It

is a dialysis procedure performed to correct an imbalance of fluid or of electrolytes in the blood or to remove toxins, drugs, or other wastes normally excreted by the kidney. The peritoneum is used as a diffusible membrane.

 In

PD, the peritoneal cavity and lining (peritoneum) is used to filter the blood. Once the cavity is filled with dialysis fluid (dialysate), uremic toxins begin to be cleared fro the blood. Diffusion and osmosis occur. This movement of solute from the blood into the dialysate fluid is called clearance. Ultrafiltration (water removal) occurs in PD through an osmotic gradient created by using a dialysate fluid with a higher glucose concentration

 Renal

failure who are unable or unwilling to undergo hemodialysis or renal transplantation Susceptible to rapid fluid, electrolyte and metabolic changes Diabetes Cardiovascular diseases

 Abdominal wound Peritonitis Abdominal disease Fecal

or infection

fistula or colostomy Gastric or diaphragmatic hernia Extensive adhesions from previous surgery

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Transfer Set- is tubing that connects the bag of dialysis solution to the catheter. Dialysis solution- comes in 1.5-, 2-, 2.5-, or 3-liter bags. The cycler-which automatically fills and drains your abdomen, usually at night while you sleep-can be programmed to deliver specified volumes of dialysis solution on a specified schedule.

Solution storage Pump Heater bag Fluid meter Disposal container Alarms

   

Explain the procedures and assist patient in obtaining signed consent. Record baseline vital sigs, weight and serum electrolyte level Evaluate of the abdomen for placement of the catheter Encourage patient to empty the bladder and bowel to reduce risk of puncture on internal organs.

Consult the physician to determine the concentration of dialysate to be used and medications to be added. Before adding the medications, the dialysate is warmed to body temperature to prevent discomfort and abdominal pain, and to dilate vessels of peritoneum to increase urea clearance.


DO NOT SOAK BAG OF SOLUTION IN WARM WATER AND USE OF MICROWAVE TO HEAT THE FLUID.

Filled tubing with prepared dialysate to reduce amt. of air entering the catheter & peritoneal cavity.

 

The catheter is inserted in the operating room or radiology suite. Catheters for long-term use are usually soft and flexible and made of silicone with radiopaque strip. 3 sections of catheter
a. b. c.

Intraperitoneal section Subcutaneous section External section

Although the catheter can be used right away, it is best to wait 10 to 14 days after placement before dialysis is performed; this allows the catheter site to heal.

 

 

An exchange is defined as the infusion, dwell and drainage of the dialysate. The dialysate is infused by gravity into the peritoneal cavity. A period of about 5-10 min. is usually required to infuse 2-3L of fluid. The prescribed dwell time allows diffusion and osmosis to occur. The tube is unclamped & the solution drains from the peritoneal cavity through a closed system for 10-20 min. Fresh dialysate is again introduced into the peritoneal cavity and the process may be repeated 4 to 5 times in a day.

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attention should be given to care of the catheter and the skin around it (catheter site) so as to maintain optimum functioning of the catheter and prevent infection. Immediately after insertion, the catheter site is covered with a sterile gauze dressing and tape so as to keep the catheter in place and also prevent infection.

The area should be kept dry until it has healed. Swimming and taking a bath should be avoided during this period. A washcloth or sponge may be used to clean the body. Lifting heavy items is not advisable. Constipation should be avoided to prevent development of hernia and problems with catheter function. After the catheter site has healed, care should be taken to keep the area clean.

 The

skin around the catheter site should be cleaned daily with antiseptic lotion or antibacterial soap and the patted dry with a clean towel. An antibiotic cream should be applied around the catheter after each dressing change.

involves multiple exchanges during the day (usually three) with an overnight dwell. A machine is not needed and the person can walk around while the fluid is in the abdomen. At bedtime, dialysate is infused and is drained upon awakening. Occasionally, a machine (called a minicycler) will be needed to perform an exchange one or more times while sleeping.

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where the exchange is done automatically by the machine while the patient sleeps. The daytime dwell is long. CCPD is more common than CAPD in developed countries. Its advantage is that a patient gets more time to attend to other commitments.

 Catheter site Peritonitis Leakage Bleeding Hernia Weight gain

infection

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3. 4.

5.

6.

Meet psychosocial needs Discuss basic principles of peritoneal dialysis Demonstrate catheter and exit site care Demonstrate measurement of vital signs & weight measurement Discuss monitoring & management of fluid balance. Discuss aseptic technique

7. Discuss complications of peritoneal dialysis: prevention, recognition & management of complication 8. Demonstrate procedure for adding medications to dialysis solution 9. Discuss dietary restrictions 10. Describe plan of follow up care 11. Demonstrate maintenance of home dialysis records