ADVANCED NURSING PRACTICES

PROCEDURE ON
PERITONEAL DIALYSIS
INTRODUCTION
Peritoneal Dialysis (PD) is a type of dialysis treatment used for patients with kidney failure. It is a
home-based therapy that uses the peritoneal membrane inside the abdomen as a natural filter to
remove waste, excess fluid, and toxins from the blood. Unlike hemodialysis, which requires a
machine and regular visits to a dialysis center, PD allows greater flexibility and can be performed at
home, at work, or even while traveling.
PD involves the insertion of a catheter into the peritoneal cavity, through which a special dialysis
solution (dialysate) is introduced. The solution absorbs waste products and is later drained out, taking
the toxins with it.
DEFINITION
Peritoneal Dialysis (PD) is a medical procedure used to remove waste products, excess fluids, and
toxins from the blood when the kidneys can no longer function properly. It utilizes the peritoneal
membrane, a natural lining in the abdomen, as a filtration system. A sterile dialysis solution is
introduced into the peritoneal cavity through a catheter, where it absorbs waste and is later drained
out, mimicking the kidney's function.
TYPES
There are two main types of PD:
1. Continuous Ambulatory Peritoneal Dialysis (CAPD) – A manual process where the patient
performs several fluid exchanges per day.
2. Automated Peritoneal Dialysis (APD) – A machine (cycler) automatically controls the
exchange process, usually performed overnight while the patient sleeps.
PD is a preferred option for many patients due to its convenience, fewer dietary restrictions, and
preservation of residual kidney function. However, it requires patient commitment and strict hygiene
to prevent infections such as peritonitis.
INDICATIONS
 End-Stage Renal Disease (ESRD)
 Acute Kidney Injury (AKI)
 Patients Seeking Home-Based Dialysis
 Poor Vascular Access for Hemodialysis
 Cardiovascular Conditions
 Children and Elderly Patients
 Patients Intolerant to Hemodialysis
CONTRAINDICATION
 Absolute Contraindications (PD should not be performed)
 Extensive abdominal adhesions (e.g., from multiple previous surgeries, severe peritonitis)
 Severe abdominal wall defects (e.g., large hernias, diaphragmatic defects)
  Loss of peritoneal membrane function (e.g., extensive peritoneal fibrosis or sclerosis)
 Active intra-abdominal infections (e.g., untreated peritonitis, abdominal tuberculosis)
 Severe malnutrition (inability to maintain adequate protein levels)
 Relative Contraindications (PD may be possible but with caution)
 Morbid obesity (difficulty in catheter placement and fluid exchange)
 Severe respiratory disease (increased intra-abdominal pressure may worsen breathing)
 Significant hernias (risk of worsening due to increased intra-abdominal pressure)
 Mental or physical disabilities (inability to perform PD independently or with assistance)
 Uncontrolled inflammatory bowel disease (IBD) (risk of infection and complications)
 Non-compliance or lack of support (PD requires strict hygiene and adherence to protocol)
EQUIPMENTS
1. Peritoneal Dialysis Catheter
 A flexible silicone or polyurethane tube surgically inserted into the peritoneal cavity to
allow the exchange of dialysis fluid.
2. Dialysis Solution (Dialysate)
 A sterile fluid containing glucose, electrolytes, and other components to draw waste and
excess fluid from the blood.
 Available in different concentrations (1.5%, 2.5%, 4.25% glucose) to control fluid removal.
3. Transfer Set
 A connecting tube that links the catheter to the dialysis system.
 Includes clamps and valves to control fluid flow.
4. Drainage and Infusion Bags
 Dialysate bag: Holds the sterile dialysis solution.
 Drainage bag: Collects the used dialysate after fluid exchange.
5. Automated Peritoneal Dialysis (APD) Cycler (For APD Patients)
 A machine that automates the fluid exchange process overnight, making PD more
convenient.
6. Cleaning and Sterilization Supplies
 Antiseptic solutions (e.g., chlorhexidine, povidone-iodine) for catheter site cleaning.
 Face masks and sterile gloves to prevent infections.
7. Securement Devices and Dressing Materials
 Adhesive tapes or catheter holders to secure the PD catheter.
 Sterile gauze and dressings for wound care.
PREPRATION OF PROCEDURE
1. Patient Education
 Training sessions: Patients and caregivers are trained by healthcare professionals on how to
perform PD, maintain hygiene, and recognize complications.
