), 1990-2001.
doi:10.2215/CJN.03470315
Misra, M., & Khanna, R. (2014). The Clinical Interpretation of Peritoneal
Equilibration Test. Seminars in Dialysis, 27(6), 598-602. doi:
10.1111/sdi.12285
Ponferrada, L. P., & Van Stone, J. C. (1995). Peritoneal dialysis kinetics.
Advances in Renal Replacement Therapy, 2(4), 341-348
Romani, R. F., Waniewski, J., Kruger, L., Lindholm, B., & Nascimento, M.
M. (2019). Comparison of three PET methods to assess peritoneal
membrane transport. Braz J Med Biol Res, 52(8), e8596.
doi:10.1590/1414-431X20198596
Struijk, D. G. and Krediet, R. T. (2003). European best practice guidelines:
adequacy in peritoneal dialysis. Contrib Nephrol(140), 170-175
Tang, Y., Zhong, H., Diao, Y., Qin, M., & Zhou, X. (2014). Peritoneal
transport rate, systemic inflammation, and residual renal function
determine peritoneal protein clearance in continuous ambulatory
peritoneal dialysis patients. International Urology and Nephrology. doi:
10.1007/s11255-014-0744-8
Twardowski, Z. j., Nolph, K. O., Khanna, R., Prowant, B. F., Ryan, L. P.,

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Moore, H. L., & Nielsen, M. P. (1987). Peritoneal Equilibration Test.

Peritoneal Dialysis International, 7(3), 138-148
Virga, G., La Milia, V., Cancarini, G., & Sandrini, M. (2013). Dialysis
adequacy in peritoneal dialysis. Journal of nephrology, 26 Suppl 21, 96-
119. doi: 10.5301/jn.2013.11636
Woodrow, G., Fan, S. L., Reid, C., Denning, J., & Pyrah, A. N. (2017).
Renal Association Clinical Practice Guideline on peritoneal dialysis in
adults and children. BMC Nephrol, 18(1), 333. doi:10.1186/s12882-017-
0687-2
Woodrow, G., & Davies, S. (2011). Renal Association Clinical Practice
Guideline on peritoneal dialysis. Nephron Clinical Practice, 118 Suppl 1,
c287-310. doi: 10.1159/000328073
5. Specialty/department Peritoneal Dialysis Committee
committee approval Dr Franziska Pettit, Staff Specialist
Signature: 20.05.20
6. Department head Dr George Mangos, Department Head Renal Services
approval Signature: 20.05.20
7. Executive sponsor Christine Day, Nurse Manager Medicine
approval – Nurse Signature: 28.05.20
Manager

Revision and Approval History

Date published Revision number Author (Position) Date revision due
Feb 2017 1 Anna Claire Cuesta (PD CNC) Feb 2020
May 2020 2 Anna Claire Cuesta (PD CNC) May 2023

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Appendix A

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Appendix B

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Appendix C

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