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 MECHANICAL PROBLEMS - TWIN BAG
Problem/Cause
1. Transfer set contaminated with
roller clamp closed.
2. Did not close roller clamp on
transfer set when disconnecting
Important things to remember from Twin Bag.
Masks 3. Drain bag has a hole.
Handwashing
Checking Your Supplies 4. Hole in dianel bag.
Connection Points
Checking the Drained Fluid
5. Your tubing separates from your
Checking Your Surroundings catheter.
connection points not tight
pulling on catheter and tubing
6. Needle goes through port of
new bag.
7. New fluid goes in drained bag.
8. Contaminated Twin Bag
Connector.
1 6
What I Should Do
Put mini cap on for 5 minutes - then
remove and put on another new mini cap.
Close roller clamp on transfer set - put
mini cap on - 5 minutes then remove and
put on another mini cap.
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.
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.]
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.]
Change to new twin bag set and new
syringe and needle.
Draw up new medication.
Do another bag exchange.
Discard the set.
Check and prepare a new set.
 FILL PROBLEMS - TWIN BAG
CLAMPS
S

O
A
Problem/Cause What I Should Do P

MINICAP
TAPE
1. Roller Clamp Is it open? MASK
Check under roller clamp for
pinched tubing.
Mask and wash hands. Open Twin
Assemble supplies on a clean surface. Bag overpouch
Check Twin Bag for: solution strength, bag and dry bag.
2. Kink in Tubing Check around dressing.
size, expiry date and calcium. Check full bag for leaks.
Check along tubing.
Check Minicap expiry date. Check medication ports.
Check empty bag.
Check pull ring, green seal and Y area.
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 Mask and wash hands with gel.
and release (repeat). Tape tubing to the table at the Y. Remove Minicap from tranfer set.
Inject heparin in fill bag. Expose transfer set and check that clamp is Immedicately attach Twin Bag connector
Squeeze bag. closed. to transfer set.
Raise pole. Remove the pull ring.

6. Constipation Increase laxatives.

7. Defective Bag Change to a new set. DRAIN

Open roller clamp to drain.

Hang fill bag and place drain bag down After draining,
on the pole. close roller clamp on
transfer set.
Place clamp on drain line.
Place drain bag on the table to check it.
5 2
 DRAIN PROBLEMS - TWIN BAG

MINICAP Problem/Cause What I Should Do

Check roller clamp
1. Roller Clamp Is it open?
is closed.
Check under roller clamp for pinched
tubing.

Check drained FLUSH
fluid for: Break green seal.
- clear: if cloudy, call Home Unit Open blue clamp on 2. Kink in Tubing Check around dressing.
- fibrin: add heparin drain line for 3 seconds. Check along drain line.
- blood: if with pain, call Home Unit. Close blue clamp on drain line. Check tape on pole.

3. Fibrin Wrap tubing tightly around pencil

and release (repeat).

FILL 4. Constipation Take more laxatives.

Open roller clamp to fill.

5. Body Position Bend back and forth.

After filling: Stand up or press on abdomen.
Ensure mask is on. Wash hands with gel. Cough
Close roller clamp
Open Minicap package. Make sure the drain bag is lower
on transfer set.
Place clamp on fill line. than abdomen.
Check that all 3 clamps are closed.

6. Air Lock Wrap tubing tightly around pencil

and release (repeat).

7. Defective Bag Change set.

Unscrew Twin Bag connector from transfer Immediately apply new Minicap to
set. Keep the transfer set in your hand. transfer set.

3 4
 DRAIN PROBLEMS - TWIN BAG

MINICAP Problem/Cause What I Should Do

Check roller clamp
1. Roller Clamp Is it open?
is closed.
Check under roller clamp for pinched
tubing.

Check drained FLUSH
fluid for: Break green seal.
- clear: if cloudy, call Home Unit Open blue clamp on 2. Kink in Tubing Check around dressing.
- fibrin: add heparin drain line for 3 seconds. Check along drain line.
- blood: if with pain, call Home Unit. Close blue clamp on drain line. Check tape on pole.

3. Fibrin Wrap tubing tightly around pencil

and release (repeat).

FILL 4. Constipation Take more laxatives.

Open roller clamp to fill.

5. Body Position Bend back and forth.

After filling: Stand up or press on abdomen.
Ensure mask is on. Wash hands with gel. Cough
Close roller clamp
Open Minicap package. Make sure the drain bag is lower
on transfer set.
Place clamp on fill line. than abdomen.
Check that all 3 clamps are closed.

6. Air Lock Wrap tubing tightly around pencil

and release (repeat).

7. Defective Bag Change set.

Unscrew Twin Bag connector from transfer Immediately apply new Minicap to
set. Keep the transfer set in your hand. transfer set.

3 4
 FILL PROBLEMS - TWIN BAG
CLAMPS
S

O
A
Problem/Cause What I Should Do P

MINICAP
TAPE
1. Roller Clamp Is it open? MASK
Check under roller clamp for
pinched tubing.
Mask and wash hands. Open Twin
Assemble supplies on a clean surface. Bag overpouch
Check Twin Bag for: solution strength, bag and dry bag.
2. Kink in Tubing Check around dressing.
size, expiry date and calcium. Check full bag for leaks.
Check along tubing.
Check Minicap expiry date. Check medication ports.
Check empty bag.
Check pull ring, green seal and Y area.
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 Mask and wash hands with gel.
and release (repeat). Tape tubing to the table at the Y. Remove Minicap from tranfer set.
Inject heparin in fill bag. Expose transfer set and check that clamp is Immedicately attach Twin Bag connector
Squeeze bag. closed. to transfer set.
Raise pole. Remove the pull ring.

6. Constipation Increase laxatives.

7. Defective Bag Change to a new set. DRAIN

Open roller clamp to drain.

Hang fill bag and place drain bag down After draining,
on the pole. close roller clamp on
transfer set.
Place clamp on drain line.
Place drain bag on the table to check it.
5 2
How To Do A Twin Bag Exchange MECHANICAL PROBLEMS - TWIN BAG
Problem/Cause
1. Transfer set contaminated with
roller clamp closed.
2. Did not close roller clamp on
transfer set when disconnecting
Important things to remember from Twin Bag.
Masks 3. Drain bag has a hole.
Handwashing
Checking Your Supplies 4. Hole in dianel bag.
Connection Points
Checking the Drained Fluid
5. Your tubing separates from your
Checking Your Surroundings catheter.
connection points not tight
pulling on catheter and tubing
6. Needle goes through port of
new bag.
7. New fluid goes in drained bag.
8. Contaminated Twin Bag
Connector.
1 6
What I Should Do
Put mini cap on for 5 minutes - then
remove and put on another new mini cap.
Close roller clamp on transfer set - put
mini cap on - 5 minutes then remove and
put on another mini cap.
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.
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.]
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.]
Change to new twin bag set and new
syringe and needle.
Draw up new medication.
Do another bag exchange.
Discard the set.
Check and prepare a new set.
 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.