2012

How To Do A
Twin Bag Exchange

Looking for more health information?

Contact your local public library for books, videos, magazine articles and online health information. For a list of public libraries in Nova Scotia go to www.publiclibraries.ns.ca
Capital Health promotes a smoke-free and scent-free environment.
Please do not use perfumed products. Thank you!
Capital Health, Nova Scotia
Illustrations: Used with permission from Baxter Health Care
Prepared by: Home Dialysis Unit Nursing Staff
Designed and Printed by: CH Audio Visual and Printing Departments
The information in this brochure is provided for information and education purposes only. The information is not intended to be and does not constitute healthcare
or medical advice. If you have any questions, please ask your healthcare provider.
WQ85-0633 Revised Jan.2012
The information in this pamphlet is to be updated every 3 years.

How To Do A Twin Bag Exchange

Important things to remember

Masks

MECHANICAL PROBLEMS - TWIN BAG

Problem/Cause

What I Should Do

1. Transfer set contaminated with

roller clamp closed.

Put mini cap on for 5 minutes - then

remove and put on another new mini cap.

2. Did not close roller clamp on

transfer set when disconnecting
from Twin Bag.

Close roller clamp on transfer set - put

mini cap on - 5 minutes then remove and
put on another mini cap.

3. Drain bag has a hole.

Close roller clamp on transfer set - clamp

drain line. Put mini cap on transfer set.
Take out new Twin Bag system and
continue with dialysis exchange.

4. Hole in dianel bag.

Clamp roller clamp on transfer set.

Clamp fill line.
Put mini cap on transfer set, call Home
Dialysis Unit IMMEDIATELY. [This is a
dialysis emergency.]

5. Your tubing separates from your

catheter.
connection points not tight
pulling on catheter and tubing

Use emergency kit. Put catheter clamp

on your catheter next to the exit site.
Put cap on end of your catheter.
Call the Home Dialysis Unit IMMEDIATELY.
[This is a dialysis emergency.]

6. Needle goes through port of

new bag.

Change to new twin bag set and new

syringe and needle.
Draw up new medication.

7. New fluid goes in drained bag.

Do another bag exchange.

8. Contaminated Twin Bag

Connector.

Discard the set.

Check and prepare a new set.

Handwashing
Checking Your Supplies
Connection Points
Checking the Drained Fluid
Checking Your Surroundings

FILL PROBLEMS - TWIN BAG

What I Should Do

1. Roller Clamp

Is it open?
Check under roller clamp for
pinched tubing.

2. Kink in Tubing

Check around dressing.

Check along tubing.

3. Green Seal Not Broken

Break green seal - space between

broken seal.

4. Body Position

Bend back and forth.

Stand up or press on abdomen.
Cough.

5. Fibrin

Wrap tubing tightly around pencil

and release (repeat).
Inject heparin in fill bag.
Squeeze bag.
Raise pole.

6. Constipation

Increase laxatives.

7. Defective Bag

Change to a new set.

CLAMPS

Problem/Cause

S
O
A
P
MINICAP

TAPE
MASK

Mask and wash hands.

Assemble supplies on a clean surface.
Check Twin Bag for: solution strength, bag
size, expiry date and calcium.
Check Minicap expiry date.

Open Twin
Bag overpouch
and dry bag.
Check full bag for leaks.
Check medication ports.
Check empty bag.
Check pull ring, green seal and Y area.

Mask and wash hands with gel.

Tape tubing to the table at the Y.
Expose transfer set and check that clamp is
closed.
Remove the pull ring.

Remove Minicap from tranfer set.

Immedicately attach Twin Bag connector
to transfer set.

DRAIN
Open roller clamp to drain.

After draining,
close roller clamp on
transfer set.
Place clamp on drain line.
Place drain bag on the table to check it.

Hang fill bag and place drain bag down

on the pole.

DRAIN PROBLEMS - TWIN BAG

MINICAP

Check roller clamp

is closed.

What I Should Do

1. Roller Clamp

Is it open?
Check under roller clamp for pinched
tubing.

2. Kink in Tubing

Check around dressing.

Check along drain line.
Check tape on pole.

3. Fibrin

Wrap tubing tightly around pencil

and release (repeat).

4. Constipation

Take more laxatives.

5. Body Position

6. Air Lock

Wrap tubing tightly around pencil

and release (repeat).

7. Defective Bag

Change set.

Problem/Cause

FLUSH
Break green seal.
Open blue clamp on
drain line for 3 seconds.
Close blue clamp on drain line.

Check drained
fluid for:
- clear: if cloudy, call Home Unit
- fibrin: add heparin
- blood: if with pain, call Home Unit.

FILL
Open roller clamp to fill.

After filling:
Close roller clamp
on transfer set.
Place clamp on fill line.
Check that all 3 clamps are closed.

Ensure mask is on. Wash hands with gel.

Open Minicap package.

Unscrew Twin Bag connector from transfer

set. Keep the transfer set in your hand.

Immediately apply new Minicap to

transfer set.

Bend back and forth.

Stand up or press on abdomen.
Cough
Make sure the drain bag is lower
than abdomen.

