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    Peritoneal Dialysis

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    Yum C
    Peritoneal dialysis is a treatment for patients with severe chronic kidney disease that uses the peritoneum in the abdomen as a membrane to exchange fluids and dissolved substances between the blood and dialysis fluid introduced through a catheter implanted in the abdomen. The process involves infusing dialysis fluid into the abdomen through the catheter where it remains for a dwell time to allow diffusion of waste products from the blood into the fluid, then draining the used fluid and replacing it with fresh fluid either continuously or during sleep. Complications can include infection, bleeding, or fluid imbalance.

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    Peritoneal Dialysis

    Uploaded by

    Yum C
    573 views45 pages
    Peritoneal dialysis is a treatment for patients with severe chronic kidney disease that uses the peritoneum in the abdomen as a membrane to exchange fluids and dissolved substances between the blood and dialysis fluid introduced through a catheter implanted in the abdomen. The process involves infusing dialysis fluid into the abdomen through the catheter where it remains for a dwell time to allow diffusion of waste products from the blood into the fluid, then draining the used fluid and replacing it with fresh fluid either continuously or during sleep. Complications can include infection, bleeding, or fluid imbalance.

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    Peritoneal dialysis is a treatment for patients with severe chronic kidney disease that uses the peritoneum in the abdomen as a membrane to exchange fluids and dissolved substances between the blood and dialysis fluid introduced through a catheter implanted in the abdomen. The process involves infusing dialysis fluid into the abdomen through the catheter where it remains for a dwell time to allow diffusion of waste products from the blood into the fluid, then draining the used fluid and replacing it with fresh fluid either continuously or during sleep. Complications can include infection, bleeding, or fluid imbalance.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    573 views45 pages

    Peritoneal Dialysis

    Uploaded by

    Yum C
    Peritoneal dialysis is a treatment for patients with severe chronic kidney disease that uses the peritoneum in the abdomen as a membrane to exchange fluids and dissolved substances between the blood and dialysis fluid introduced through a catheter implanted in the abdomen. The process involves infusing dialysis fluid into the abdomen through the catheter where it remains for a dwell time to allow diffusion of waste products from the blood into the fluid, then draining the used fluid and replacing it with fresh fluid either continuously or during sleep. Complications can include infection, bleeding, or fluid imbalance.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 45

    PERITONEAL DIALYSIS

    Prepared by:

    PERITONEAL DIALYSIS

    Peritoneal

    dialysis (PD) is a

    treatment for patients with severe chronic kidney disease.

    THE PROCESS USES THE PATIENT'S PERITONEUM


    IN THE ABDOMEN AS A MEMBRANE ACROSS WHICH FLUIDS AND DISSOLVED SUBSTANCES (ELECTROLYTES, UREA, GLUCOSE, ALBUMIN AND OTHER SMALL MOLECULES) ARE EXCHANGED FROM THE BLOOD. FLUID IS INTRODUCED THROUGH A PERMANENT TUBE IN THE ABDOMEN AND FLUSHED OUT EITHER EVERY NIGHT WHILE THE PATIENT SLEEPS (AUTOMATIC PERITONEAL DIALYSIS) OR VIA

    REGULAR EXCHANGES THROUGHOUT THE DAY (CONTINUOUS AMBULATORY PERITONEAL DIALYSIS).

    HOOK UP

    THE ABDOMEN IS CLEANED


    IN PREPARATION FOR

    SURGERY, AND A CATHETER IS SURGICALLY INSERTED WITH ONE END IN THE ABDOMEN AND THE OTHER PROTRUDING FROM THE SKIN.

    INFUSION

    BEFORE EACH INFUSION THE AREA MUST BE CLEANED, AND FLOW INTO AND OUT OF THE ABDOMEN TESTED. A LARGE VOLUME OF FLUID IS
    INTRODUCED TO THE ABDOMEN OVER THE NEXT TEN TO FIFTEEN MINUTES. THE TOTAL VOLUME IS

    REFERRED TO AS A DWELL WHILE THE FLUID ITSELF IS REFERRED TO AS DIALYSATE. THE DWELL CAN BE AS MUCH AS 2.5 LITERS, AND MEDICATION CAN ALSO BE ADDED TO THE FLUID IMMEDIATELY BEFORE INFUSION.

