Peritoneal Dialysis

Presented by:
Advincula, Jasmin
Cailles, Patricia
Casco, Gerald
Coson. Jan Karmela
Ecleo, Jorhene

Francisco, Bernadette

Definition:
Removal of solutes and fluid
across a semi-permeable
membrane which is the
peritonuem.

Purpose:
Aid in removal of toxins and metabolic

wastes
Establish electrolyte balance
Remove excess body fluid
Assist in regulating the fluid balance of
the body
Control BP
Control severe intractable heart failure
when diuretics no longer promote
elimination of water and sodium

Types of Peritoneal Dialysis:

1. Continuous ambulatory
2.
3.
4.
5.

peritoneal dialysis
Automated peritoneal dialysis
Continuous cyclic peritoneal
dialysis
Intermittent peritoneal dialysis
Nightly intermittent peritoneal
dialysis

Continuous ambulatory peritoneal

dialysis
Used with patients with ESRD
Performed at home by the patient or the

trained caregiver who is usually the

family member, the procedure allows
the patient reasonable freedom and
control of daily activities

Automated peritoneal dialysis

Necessitates use of a peritoneal cycling

machine
Can be performed as continuous cyclic,
intermittent, or nightly intermittent
peritoneal dialysis

Continuous cyclic peritoneal dialysis

Usually three cycles at night

and one cycle with an 8-hour

dwell in the morning
Advantage is that the
peritoneal catheter is opened
only for the on-and-off
procedures, which reduces the
risk of infection
Does not require exchanges at

Intermittent peritoneal
dialysis
Dialysis is performed for 10 to 14

hours, three to four times a week,

by the same peritoneal cycling
machine as in continuous cyclic
peritoneal
dialysis
Nightly
intermittent
peritoneal dialysis
Dialysis is performed for 8 to 12

hours each night with no daytime

dwells

Steps of intermittent peritoneal

dialysis
Introduction of dialysate (1 to 8 L)
Open infusion tube
Close drainage
For 10-15 minutes
2. Dwell time
Retained dialysate
Closed infusion tube/regulator
Allows diffusion
For 20-30 minutes
3. Drain dialysate
Open drainage regualtor
Change 2 L of dialysate
4. Repeat process
30-32 exchange
2-3 days
1.

Steps of continuous ambulatory

peritoneal dialysis
1. 1.5 to 3L of dialysate is instilled into

2.

3.

4.
5.

the abdomen and left in place for a

prescribed period of time
The empty dialysate bag is folded up
and carried in a pouch or pocket until it
is time to drain the dialysate
The bag is then unfolded and placed
lower than the insertion site so that the
fluid drains by gravity flow.
When full, the bag is changed and the
new dialysate is instilled
Usually uses four cycles every 24 hours

PREDIALYSIS CARE
Document VS
Weigh daily or between dialysis runs as

indicated
Note BUN, serum electrolytes, creatinine, pH
and hct levels prior to peritoneal dialysis and
periodically during the procedure
Measure and record abdominal girth
Maintain fluid and dietary restrictions as
ordered
Have the client empty the bladder prior to
catheter insertion
Warm the prescribed dialysate solution to body
temperature (37C) using a warm water bath or

INTRADIALYSIS CARE
Use strict aseptic technique during the

dialysis procedure and when caring for

the peritoneal catheter
Add prescribed medications to the
dialysate; prime the tubing with solution
and connect it to the peritoneal
catheter, taping connections securely
and avoiding kinks
Instil dialysate into the abdominal cavity
over a period of approximately 10
minutes. Clamp tubing and allow the
dialysate to remain in the abdomen at

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
After prescribed dwell time, open
drainage tubing clamps and allows
dialysate to drain by gravity into a
sterile container. Note the clarity, color,
and odor of returned dialysate.

Accurately record the amount and

type of dialysate instilled (including

any added medications), dwell time,
amount, and character of drainage.
Monitor BUN, serum electrolyte and
creatinine levels
Troubleshoot for possible problems
during dialysis

POSTDIALYSIS CARE
Assess vital signs, including

temperature.
Time meals to corresponds with
dialysis outflow.
Teach the client and family about
the procedure.

Complications of
Peritoneal
Dialysis

Pulmonary Edema
Causes:
High levels or nitrogen
compounds and waste products
- Azotemia
High concentration of glucose
dialysate.

Sample Nursing Diagnosis

Impaired gas exchange related to

altered oxygen supplementation

secondary to peritoneal dialysis.

Nursing Interventions
Monitor respiratory rate/effort. Reduce

infusion rate if dyspnea is present.