DRAIN PROBLEMS - TWIN BAG

MINICAP

Check roller clamp

is closed.

What I Should Do

1. Roller Clamp

Is it open?
Check under roller clamp for pinched
tubing.

2. Kink in Tubing

Check around dressing.

Check along drain line.
Check tape on pole.

3. Fibrin

Wrap tubing tightly around pencil

and release (repeat).

4. Constipation

Take more laxatives.

5. Body Position

6. Air Lock

Wrap tubing tightly around pencil

and release (repeat).

7. Defective Bag

Change set.

Problem/Cause

FLUSH
Break green seal.
Open blue clamp on
drain line for 3 seconds.
Close blue clamp on drain line.

Check drained
fluid for:
- clear: if cloudy, call Home Unit
- fibrin: add heparin
- blood: if with pain, call Home Unit.

FILL
Open roller clamp to fill.

After filling:
Close roller clamp
on transfer set.
Place clamp on fill line.
Check that all 3 clamps are closed.

Ensure mask is on. Wash hands with gel.

Open Minicap package.

Unscrew Twin Bag connector from transfer

set. Keep the transfer set in your hand.

Immediately apply new Minicap to

transfer set.

Bend back and forth.

Stand up or press on abdomen.
Cough
Make sure the drain bag is lower
than abdomen.

FILL PROBLEMS - TWIN BAG

What I Should Do

1. Roller Clamp

Is it open?
Check under roller clamp for
pinched tubing.

2. Kink in Tubing

Check around dressing.

Check along tubing.

3. Green Seal Not Broken

Break green seal - space between

broken seal.

4. Body Position

Bend back and forth.

Stand up or press on abdomen.
Cough.

5. Fibrin

Wrap tubing tightly around pencil

and release (repeat).
Inject heparin in fill bag.
Squeeze bag.
Raise pole.

6. Constipation

Increase laxatives.

7. Defective Bag

Change to a new set.

CLAMPS

Problem/Cause

S
O
A
P
MINICAP

TAPE
MASK

Mask and wash hands.

Assemble supplies on a clean surface.
Check Twin Bag for: solution strength, bag
size, expiry date and calcium.
Check Minicap expiry date.

Open Twin
Bag overpouch
and dry bag.
Check full bag for leaks.
Check medication ports.
Check empty bag.
Check pull ring, green seal and Y area.

Mask and wash hands with gel.

Tape tubing to the table at the Y.
Expose transfer set and check that clamp is
closed.
Remove the pull ring.

Remove Minicap from tranfer set.

Immedicately attach Twin Bag connector
to transfer set.

DRAIN
Open roller clamp to drain.

After draining,
close roller clamp on
transfer set.
Place clamp on drain line.
Place drain bag on the table to check it.

Hang fill bag and place drain bag down

on the pole.

How To Do A Twin Bag Exchange

Important things to remember

Masks

MECHANICAL PROBLEMS - TWIN BAG

Problem/Cause

What I Should Do

1. Transfer set contaminated with

roller clamp closed.

Put mini cap on for 5 minutes - then

remove and put on another new mini cap.

2. Did not close roller clamp on

transfer set when disconnecting
from Twin Bag.

Close roller clamp on transfer set - put

mini cap on - 5 minutes then remove and
put on another mini cap.

3. Drain bag has a hole.

Close roller clamp on transfer set - clamp

drain line. Put mini cap on transfer set.
Take out new Twin Bag system and
continue with dialysis exchange.

4. Hole in dianel bag.

Clamp roller clamp on transfer set.

Clamp fill line.
Put mini cap on transfer set, call Home
Dialysis Unit IMMEDIATELY. [This is a
dialysis emergency.]

5. Your tubing separates from your

catheter.
connection points not tight
pulling on catheter and tubing

Use emergency kit. Put catheter clamp

on your catheter next to the exit site.
Put cap on end of your catheter.
Call the Home Dialysis Unit IMMEDIATELY.
[This is a dialysis emergency.]

6. Needle goes through port of

new bag.

Change to new twin bag set and new

syringe and needle.
Draw up new medication.

7. New fluid goes in drained bag.

Do another bag exchange.

8. Contaminated Twin Bag

Connector.

Discard the set.

Check and prepare a new set.

Handwashing
Checking Your Supplies
Connection Points
Checking the Drained Fluid
Checking Your Surroundings

2012

How To Do A
Twin Bag Exchange

Looking for more health information?

Contact your local public library for books, videos, magazine articles and online health information. For a list of public libraries in Nova Scotia go to www.publiclibraries.ns.ca
Capital Health promotes a smoke-free and scent-free environment.
Please do not use perfumed products. Thank you!
Capital Health, Nova Scotia
Illustrations: Used with permission from Baxter Health Care
Prepared by: Home Dialysis Unit Nursing Staff
Designed and Printed by: CH Audio Visual and Printing Departments
The information in this brochure is provided for information and education purposes only. The information is not intended to be and does not constitute healthcare
or medical advice. If you have any questions, please ask your healthcare provider.
WQ85-0633 Revised Jan.2012
The information in this pamphlet is to be updated every 3 years.