    DIFFUSION ( FRESH )

    THE DWELL REMAINS IN THE ABDOMEN AND WASTE


    PRODUCTS DIFFUSE ACROSS THE PERITONEUM FROM THE UNDERLYING BLOOD VESSELS. AFTER A VARIABLE PERIOD OF TIME DEPENDING ON THE TREATMENT (USUALLY

    4-6 HOURS), THE FLUID IS REMOVED AND REPLACED WITH FRESH FLUID. THIS
    CAN OCCUR AUTOMATICALLY WHILE THE PATIENT IS SLEEPING (AUTOMATED PERITONEAL DIALYSIS,

    APD), OR DURING THE DAY BY KEEPING TWO


    LITERS OF FLUID IN THE ABDOMEN AT ALL TIMES, EXCHANGING THE FLUIDS FOUR TO SIX TIMES PER DAY (CONTINUOUS AMBULATORY PERITONEAL DIALYSIS,

    CAPD).

    DIFFUSION ( WASTE )

    THE FLUID USED TYPICALLY CONTAINS SODIUM, CHLORIDE, LACTATE OR


    BICARBONATE AND A HIGH PERCENTAGE OF GLUCOSE TO ENSURE HYPEROSMOLARITY. THE

    AMOUNT OF DIALYSIS THAT OCCURS DEPENDS ON THE VOLUME OF THE DWELL, THE REGULARITY OF THE EXCHANGE AND THE CONCENTRATION OF THE FLUID.

    DRAINAGE

    THE ABILITY TO EXCHANGE


    FLUIDS BETWEEN THE
    PERITONEUM AND BLOOD SUPPLY CAN BE CLASSIFIED AS HIGH, LOW OR INTERMEDIATE.

    HIGH TRANSPORTERS TEND TO


    DIFFUSE SUBSTANCES WELL (EASILY EXCHANGING SMALL MOLECULES BETWEEN BLOOD AND THE DIALYSIS FLUID, WITH SOMEWHAT IMPROVED RESULTS FREQUENT, SHORTRATION DWELLS SUCH AS WITH APD)

    LOW TRANSPORTERS FILTER FLUIDS BETTER (TRANSPORTING FLUIDS ACROSS

    THE MEMBRANE INTO THE BLOOD MORE QUICKLY WITH SOMEWHAT BETTER RESULTS WITH LONG-TERM, HIGH-VOLUME DWELLS SUCH) THOUGH IN PRACTICE EITHER TYPE OF TRANSPORTER CAN GENERALLY BE MANAGED THROUGH THE APPROPRIATE USE OF EITHER APD OR

    CAPD.

    PERITONEAL DIALYSIS
    ACCESS

    PERITONEAL DIALYSIS REQUIRES ACCESS TO THE PERITONEAL CAVITY. DURING A MINOR OPERATION, PERFORMED USING A LOCAL OR A GENERAL ANESTHETIC, THE
    DOCTOR INSERTS A SOFT PLASTIC TUBE INTO THE ABDOMEN.

    THIS TUBE IS CALLED A PERITONEAL DIALYSIS CATHETER (PD CATHETER). IT ACTS AS A PERMANENT PATHWAY INTO THE PERITONEAL CAVITY.

    THE PD CATHETER IS ABOUT 30 CM (12 INCHES) LONG, AND ABOUT AS WIDE AS A PENCIL. ABOUT 15 CM (6 INCHES) OF
    THE TUBE REMAINS OUTSIDE YOUR BODY,

    ALLOWING THE DISPOSABLE DIALYSIS BAGS TO BE ATTACHED. THE PLACE WHERE THE CATHETER COMES OUT OF THE BODY IS CALLED THE EXIT SITE.

    THE CATHETER IS USUALLY PLACED JUST


    BELOW AND SLIGHTLY TO THE SIDE OF THE BELLY BUTTON.

