PANNA DHAI MAA SUBHARTI NURSING

COLLEGE

AN ASSIGNEMENT
ON
PERITONEL DIALYSIS

SUBMITTED TO: - SUBMITTED BY:-

MR.ANANDHMs. POONAM TOMAR
ASSISTANT PROFESSOR M.SC NSG 1ST YEAR
MSN DPT. (2018-19 Batch)
INTRODUCTION:
Peritoneal dialysis (PD) is a treatment for kidney failure. A special sterile fluid
is introduced into the abdomen through a permanent tube that is placed in the
peritoneal cavity. The fluid circulates through abdomen to draw impurities from
surrounding blood vessels in the peritoneum, which is then drained from the
body

HOW DOES IT WORK:

PD uses a cleaning solution called dialysate to draw waste and fluid from your
blood, through your peritoneum. Your peritoneum is the lining of the wall that
separates the inside of your abdomen from the rest of your body.

When you do PD, you will fill your abdomen (belly area) with dialysate and let
it sit in your abdomen for a period of time while it does its job. This time is
called a dwell time. Your doctor will tell you how long your dwell time should
be. When the dwell time is over, you will drain the used dialysate out of your
abdomen and refill your abdomen with fresh dialysate. This process of draining
used dialysate and refilling your abdomen with fresh dialysate is called an
exchange. Each exchange (drain and refill) usually takes between 30 and 40
minutes. Depending on the type of PD you choose to do, you may do these
exchanges yourself or with the help of a machine.

Dialysate has a sugar in it called dextrose, which pulls fluid and waste from
your blood, through your peritoneum, into the dialysate. The waste and fluid are
held in the dialysate and removed from your body when you do an exchange.
PD must be done every day or night. Your doctor will tell you how many
exchanges you should do each day. Most people do their PD exchanges at
home, but you can do them any place that is clean and dry.
PROCEDURE:

1. A PD catheter is inserted permanently at the abdomen to allow filling and

draining of about two litres of PD solution into and out of the peritoneum or
abdominal cavity, which is surrounded by the peritoneal membrane. The
peritoneal membrane then filters waste and fluids from the blood into the
solution.

2.The PD solution is allowed to remain in the abdomen for four to six hours
before it is drained and replaced with fresh PD solution. The replacing of fresh
PD solution with the used PD solution is called an exchange. Each exchange
takes about 30 minutes. PD patients perform an average of four exchanges per
day. Different types of PD have different schedules of daily exchanges.

Types of PD:

1.Continuous Ambulatory Peritoneal Dialysis (CAPD):

Unlike Haemodialysis, patients do not need a machine for CAPD. They need
gravity to fill and empty their abdomen. The doctor will prescribe the number of
exchanges a patient needs, typically three or four exchanges during the day and
one evening exchange with a long overnight dwell time while one sleeps. As the
word “ambulatory” suggests, the patient can walk around with the dialysis
solution in the abdomen. CCPD is usually done at night, while you sleep. You
will connect your catheter to tubes going to a machine called a cycler. This
machine does your exchanges for you. It will fill your abdomen with dialysate,
wait for the correct dwell time, and then drain the used dialysate from your
abdomen into a bag. The machine will refill your abdomen with clean dialysate
and begin the process again.

In most cases, the cycler will do three to five exchanges overnight. This usually
takes about nine hours. Every morning, the machine will fill your abdomen with
dialysate for the last time. This time, the dialysate will sit in your abdomen for
the whole day, until you go to bed and begin your nightly CCPD treatment
again.

Your doctor will tell you how many exchanges you should do and how long
your dwell times should be. Your dialysis nurse or technician will show you
how to set up the cycler machine to give you the right treatment.

During the long daytime dwell time, some people have problems with their
bodies holding on to too much of the dialysate. If this is a problem for you, your
doctor may tell you to do one exchange during the day. Your doctor might also
ask you to do some daytime exchanges if you weigh over 175 pounds or if you
need to have more waste removed from your blood than what can be done
during your CCPD treatments overnight.

