Peritoneal Dialysis (PD)

Definition:
Peritoneum Dialysis is the process of removing wastes and water from blood by use of the living semi-permeable membrane called peritoneum.

Type of PD:
i. Intermittent Peritoneal dialysis (IPD)
ii. Continous ambulatory peritoneal dialysis (CAPD)
iii. Continous cycling peritoneal dialysis

Indications:

• acute renal failure
• chronic renal failure
• end stage renal failure awaiting for haemodialysis/ vascular problem
• severe fluid overload
• electrolyte imbalance

Contraindications:

- post recent recent abdominal surgery

-pregnancy

-peritoneal adhesions

-pleura peritoneal leak

-colostomy/gastrostomy

- severe polycystic kidney

Complications:

-peritonitis

-exit site infection

-bleeding

- catheter leakage and obstruction

-intestinal perforation

-fluid overload/dehydration

Nurses responsibilities:

i) pre-procedure
–Stability of the client, indication
–Vital sign, baseline data (weight)
–Latest investigation result (ECG, BUSE, BUN, FBC, PT/PTT, creatinine, etc)
–Consent
–Position (supine), assistant needed or not, etc

-Voiding

ii) during procedure
•Observe client reactions
•Maintain sterility
•Ensure patency of catheter. Check for any occlusion, kinking and etc.
•Instill dialysate into abdominal cavity approximately 10 minutes. After that, the clamp the tubing and allow the dialysate to remain in the abdomen for the prescribed dwell time. Rationale here is, the exchange of solutes and water between the blood and dialysate, across the peritoneal membrane occurs during the dwell time.
•Vital sign monitoring for any respiratory distress.
•After prescribed dwell time, drainage tubing clamp will be opened and allowed dialysate to drain by gravity into sterile container.
•Close observation of quality of PD fluid that has been out from client. Note for volume, color, presence of sediment, fibrin, odor and etc.
•Accurately record amount and type of dialysate instilled (including any added medications), dwell time and amount and character of the drainage must be recorded .
•Monitoring capillary blood sugar (CBS) due to dialysate (dextrose) used during dialysis; blood urea nitrogen (BUN), BUSE, and creatinine levels for assessment the effectiveness of dialysis.
•Documentation of PD chart is continuous process, so it need to be documented as a running report.
•Check outflow - cloudy, blood, and/or fibrin – may indicate blood clots.
•If the fluid is not draining properly, move the patient from side to side to facilitate the removal of peritoneal drainage. The head of the bed may also be elevated.
•When the outflow drainage ceases to run, clamp off the drainage tube and infuse the next exchange, using strict aseptic technique.
•The procedure is repeated until the blood chemistry levels improve. The usual duration for short-term dialysis is 48–72 h. Depending on the patient’s condition, he will receive 48–72 cycles.
•Keep an exact record of the patient’s fluid balance during the treatment.
•Know the status of the patient’s loss or gain of fluid at the end of each cycle. Check dressing for leakage and weight on gram scale if significant.

iii) post procedure:
•Monitor vital signs
•PD catheter still in place
•Close observation of risk for complications
•Maintain aseptic technique as well as client’s comfort in term of encouraging ambulation and appropriate position.
•If after insertion of PD catheter- secure PD system in position with plaster
•Hang the collecting bag at lower to client’s level
•Evaluate fluid balance with strict intake- output charting
•Documentation.

ref: note gastrointestinal and renal/urology (gtj 207)