    YOUR DOCTOR OR

    NURSE WILL DETERMINE WITH YOU THE

    EXACT LOCATION FOR THE EXIT SITE SO


    THAT THE CATHETER CAN BE

    COMFORTABLY AND EASILY HIDDEN


    UNDER CLOTHING

    COMPLICATIONS

    HYPERTENSION AND EDEMA PRESENCE OF PINK OR BLOODY EFFLUENT


    SUGGESTS BLEEDING INSIDE THE ABDOMEN(INDICATE A PERFORATED BOWEL PERFORATED BOWEL AND CLOUDY FLUID SUGGESTS INFECTION). PAIN OR DISCOMFORT IMPAIRED BREATHING CONSTIPATION

    PREDIALYSIS CARE

    DOCUMENT VITAL SIGNS INCLUDING TEMPERATURE, ORTHOSTATIC BLOOD PRESSURES (LYING, SITTING, AND STANDING), APICAL PULSE, RESPIRATIONS AND LUNG SOUNDS. THESE
    BASELINE DATA HELP ASSESS FLUID VOLUME STATUS AND TOLERANCE OF THE DIALYSIS PROCEDURE.

    HYPERTENSION, ABNORMAL HEART OR LUNG SOUNDS, OR DYSPNEA MAY INDICATE EXCESS FLUID VOLUME. POOR RESPIRATORY FUNCTION MAY
    AFFECT THE ABILITY TO TOLERATE PERITONEAL DIALYSIS. TEMPERATURE MEASUREMENT IS VITAL, BECAUSE INFECTION IS THE MOST COMMON COMPLICATION OF PERITONEAL DIALYSIS.

    WEIGH DAILY OR BETWEEN DIALYSIS RUNS AS INDICATED. WEIGHT IS AN ACCURATE INDICATOR OF FLUID VOLUME STATUS.

    NOTE BUN,SERUM ELECTROLYTE, CREATININE, PH, AND HEMATOCRIT LEVELS


    PRIOR TO PERITONEAL DIALYSIS AND PERIODICALLY DURING THE PROCEDURE.

    THESE VALUES ARE USED TO ASSESS


    THE EFFICACY OF TREATMENT.

    MEASURE AND RECORD ABDOMINAL GIRTH.


    INCREASING ABDOMINAL GIRTH MAY INDICATE RETAINED DIALYSATE,
    EXCESS FLUID VOLUME OR EARLY PERITONITES.

    MAINTAIN FLUID AND DIETARY RESTRICTIONS AS ORDERED. FLUID AND DIET RESTRICTIONS HELP
    REDUCE HYPERVOLEMIA AND CONTROL AZOTEMIA.

    HAVE THE CLIENT EMPTY THE


    BLADDER PRIOR TO CATHETER INSERTION.

    EMPTYING THE BLADDER REDUCES


    THE RISK OF INADVERTENT PUNCTURE.

    WARM THE PRESCRIBED DIALYSATE


    SOLUTION TO BODY TEMPERATURE

    USING A WARM WATER BATH OR HEATING PAD ON LOW SETTING. DIALYSATE IS WARMED TO PREVENT HYPOTHERMIA.

    EXPLAIN ALL PROCEDURES AND EXPECTED SENSATIONS. KNOWLEDGE HELPS REDUCE


    ANXIETY AND ELICIT COOPERATION.

    INTRADIALYSIS CARE

    USE STRICT ASEPTIC TECHNIQUE DURING


    THE DIALYSIS PROCEDURE AND WHEN CARING FOR THE PERITONEAL CATHETER.

    PERITONITIS IS A COMMON
    COMPLICATION OF PERITONEAL DIALYSIS; STERILE TECHNIQUE REDUCES THE RISK.

    ADD PRESCRIBED MEDICATIONS TO THE DIALYSATE; PRIME THE TUBING WITH


    SOLUTION AND CONNECT IT TO THE

    PERITONEAL CATHETER, TAPING CONNECTIONS SECURELY AND AVOIDING KINKS.