2.Continuous ambulatory peritoneal dialysis (CAPD):

CAPD exchanges are done by hand, using gravity to help fill your abdomen
with dialysate and drain it once the dwell time is over. These exchanges are
called manual exchanges. Because you need to do each exchange yourself, this
type of PD must be done during the day. You may do your exchanges anywhere
that is clean and dry.

To fill your abdomen with dialysate, you will sit in a chair, with a tube attached
to a bag of dialysate that is hanging above you. Gravity will pull the dialysate
down from the bag, through the tube into your abdomen. To drain the used
dialysate, you will attach a tube to your catheter, and let gravity pull the
dialysate out of your abdomen, through the tube and into a bag below you. It
usually takes between 30 and 40 minutes to drain and refill your abdomen with
dialysate.
 Between exchanges, you will let the dialysate sit in your abdomen for the dwell
time. At the end of each day, you will fill your abdomen one last time, and the
dialysate will sit in your abdomen all night long. In the morning, you will begin
doing normal exchanges again. Your doctor will tell you how many exchanges
you should do each day and how long your dwell times should be.

During the long nighttime dwell time, some people have problems with their
bodies holding on to too much of the dialysate. If this is a problem for you, your
doctor may tell you to use a minicycler to do some exchanges at night, while
you sleep. A minicycler is a small version of the cycler machine that is used for
CCPD. Your doctor might also ask you to use the minicycler at night if you
weigh over 175 pounds or if you need to have more waste removed from your
blood than what can be done during your CAPD treatments during the day.

RISKS:

Peritonitis is an infection of your peritoneum, the lining inside of your abdomen

that is used as a filter for peritoneal dialysis (PD). Peritonitis is the most
common problem that happens in people who do PD.

Peritonitis is caused by bacteria that get into your abdomen through your
catheter or through your catheter incision (where the tube enters your body).
This can happen if your incision is not cleaned well. It can also happen when
bacteria get into your catheter while you are connecting to or disconnecting
from the tubes from your dialysate bags. Peritonitis is less common in people
who have their catheters in their chests instead of their abdomens.Taking good
care of your catheter and doing your exchanges safely can help to prevent
peritonitis

Benefits of PD: Some of the major benefits of PD are:

 Painless and No Needling

1. Unlike HD, no vascular access or needling is required for PD, hence PD is
apainless procedure.
2. Vascular access-related complications are one of the common causes of
hospitalisation in haemodialysis patients.
  Home-based Therapy
1. Patients carry out treatment themselves in the comfort of their own homes.
2. No need to travel to the dialysis centre for treatment and not restricted to
dialysiscentres’s schedule.

3. More flexibility to better fit dialysis into their lifestyle.

4. Patients take charge their own treatment plan and advice given by the PD
care team.
 Gentler and works more like the natural kidney
1. PD mimics the function of real kidneys more as the constant presence of
the PD solution in the abdominal cavity allows waste products and excess
waterfrom the blood to be removed continuously.
2. The non-intermittent nature of PD makes it a gentler treatment. Patients
have lesser food restrictions and experience lesser side effects.

Disadvantage:Some of the disadvantages of PD are:

1. Infections. An infection of the abdominal lining (peritonitis) is a common
complication of peritoneal dialysis. An infection can also develop at the site
where the catheter is inserted to carry the cleansing fluid (dialysate) into and out
of your abdomen. The risk of infection is greater if the person doing the dialysis
isn't adequately trained.

2. Weight gain. The dialysate contains sugar (dextrose). Absorbing some of the
dialysate might cause you to take in hundreds of extra calories daily, leading to
weight gain. The extra calories can also cause high blood sugar, especially if
you have diabetes.
3. Hernia. Holding fluid in your abdomen for long periods may strain your
muscles.

4. Inadequate dialysis. Peritoneal dialysis can become ineffective after several

years. You might need to switch to hemodialysis.

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