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HOSPITALIZED
PERITONEAL DIALYSIS
PATIENT
Documentation :
All exchanges
Exit Site care
Daily weights
CVPH utilizes a 24 Hour
Peritoneal Dialysis Record
to document.
PD Patients Are Knowledgeable
Keep in mind that PD patients (or
a caregiver), have been through
extensive training and carry out
their dialysis at home daily.
They are protective of their
“lifelines”, and will want to
ensure that proper technique is
used.
If you get them the supplies they
need, encourage them to carry out
the exchange themselves if they
are able.
Fluid Balance
Fluid & electrolyte balance must be maintained
to prevent dehydration and/or fluid overload.
Assess the patient for fluid volume status and
obtain orders from the MD to adjust dextrose in
dialysate if needed. Monitor:
Daily weights.
Lung sounds.
Presence of edema.
Total I & O (including + and – PD fluid balances).
Blood pressure.
Other S&S of dehydration or fluid overload.
Catheter Care
Exit site care will be done
daily by the patient if able, or
by trained staff.
Scrub hands well.
Examine exit site for S&S of
infection, irritation, or
leakage – if any, notify the
nephrologist.
Check the catheter &
connections – They should be
free from cracks, tears or
leaks.
Feel the catheter tunnel,
report any swelling or pain.
Daily Exit Site Care
Clean the skin around the catheter
with a sterile gauze pad &
antibacterial soap (Start close to the
catheter & move out).
Rinse well to remove all the soap.
Dry the exit site area with a sterile
gauze pad.
Tape the tubing to the abdomen in a
natural position to anchor/ immobilize
it, & protect it from trauma.
If patient uses mupirocin ointment,
obtain an order from MD, & apply to
exit site. If they use povidone-iodine
prep pads, paint a 1” circle around
the exit site & allow to air dry.
Exit Site Care
Apply a sterile gauze
dressing ( if Pt. doesn’t
normally wear a dressing,
they must wear one while
in the hospital).
Loop the catheter around
& tape again to secure it
better.
Repeat exit site care if exit
becomes wet or soiled.
Document any findings &
that site care was done.
Peritonitis in the PD Patient
CVPH has a protocol for peritonitis in the PD patient
which can be found in policy manager.
Patients with peritonitis usually present with cloudy
fluid and abdominal pain.
Send the first cloudy drain bag to the lab for stat cell
count w/ diff, gram stain & culture.
Prompt initiation of antibiotic therapy for peritonitis is
critical to prevent complications & limit damage to the
peritoneal membrane. (If the patient has cloudy effluent
& Abd pain, antibiotic therapy should be initiated
without waiting for confirmation of the cell count).
The nephrologist on-call must be notified.
Abdominal Pain in Peritonitis
Ranges from mild or even no pain to severe
pain.
The degree of pain is somewhat organism
specific.
If the patient is experiencing severe abdominal
pain, rapid exchanges may be done up to two
times to decrease pain (This delays initiation of
antibiotics, & should only be used in cases of
extreme pain).
In most cases, symptoms decrease rapidly after
initiation of antibiotic therapy.
Pain medications may be ordered PRN.
Peritonitis Continued
Heparin 2000 units per bag is added (by the
pharmacist) to dialysate when effluent is cloudy.
Vancomycin should be infused over 45 minutes
to prevent adverse reactions.
Antibiotics must dwell in peritoneum for at least
4 Hrs. (6-8 Hrs. preferred).
Assess patient for possible source of infection
(i.e. Catheter exit site, break in technique, recent
contamination, constipation or diarrhea, cracks
or leak in the catheter or transfer set).
Documentation
Record assessment data in nurses’
notes.
Record medications given.
Notify Peritoneal Dialysis unit staff
of peritonitis episode (so follow-up
care can be arranged).
Emergencies
Clamp tubing above disconnected area (nearer
to the patient), immediately if system becomes
disconnected, or if a leak is noted.
Notify Nephrologist (prophylactic antibiotic
orders may be needed).
Stop any further instillation of fluid to the
patient until a complete tubing change is made,
and orders are received from the Nephrologist.
Miscellaneous
Assess for alterations in blood glucose levels in
diabetics from the use of dextrose-based dialysate.
Check visually for changes in the appearance of the
effluent with each exchange.
If fibrin is present, an order can be obtained for the
pharmacy to add heparin to the bags.
If effluent is cloudy, Notify Nephrologist & initiate
peritonitis protocol.
Document clarity of each exchange on PD flow sheet.
Reinforce exit site dressing for newly inserted PD
catheters. Do not remove original dressing unless
trained to do so.
Be alert to tubing getting kinked or caught under
patient, which will prevent infusion or draining of
dialysate.
Bibliography
B. Piraino, et al., ISPD Guidelines/Recommendations,
Peritoneal Dialysis – Related Infections,
Recommendations: 2005 Update.
www.renalsource.com. Baxter Healthcare Corp.
“Introduction to Peritoneal Dialysis for Hospital
Nursing Staff” / 2004.
CVPH Policy Manager:
Peritonitis Protocol in the Peritoneal Dialysis (PD)
Patient.
Protocol for PD Patient, Care of the Patient
Receiving.
Policy for CAPD exchanges.
Procedure for PD Using the Manifold System.
Catheter and Exit Site Care, Baxter Healthcare Corp.
2000.