PERITONEAL DIALYSIS

Prepared by:

PERITONEAL DIALYSIS

Peritoneal

dialysis (PD) is a

treatment for patients with severe chronic kidney disease.

THE PROCESS USES THE PATIENT'S PERITONEUM

IN THE ABDOMEN AS A MEMBRANE ACROSS WHICH FLUIDS AND DISSOLVED SUBSTANCES (ELECTROLYTES, UREA, GLUCOSE, ALBUMIN AND OTHER SMALL MOLECULES) ARE EXCHANGED FROM THE BLOOD. FLUID IS INTRODUCED THROUGH A PERMANENT TUBE IN THE ABDOMEN AND FLUSHED OUT EITHER EVERY NIGHT WHILE THE PATIENT SLEEPS (AUTOMATIC PERITONEAL DIALYSIS) OR VIA

REGULAR EXCHANGES THROUGHOUT THE DAY (CONTINUOUS AMBULATORY PERITONEAL DIALYSIS).

HOOK UP

THE ABDOMEN IS CLEANED

IN PREPARATION FOR

SURGERY, AND A CATHETER IS SURGICALLY INSERTED WITH ONE END IN THE ABDOMEN AND THE OTHER PROTRUDING FROM THE SKIN.

INFUSION

BEFORE EACH INFUSION THE AREA MUST BE CLEANED, AND FLOW INTO AND OUT OF THE ABDOMEN TESTED. A LARGE VOLUME OF FLUID IS
INTRODUCED TO THE ABDOMEN OVER THE NEXT TEN TO FIFTEEN MINUTES. THE TOTAL VOLUME IS

REFERRED TO AS A DWELL WHILE THE FLUID ITSELF IS REFERRED TO AS DIALYSATE. THE DWELL CAN BE AS MUCH AS 2.5 LITERS, AND MEDICATION CAN ALSO BE ADDED TO THE FLUID IMMEDIATELY BEFORE INFUSION.

DIFFUSION ( FRESH )

THE DWELL REMAINS IN THE ABDOMEN AND WASTE

PRODUCTS DIFFUSE ACROSS THE PERITONEUM FROM THE UNDERLYING BLOOD VESSELS. AFTER A VARIABLE PERIOD OF TIME DEPENDING ON THE TREATMENT (USUALLY

4-6 HOURS), THE FLUID IS REMOVED AND REPLACED WITH FRESH FLUID. THIS
CAN OCCUR AUTOMATICALLY WHILE THE PATIENT IS SLEEPING (AUTOMATED PERITONEAL DIALYSIS,

APD), OR DURING THE DAY BY KEEPING TWO

LITERS OF FLUID IN THE ABDOMEN AT ALL TIMES, EXCHANGING THE FLUIDS FOUR TO SIX TIMES PER DAY (CONTINUOUS AMBULATORY PERITONEAL DIALYSIS,

CAPD).

DIFFUSION ( WASTE )

THE FLUID USED TYPICALLY CONTAINS SODIUM, CHLORIDE, LACTATE OR

BICARBONATE AND A HIGH PERCENTAGE OF GLUCOSE TO ENSURE HYPEROSMOLARITY. THE

AMOUNT OF DIALYSIS THAT OCCURS DEPENDS ON THE VOLUME OF THE DWELL, THE REGULARITY OF THE EXCHANGE AND THE CONCENTRATION OF THE FLUID.

DRAINAGE

THE ABILITY TO EXCHANGE

FLUIDS BETWEEN THE
PERITONEUM AND BLOOD SUPPLY CAN BE CLASSIFIED AS HIGH, LOW OR INTERMEDIATE.

HIGH TRANSPORTERS TEND TO

DIFFUSE SUBSTANCES WELL (EASILY EXCHANGING SMALL MOLECULES BETWEEN BLOOD AND THE DIALYSIS FLUID, WITH SOMEWHAT IMPROVED RESULTS FREQUENT, SHORTRATION DWELLS SUCH AS WITH APD)

LOW TRANSPORTERS FILTER FLUIDS BETTER (TRANSPORTING FLUIDS ACROSS

THE MEMBRANE INTO THE BLOOD MORE QUICKLY WITH SOMEWHAT BETTER RESULTS WITH LONG-TERM, HIGH-VOLUME DWELLS SUCH) THOUGH IN PRACTICE EITHER TYPE OF TRANSPORTER CAN GENERALLY BE MANAGED THROUGH THE APPROPRIATE USE OF EITHER APD OR

CAPD.

