INTRODUCTION Peritoneal dialysis is the process during which the peritoneal cavity acts as reservoir for
the dialysate and peritoneum serves as semi-permeable membrane, across which excess body fluids and
solutes, including uremic toxins are removed .Peritoneal membrane is in contact with rich blood supply
to the abdominal organs and dialysate is infused into peritoneal cavity via catheter.
3. .
4. DEFINITION Peritoneal Dialysis is a process or procedure which allows exchange of wastes, fluids
and electrolytes in the peritoneal cavity. ( Ignativicious) Peritoneal dialysis involves repeated cycling of
instilling dialysate into peritoneal cavity, allowing the time for substance exchange and then removing
the dialysate. (Joyce M Black)
5. INCIDENCE The use of peritoneal dialysis has decreased and currently accounts for only 5 % to 6% of
the dialysis.
6. PRINCIPLES • Diffusion • Osmosis • Ultrafiltration.
7. INDICATIONS Patient’s with Chronic Kidney Disease. Unstable patients who cannot tolerate
anticoagulation. Patients with chronic infections, vascular access problems Peritoneal dialysis is often
the treatment of choice for older adults, because it offers more flexibility, if his or her status changes
frequently.
8. CONTRAINDICATIONS Peritoneal adhesions. Extensive Intra-abdominal surgery. Obesity
Recurrent episodes of peritonitis Abdominal malignancies. Respiratory diseases, ruptured
diverticulum.
9. CONTINUE….. • ADVANTAGES • Easy to learn • Can be done at home • Ambulatory – no machines are
needed , when machines are used, they are small • Better BP Control • Less dietary and fluid restriction
• Greater freedom in scheduling and travelling. • DISADVANTEGES • Time consuming • Sterile technique
is required • Presence of permentant catheter • Risk for peritonitis and peritoneal injury •
Contraindicated in abdominal surgeries, chronic back pain or development of hernias.
10. PROCEDURE • Each peritoneal exchange consists of 3 phases. • Fill, dwell and drain. • A siliconized
rubber catheter is surgically placed into the abdominal cavity for infusion of dialysate. • Usually 1 to 2 l
of dialysate is infused by gravity (Fill phase) • Fluid stays ( dwells) in the cavity for a specified time,
prescribed by the nephrologist.
11. CONTINUE…….. • Fluid then flows out of the body (drains) by the gravity into drainage bag.
( peritoneal outflow generally called as “peritoneal effluent “ contains the dialysate and excess waste ,
electrolytes and nitrogen –based waste products.) • The 3 phases of the process ( infusion or fill, dwell
and outflow or drain)makes up one peritoneal dialysis exchange.
12. PROCESS Peritoneal dialysis occurs through diffusion and osmosis across the semi- preamble
peritoneal membrane and capillaries. The peritoneal membrane is large and porous. It allows solutes
and water to move from an area of higher concentration in blood to an area of lower concentration in
dialysing fluid ( diffusion). The fluid and waste products dialysed from patient move through blood
vessels wall, interstitial tissue and the peritoneal membrane and are removed when dialyzing fluid drain
from the body.
13. Factors affecting peritoneal dialysis efficiency • Decreased peritoneal membrane permeability
caused by infection or scarring. • Reduced capillary blood flow resulting from blood vessel constriction.
• Vascular disease • Decreased perfusion of peritoneum.
14. Dialysate Additives • Heparin may be added to the dialysate to prevent clotting of the catheter or
tubing. • Other agents includes potassium and antibiotics. • Antibiotics is given by intraperitoneal routes
when peritonitis is present or suspected.
15. TYPES OF DIALYSIS. • Continuous Ambulatory Peritoneal Dialysis. • Automated Peritoneal dialysis. •
Intermittent Peritoneal Dialysis. • Continuous cycling peritoneal Dialysis.