    THIS ALLOWS DIALYSATE TO FLOW


    FREELY INTO THE ABDOMINAL CAVITY AND PREVENTS LEAKING OR CONTAMINATION.

    INSTILL DIALYSATE INTO THE ABDOMINAL


    CAVITY OVER A PERIOD OF APPROXIMATELY MINUTES.

    10

    CLAMP TUBING AND ALLOW THE

    DIALYSATE TO REMAIN IN THE ABDOMEN FOR


    THE PRESCRIBED DWELL TIME.

    KEEP DRAINAGE TUBING CLAMPED AT ALL


    TIMES DURING INSTILLATION AND DWELL TIME.

    DIALYSATE SHOULD FLOW FREELY INTO THE


    ABDOMEN IF THE PERITONEAL CATHETER IS

    PATENT.

    DIALYSIS, THE EXCHANGE OF SOLUTES

    AND WATER BETWEEN THE BLOOD AND DIALYSATE, OCCURS ACROSS THE PERITONEAL

    MEMBRANE DURING THE DWELL TIME.

    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. RESPIRATORY COMPROMISE MAY RESULT FROM OVERLY RAPID FILLING OR OVERFILLING OF THE ABDOMEN OR FROM A DIAPHRAGMATIC DEFECT THAT ALLOWS FLUID TO ENTER THE THORACIC CAVITY.

    AFTER PRESCRIBED DWELL TIME, OPEN


    DRAINAGE TUBING CLAMPS AND ALLOW DIALYSATE TO DRAIN BY GRAVITY INTO A

    STERILE CONTAINER.

    NOTE THE CLARITY, COLOR, AND ODOR OF RETURNED DIALYSATE. BLOOD OR


    FECES IN THE DIALYSATE MAY INDICATE ORGAN OR BOWEL PERFORATION; CLOUDY OR MALODOROUS DIALYSATE MAY INDICATE AN INFECTION.

    ACCURATELY RECORD AMOUNT


    AND TYPE OF DIALYSATE INSTILLED. MONITOR BUN, SERUM ELECTROLYTE, AND CREATININE LEVELS.

    SLOW DIALYSATE INSTILLATION.


    INCREASE THE HEIGHT OF THE
    CONTAINER AND REPOSITION THE CLIENT. CHECK TUBING AND CATHETER FOR KINKS. CHECK ABDOMINAL DRESSING FOR WETNESS, INDICATING LEAKAGE AROUND THE CATHETER. SLOW DIALYSATE FLOW MAY BE RELATED TO A PARTIALLY OBSTRUCTED TUBE OR CATHETER.

    EXCESS DWELL TIME. PROLONGED DWELL TIME MAY LEAD TO WATER DEPLETION OR HYPERGLYCEMIA. POOR DIALYSATE DRAINAGE.
    LOWER THE DRAINAGE CONTAINER, REPOSITION, CHECK FOR TUBING KINKS. CHECK ABDOMINAL DRESSING. TUBING OR
    CATHETER OBSTRUCTION CAN ALSO INTERFERE WITH DIALYSATE DRAINAGE.

    POSTDIALYSIS CARE

    ASSESS VITAL SIGNS, INCLUDING TEMPERATURE. COMPARISON OF PRE AND POST


    DIALYSIS VITAL SIGNS HELPS IDENTIFY BENEFICIAL AND ADVERSE EFFECTS OF THE PROCEDURE.

    TIME MEALS TO CORRESPOND WITH DIALYSIS OUTFLOW.


    SCHEDULING MEALS WHILE THE
    ABDOMEN IS EMPTY OF DIALYSATE

    ENHANCES INTAKE AND REDUCES NAUSEA.

    TEACH THE CLIENT AND FAMILY ABOUT THE PROCEDURE. THE CLIENT MAY ELECT TO USE
    PERITONEAL DIALYSIS AT HOME TO MANAGE
    END STAGE RENAL DISEASE AND PREVENT UREMIA.

    END!!! THANK YOU!!!

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