PERITONEAL DIALYSIS
ACCESS

PERITONEAL DIALYSIS REQUIRES ACCESS TO THE PERITONEAL CAVITY. DURING A MINOR OPERATION, PERFORMED USING A LOCAL OR A GENERAL ANESTHETIC, THE
DOCTOR INSERTS A SOFT PLASTIC TUBE INTO THE ABDOMEN.

THIS TUBE IS CALLED A PERITONEAL DIALYSIS CATHETER (PD CATHETER). IT ACTS AS A PERMANENT PATHWAY INTO THE PERITONEAL CAVITY.

THE PD CATHETER IS ABOUT 30 CM (12 INCHES) LONG, AND ABOUT AS WIDE AS A PENCIL. ABOUT 15 CM (6 INCHES) OF
THE TUBE REMAINS OUTSIDE YOUR BODY,

ALLOWING THE DISPOSABLE DIALYSIS BAGS TO BE ATTACHED. THE PLACE WHERE THE CATHETER COMES OUT OF THE BODY IS CALLED THE EXIT SITE.

THE CATHETER IS USUALLY PLACED JUST

BELOW AND SLIGHTLY TO THE SIDE OF THE BELLY BUTTON.

YOUR DOCTOR OR

NURSE WILL DETERMINE WITH YOU THE

EXACT LOCATION FOR THE EXIT SITE SO

THAT THE CATHETER CAN BE

COMFORTABLY AND EASILY HIDDEN

UNDER CLOTHING

COMPLICATIONS

 HYPERTENSION AND EDEMA PRESENCE OF PINK OR BLOODY EFFLUENT

SUGGESTS BLEEDING INSIDE THE ABDOMEN(INDICATE A PERFORATED BOWEL PERFORATED BOWEL AND CLOUDY FLUID SUGGESTS INFECTION). PAIN OR DISCOMFORT IMPAIRED BREATHING CONSTIPATION

PREDIALYSIS CARE

DOCUMENT VITAL SIGNS INCLUDING TEMPERATURE, ORTHOSTATIC BLOOD PRESSURES (LYING, SITTING, AND STANDING), APICAL PULSE, RESPIRATIONS AND LUNG SOUNDS. THESE
BASELINE DATA HELP ASSESS FLUID VOLUME STATUS AND TOLERANCE OF THE DIALYSIS PROCEDURE.

HYPERTENSION, ABNORMAL HEART OR LUNG SOUNDS, OR DYSPNEA MAY INDICATE EXCESS FLUID VOLUME. POOR RESPIRATORY FUNCTION MAY
AFFECT THE ABILITY TO TOLERATE PERITONEAL DIALYSIS. TEMPERATURE MEASUREMENT IS VITAL, BECAUSE INFECTION IS THE MOST COMMON COMPLICATION OF PERITONEAL DIALYSIS.

WEIGH DAILY OR BETWEEN DIALYSIS RUNS AS INDICATED. WEIGHT IS AN ACCURATE INDICATOR OF FLUID VOLUME STATUS.

NOTE BUN,SERUM ELECTROLYTE, CREATININE, PH, AND HEMATOCRIT LEVELS

PRIOR TO PERITONEAL DIALYSIS AND PERIODICALLY DURING THE PROCEDURE.

THESE VALUES ARE USED TO ASSESS

THE EFFICACY OF TREATMENT.

MEASURE AND RECORD ABDOMINAL GIRTH.

INCREASING ABDOMINAL GIRTH MAY INDICATE RETAINED DIALYSATE,
EXCESS FLUID VOLUME OR EARLY PERITONITES.

MAINTAIN FLUID AND DIETARY RESTRICTIONS AS ORDERED. FLUID AND DIET RESTRICTIONS HELP
REDUCE HYPERVOLEMIA AND CONTROL AZOTEMIA.

HAVE THE CLIENT EMPTY THE

BLADDER PRIOR TO CATHETER INSERTION.

EMPTYING THE BLADDER REDUCES

THE RISK OF INADVERTENT PUNCTURE.

WARM THE PRESCRIBED DIALYSATE

SOLUTION TO BODY TEMPERATURE

USING A WARM WATER BATH OR HEATING PAD ON LOW SETTING. DIALYSATE IS WARMED TO PREVENT HYPOTHERMIA.

EXPLAIN ALL PROCEDURES AND EXPECTED SENSATIONS. KNOWLEDGE HELPS REDUCE

ANXIETY AND ELICIT COOPERATION.

INTRADIALYSIS CARE

USE STRICT ASEPTIC TECHNIQUE DURING

THE DIALYSIS PROCEDURE AND WHEN CARING FOR THE PERITONEAL CATHETER.

PERITONITIS IS A COMMON
COMPLICATION OF PERITONEAL DIALYSIS; STERILE TECHNIQUE REDUCES THE RISK.

