Peritoneal Dialysis PDF

PERITONEAL DIALYSIS  PERITONEAL DIALYSIS Peritoneal dialysis (PD) is a treatment for patients with severe chronic kidney disease A dialysis technique that uses the patient’s own body tissue-peritoneal membrane inside the abdominal cavity as a  GOALS Remove toxic substances and metabo...

PERITONEAL DIALYSIS  PERITONEAL DIALYSIS Peritoneal dialysis (PD) is a treatment for patients with severe chronic kidney disease A dialysis technique that uses the patient’s own body tissue-peritoneal membrane inside the abdominal cavity as a  GOALS Remove toxic substances and metabolic wastes Re-establish normal fluid and electrolyte balance Maintain a positive nitrogen balance Prolong life Have the maximum level of quality of life PERITONEAL DIALYSIS CATHETER Straight Tenckhoff Curled Tenckhoff Swan-neck T-fluted  PREPARING THE PATIENT nurse’s preparation of the patient and family for PD The nurse and surgeon or interventional radiologist or nephrologist explain the procedure to the patient. The nurse assists the provider in obtaining signed consent for insertion of the catheter. The patient is instructed to empty the bladder and bowel  PREPARING THE EQUIPMENT Assemble the equipment needed Check physician’s order for the concentration of dialysate and medications to be added Heparin : to prevent clotting KCI : to prevent hypokalaemia Antibiotics : peritonitis Insulin : for diabetic patients  PREPARING THE EQUIPMENT Warm the dialysate solution to body temperature Dry heating should be done Too cold solution be done Too cold solution causes pain, cramping , and reduce clearance PD is accomplished by putting dialysis solution into the peritoneal space. The three phases of the PD cycle are inflow , dwell , and drain. The three phases are called an exchange  PERFORMING THE EXCHANGE All types of PD involve a series of exchanges or cycles. An exchange is the entire cycle including drainage of the effluent (fluid), instillation of the dialysate, and dwell. This cycle is repeated throughout the course of the dialysis.  PERFORMING THE EXCHANGE The dialysate is infused by gravity into the peritoneal cavity. A period of about 10 minutes is usually required to infuse 2 to 3 L of fluid. A sterile cap is applied to the transfer set and the patient can perform ADLs. The prescribed dwell, or equilibration time, allows diffusion and osmosis to occur.  PERFORMING THE EXCHANGE At the end of the prescribed dwell, the patient performs hand hygiene, dons a mask, removes the sterile cap, unclamps the transfer set, and the solution drains from the peritoneal cavity by gravity through a closed system. Drainage is usually completed in 20 to 30 minutes. The drainage fluid is normally colorless or straw- colored and should not be cloudy. Bloody or pink- colored drainage may be seen in the first few exchanges after insertion of a new catheter, but should not occur after that time  PERFORMING THE EXCHANGE The removal of excess water during PD occurs because dialysate has a high dextrose concentration, making it hypertonic. An osmotic gradient is created between the blood and the dialysate solution. Dextrose solutions of 1.5%, 2.5%, and 4.25% are available in several volumes, from 1000 to 3000 ML.  TYPES OF PERITONEAL DIALYSIS Continuous ambulatory peritoneal dialysis (CAPD) Automated peritoneal dialysis ( APD ) ○ Continuous cycling peritoneal dialysis (CCPD) ○ Intermittent peritoneal dialysis ○ Nocturnal (nightly) intermittent peritoneal dialysis  COMPLICATION Peritonitis Leakage Bleeding Exit Site infection Hernias Lower Back Problems. Increased intraabdominal pressure can cause or aggravate lower back pain Pulmonary Complications. Atelectasis , pneumonia , and Bronchitis may occur from repeated upward displacement of the diaphragm , resulting in decrease lung expansion. Protein Loss : The amount of loss is usually about 0.5 g/L of dialysate drainage , but it can be as high as 10 to 20 g/day.  NURSING MANAGEMENT PREDIALYSIS CARE Document vital signs including temperature , pulse and blood pressure. Check the weight daily before the dialysis Note BUN , Serum electrolytes and creatinine , PH, haematocrit level , prior to peritoneal dialysis or periodically Measure and record abdominal girth Maintain fluid and dietary restriction as ordered Have the client empty the bladder prior to catheter insertion. Warm the prescribed dialysate solution to body temperature. Explain all procedures and expected sensations  INTRA-DIALYSIS CARE Use strict aseptic technique during procedure Add prescribed medications to the dialysate solution Prime the tubing with solution and connect it to peritoneal catheter , tapping connections securely and avoiding kinks. Instil dialysate into the abdominal cavity over a period of a period of approximately 10 minutes. Clamp tubing and allow the dialysate to remain in the abdomen for prescribed dwell time. Keep the drainage tubing and allow the dialysate to remain in the abdomen foe prescribed dwell time. Keep the drainage tubing , clamped at all time, during installation and dwell time After prescribed dwell time , open the drainage tubing clamps and allow the dialysate to drain by gravity into sterile container. Note the clarity , color and odor of the returned dialysate. Accurately record amount and type of dialysate instilled , dwell time and amount and character of drainage Monitor BUN, serum electrolytes and creatinine level.  POST DIALYSIS CARE Assess vitals sign Time meals to correspond with dialysate outflow Teach the client and family about the procedure. Watch for complication