For a manual CAPD exchange, which sequence best minimizes contamination risk?

• A. Hand hygiene, assemble supplies, clean the catheter exit site with antiseptic, connect the bags using aseptic technique, infuse dialysate, dwell, drain, disconnect and seal, then perform exit-site care.
• B. Hand hygiene, assemble supplies, connect the bags using aseptic technique, clean the catheter exit site with antiseptic, infuse dialysate, dwell, drain, disconnect and seal, then perform exit-site care
• C. Hand hygiene, assemble supplies, clean the catheter exit site with antiseptic, infuse dialysate, disconnect and seal, dwell, drain, then perform exit-site care
• D. Hand hygiene, assemble supplies, connect the bags using aseptic technique, infuse dialysate, dwell, drain, then perform exit-site care, clean the exit site with antiseptic

Answer: (A)

Preventing contamination during a manual CAPD exchange relies on keeping everything sterile and ordering steps to reduce exposure of the catheter system to potential microbes. Cleaning the catheter exit site with antiseptic before connecting the bags lowers the microbial load right at the entry point, so when you establish the connection the risk of introducing organisms is minimized. Then performing the connections with aseptic technique maintains a sterile interface as dialysate is infused. After the exchange—when you disconnect, seal, and complete the drain—the exit-site care is done at the end to protect and seal the area once the system is closed. Other sequences that delay antiseptic cleaning or skip aseptic connection increase the chance of contamination during the exchange.