(suggest diaphragmatic pressure from
distended peritoneal cavity or may indicate
developing complications.)
Auscultate lungs, noting decreased,
absent, or adventitious breath sounds,
e.g., crackles/wheezes/rhonchi. (presence
of atelectasis)
Palpate for fremitus.(fluid collection on air
tapping.)
Note character, amount, and color of
secretions.(susceptible to pulmonary
infections as a result of depressed cough reflex

Nursing Interventions
Elevate head of bed or have patient sit up

in chair. Promote deep-breathing

exercises and coughing. (facilitation of chest
expansion and mobilization of secretions)
Review ABGs/pulse oximetry and serial
chest x-rays. (appearance of
infiltrates/congestion on chest x-ray suggest
developing pulmonary problems)
Administer supplemental O2 as indicated.
(to lessen hypoxia)Administer analgesics as
indicated. (alleviates pain, promotes cough
expansion)
Suction as needed. (expectorations of
secretions.)

Abdominal Pain
CAUSES:
high hypertonicity dialysate
high or low temperature of
dialysate
excessive dialysate
celiac infection
catheter movement

Abdominal Pain
NURSING DIAGNOSIS:
Acute pain r/t Infusion of
cold or acidic dialysate,
abdominal distension, rapid
infusion of dialysate as
manifested by pain scale of
7/10, guarding behavior,
restlessness

Abdominal Pain
NURSING INTERVENTIONS:
Assess PQRST of pain
Explain that initial discomfort
usually subsides after the first few
exchanges.
Monitor for pain that begins during
inflow and continues during
equilibration phase. Slow infusion
rate as indicated.

Abdominal Pain
NURSING INTERVENTIONS:

Note reports of discomfort that is most

pronounced near the end of inflow and
instill no more than 2000 mL of solution
at a single time.

Prevent air from entering peritoneal

Abdominal Pain
NURSING INTERVENTIONS:
Elevate head of bed at intervals.
Turn patient from side to side.
Provide back care and tissue
massage
Warm dialysate to body
temperature before infusing
Monitor for severe/continuous
abdominal pain and temperature
elevation (especially after dialysis

Abdominal Pain
NURSING INTERVENTIONS:
Encourage use of relaxation
techniques
Administer analgesics.
Add sodium hydroxide to
dialysate, if indicated.

Peritonitis
Causes:
Catheter-related infection
Touch contamination
Transvisceral migration due to intraabdominal pathology
(eg, bowel leak)
Hematogenous
Vaginal leak, which is very rare
Risk Factors:
Obese and diabetic patients
Can lead to:
severe loss of protein, peritoneal adhesion, peritoneal
thickening and peritoneal dialysis failure as well as blocking
catheter, which can threaten life.

Sample Nursing Diagnosis

Altered Thermoregulation:

Hyperthermia related to Inflammatory

process as manifested by body
temperature of 38.5C, flushed skin:
warm to touch.

Nursing Interventions
Monitor VS especially core temperature

every hour.
Note presence or absence of sweating as
body attempts to increase heat loss by
evaporation. ((Evaporation is decreased bye
environmental factors of high humidity and
high as well as body factorsproducing loss of
ability to sweat.))
Increase oral fluid intake. (To support
circulating volume and tissue perfusion.)
Promote bed rest, encourage relaxation
skills and diversional activities. (To reduce
metabolic demands/oxygen consumption.)
Promote surface cooling, loosen clothing

Nursing Interventions
Provide TSB as needed.
Review specific risks factors/causes, signs

and symptoms with the interventions

required. (Heat loss is by convection radiation
and conduction. )
Discuss importance ofadequate fluid
intake andprotein diet. (To prevent
dehydration.)
Administermedications as indicated to
treat underlying cause, such as antipyretics.
Administerreplacement fluids and
electrolytes to support circulating volume
and tissue perfusion. (To support circulating

Obstructed drainage and blocking

catheter

CAUSES:
Warping, movement, and
blocking by fibrin, blood clot
too much gas in enteric cavity
or abdominal cavity

Obstructed drainage and blocking

catheter
NURSING DIAGNOSIS:
Risk for Excess Fluid Volume
r/t Fluid retention
(malpositioned or
kinked/clotted catheter)

Obstructed drainage and blocking

catheter
INTERVENTIONS:
Accurate recording of I & O
Record serial weights, compare
with I&O balance. Weigh patient
when abdomen is empty of
dialysate (consistent reference
point).
Assess patency of catheter, noting
difficulty in draining. Note presence
of fibrin strings/plugs.

Obstructed drainage and blocking

catheter
INTERVENTIONS:
Check tubing for kinks; note
placement of bottles/bags. Anchor
catheter so that adequate
inflow/outflow is achieved.
Turn from side to side, elevate the
head of the bed, apply gentle
pressure to the abdomen.
Note abdominal distension
associated with decreased bowel

Obstructed drainage and blocking

catheter
INTERVENTIONS:
Monitor BP and pulse, noting
hypertension, bounding pulses,
neck vein distension, peripheral
edema; measure CVP if available.
Evaluate development of
tachypnea, dyspnea, increased
respiratory effort. Drain dialysate,
and notify physician.
Assess for headache, muscle

Obstructed drainage and blocking

catheter
INTERVENTIONS:
Alter dialysate regimen as indicated.
Monitor serum sodium
Add heparin to initial dialysis runs;
assist with irrigation of catheter with
heparinized saline.
Maintain fluid restriction as
indicated.

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