16. ContinuousAmbulatory Peritoneal Dialysis • Most commonly used peritoneal dialysis. • Cleanse the
body ,helps to control the water and replaces the work of replaced kidney. • Portable type of Dialysis. •
Performed by the patients with the infusion of 2l -4l exchange of Dialysate into the peritoneal cavity. •
Duration of dialysate is 4 to 8 hours in peritoneum in a day and exchange occurs 7 days in a week. •
During dwell period patient can use a continuous connect system or disconnect system
17. Continuous Ambulatory Peritoneal Dialysis
18. AUTOMATED PERITONEAL DIALYSIS • Often used in acute care setting settings, outpatient dialysis
centers or in patient’s home. • APD uses a cycling machine for dialysate inflow ,dwell and outflow
according to pre-set times and volumes.A warming chamber for dialysate is the part of machine •
Functions are monitored for patient’s specific needs • Permits home dialysis while patient sleeps •
Reduces the incidence of peritonitis, because fewer connections and disconnections are needed
19. AUTOMATED PERITONEAL DIALYSIS
20. Continuous- Cycling Peritoneal Dialysis (CCPD) Continuous – Cycling Peritoneal Dialysis is a form of
automated dialysis that uses an automated cycling machine. Exchange occurs at night while patient
sleep. The final exchange of the night is left to dwell through the day and is drained in the next evening
as process is repeated.
21. INTERMITTENT PERITONEAL DIALYSIS • IPD combines osmotic pressure with true dialysis.The patient
usually requires the exchange of 2l of dialysate at 30 to 60 minutes interval , allowing 15 to 20 minutes
of drain time. • For most patients 30 to 40 exchanges of 2 L three times weekly are needed. • IPD can be
automated or manual.
22. COMPLICATIONS • Peritonitis • Bleeding • Dialysate leakage • Bladder perforation • Pain • Bowel
Perforation.
23. NURSING MANAGEMENT
24. PREDIALYSIS CARE • Document vital signs including temperature, pulse and Blood pressure.These
baseline data help to assess fluid volume status and tolerance of the dialysis procedure. • Check the
weight daily before the dialysis. • Note BUN, Serum electrolytes and creatinine, PH, haematocrit level
,prior to peritoneal dialysis or periodically ( helps to assess the efficiency of the treatment.) • Measure
and record abdominal girth(Increasing abdominal girth may indicate retained dialysate, excess fluid
volume or early peritonitis)
25. Continue…… • Maintain fluid and dietary restriction as ordered (fluid and dietary restriction help to
reduce hypervolemia and control azotaemia.) • Have the client empty the bladder prior to catheter
insertion.(emptying bladder reduces the risk of inadvertent puncture) • Warm the prescribed dialysate
solution to body temperature (98.60 F) using a warm bath or heating pad .( helps to prevent
hypothermia) • Explain all procedures and expected sensations.
26. Intra-dialysis care. • Use Strict aseptic technique during the procedure. • Add prescribed
medications to the dialysate solution Prime the tubing with solution and connect it to peritoneal
catheter, taping connections securely and avoiding kinks. • Instil dialysate into the abdominal cavity over
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 ,clamped at all time, during installation and dwell
time.
27. Continue… • During instillation and dwell time. Observe closely for the signs of respiratory distress
such as dyspnoea, tachyapnea or crackles. • Place in fowler’s or semi fowler's and slow the rate of
instillation slightly to relieve the respiratory distress. • After prescribed dwell time, open the drainage
tubing clamps and allow the dialysate to drain by gravity into a sterile container. Note the clarity, color
and odor of the returned dialysate. ( Blood or feces in the dialysate may indicates organ or bowel
perforation.)
28. Continue…. • Accurately record amount and type of dialysate instilled ( including added
medications),dwell time and amount and character of drainage. • Monitor BUN, serum electrolytes and
creatinine level ( helpful in assessing the effectiveness of dialysis). • Analyse for possible complications.
29. POST DIALYSIS CARE • Assess vital signs ( compare with pre-dialysis vital signs) • Time meals to
correspond with dialysis outflow. • Teach the client and family about the procedure. • Watch for
complications.
30. CONCLUSION • Peritoneal dialysis is a way to remove waste products from blood when kidneys can't
adequately do the job any longer. During peritoneal dialysis, a cleansing fluid flows through a tube
(catheter) into part of abdomen.The lining of abdomen (peritoneum) acts as a filter and removes waste
products from blood. After a set period of time, the fluid with the filtered waste products flows out of y
abdomen and is discarded.These treatments can be done at home, at work or while traveling.