ADD PRESCRIBED MEDICATIONS TO THE DIALYSATE; PRIME THE TUBING WITH

SOLUTION AND CONNECT IT TO THE

PERITONEAL CATHETER, TAPING CONNECTIONS SECURELY AND AVOIDING KINKS.

THIS ALLOWS DIALYSATE TO FLOW

FREELY INTO THE ABDOMINAL CAVITY AND PREVENTS LEAKING OR CONTAMINATION.

INSTILL DIALYSATE INTO THE ABDOMINAL

CAVITY OVER A PERIOD OF APPROXIMATELY MINUTES.

10

CLAMP TUBING AND ALLOW THE

DIALYSATE TO REMAIN IN THE ABDOMEN FOR

THE PRESCRIBED DWELL TIME.

KEEP DRAINAGE TUBING CLAMPED AT ALL

TIMES DURING INSTILLATION AND DWELL TIME.

DIALYSATE SHOULD FLOW FREELY INTO THE

ABDOMEN IF THE PERITONEAL CATHETER IS

PATENT.

DIALYSIS, THE EXCHANGE OF SOLUTES

AND WATER BETWEEN THE BLOOD AND DIALYSATE, OCCURS ACROSS THE PERITONEAL

MEMBRANE DURING THE DWELL TIME.

DURING INSTILLATION AND DWELL TIME,

OBSERVE CLOSELY FOR SIGNS OF RESPIRATORY DISTRESS. SUCH AS DYSPNEA, TACHYPNEA, OR CRACKLES. PLACE IN FOWLERS OR SEMIFOWLERS POSITION AND SLOW THE RATE OF INSTILLATION SLIGHTLY TO RELIEVE RESPIRATORY DISTRESS IF IT DEVELOPS. RESPIRATORY COMPROMISE MAY RESULT FROM OVERLY RAPID FILLING OR OVERFILLING OF THE ABDOMEN OR FROM A DIAPHRAGMATIC DEFECT THAT ALLOWS FLUID TO ENTER THE THORACIC CAVITY.

AFTER PRESCRIBED DWELL TIME, OPEN

DRAINAGE TUBING CLAMPS AND ALLOW DIALYSATE TO DRAIN BY GRAVITY INTO A

STERILE CONTAINER.

NOTE THE CLARITY, COLOR, AND ODOR OF RETURNED DIALYSATE. BLOOD OR

FECES IN THE DIALYSATE MAY INDICATE ORGAN OR BOWEL PERFORATION; CLOUDY OR MALODOROUS DIALYSATE MAY INDICATE AN INFECTION.

 ACCURATELY RECORD AMOUNT

AND TYPE OF DIALYSATE INSTILLED. MONITOR BUN, SERUM ELECTROLYTE, AND CREATININE LEVELS.

SLOW DIALYSATE INSTILLATION.

INCREASE THE HEIGHT OF THE
CONTAINER AND REPOSITION THE CLIENT. CHECK TUBING AND CATHETER FOR KINKS. CHECK ABDOMINAL DRESSING FOR WETNESS, INDICATING LEAKAGE AROUND THE CATHETER. SLOW DIALYSATE FLOW MAY BE RELATED TO A PARTIALLY OBSTRUCTED TUBE OR CATHETER.

EXCESS DWELL TIME. PROLONGED DWELL TIME MAY LEAD TO WATER DEPLETION OR HYPERGLYCEMIA. POOR DIALYSATE DRAINAGE.
LOWER THE DRAINAGE CONTAINER, REPOSITION, CHECK FOR TUBING KINKS. CHECK ABDOMINAL DRESSING. TUBING OR
CATHETER OBSTRUCTION CAN ALSO INTERFERE WITH DIALYSATE DRAINAGE.

POSTDIALYSIS CARE

ASSESS VITAL SIGNS, INCLUDING TEMPERATURE. COMPARISON OF PRE AND POST

DIALYSIS VITAL SIGNS HELPS IDENTIFY BENEFICIAL AND ADVERSE EFFECTS OF THE PROCEDURE.

TIME MEALS TO CORRESPOND WITH DIALYSIS OUTFLOW.

SCHEDULING MEALS WHILE THE
ABDOMEN IS EMPTY OF DIALYSATE

ENHANCES INTAKE AND REDUCES NAUSEA.

TEACH THE CLIENT AND FAMILY ABOUT THE PROCEDURE. THE CLIENT MAY ELECT TO USE
PERITONEAL DIALYSIS AT HOME TO MANAGE
END STAGE RENAL DISEASE AND PREVENT UREMIA.

END!!! THANK YOU!!!