 Dietary counseling: Information on dietary restrictions and fluid intake management.
2. Pre-Procedure Assessments
 Baseline tests: Blood tests (e.g., electrolytes, kidney function tests), and imaging studies (e.g.,
ultrasound) to assess abdominal anatomy.
 Infection screening: Screening for infections to prevent complications.
3. Catheter Insertion
 Timing: Usually performed 2–3 weeks before starting PD to allow healing.
 Procedure: Surgical insertion of the catheter into the peritoneal cavity under local or general
anesthesia.
4. Site Care and Healing
 Daily cleaning: Clean the catheter exit site daily with antiseptic solution and apply a sterile
dressing.
 Monitor for signs of infection: Redness, swelling, or discharge.
5. Assembling Supplies
 Check equipment: Ensure all equipment (dialysate, transfer sets, drainage bags) is available
and sterile.
 Warm the dialysate: Use a dialysate warmer to bring the solution to body temperature (avoid
microwaves).
6. Setting Up a Clean Environment
 Dedicated space: Create a clean, clutter-free area to perform exchanges.
 Hand hygiene: Wash hands thoroughly with soap and water or use an alcohol-based sanitizer.
 Use of sterile technique: Wear a face mask and sterile gloves during exchanges.
7. Psychological Preparation
 Address concerns: Discuss any fears or anxieties with healthcare providers.
 Support networks: Connect with support groups or other PD patients for shared experiences.

PROCEDURE
1. Preparation
Hand Hygiene & Personal Protection
 Wash hands thoroughly with soap and water.
  Wear sterile gloves and a face mask to prevent infection.
Prepare the Dialysis Solution
 Select the appropriate dialysate (1.5%, 2.5%, or 4.25% glucose).
 Warm the dialysate to body temperature using a heating pad or warmer (never use a
microwave).
Set Up a Clean Area
 Perform PD in a clean, dust-free environment.
 Ensure all supplies (dialysis bag, tubing, and catheter) are sterile and ready.
2. Catheter Connection
Inspect the Peritoneal Catheter
 Check for leaks, blockages, or signs of infection.
 Clean the catheter exit site with antiseptic solution.
Connect the Transfer Set
 Remove the cap from the PD catheter.
 Connect the catheter to the dialysis tubing using aseptic technique.
3. Exchange Process
The dialysis process consists of three main phases:
A. Fill Phase
 The warmed dialysate is infused into the peritoneal cavity through the catheter.
 The infusion typically takes 10–15 minutes.
 Ensure there is no pain or discomfort during filling.
B. Dwell Phase
 The dialysate remains in the abdomen for a prescribed period (usually 4–6 hours for CAPD or
overnight for APD).
 During this time, waste products, toxins, and excess fluids move from the blood into the
dialysis fluid via the peritoneal membrane.
C. Drain Phase
 The used dialysis solution is drained out via gravity into a drainage bag.
 This takes 20–30 minutes and should be clear or light yellow.
 If the fluid is cloudy, it may indicate an infection (peritonitis), requiring medical attention.
4. Completion & Disconnection
Clamp and Disconnect
 Clamp the tubing and disconnect the catheter from the transfer set.
  Apply a fresh sterile cap to the catheter.
Dispose of Waste Properly
 Discard used dialysate bags and supplies according to medical waste guidelines.
Monitor for Complications
 Watch for signs of infection (peritonitis): fever, cloudy drainage, or abdominal pain.
 Report any unusual symptoms to the healthcare provider.
NURSING MANAGEMENT
1. Pre-Procedure Nursing Care
Patient Assessment
 Assess vital signs (BP, heart rate, temperature, respiratory rate).
 Monitor fluid status (weight, urine output, edema).
 Evaluate electrolyte levels (potassium, sodium, creatinine).
 Check for signs of infection at the catheter site.
Preparation of Equipment & Environment
 Ensure sterile technique is followed to prevent peritonitis.
 Warm the dialysate solution to body temperature.
 Educate the patient on the importance of hand hygiene and aseptic technique.
 Check catheter patency and secure the catheter properly.
Patient Education
 Teach the patient about the procedure, purpose, and potential complications.
 Demonstrate proper catheter care and exchange techniques.
 Reinforce the need for strict hygiene and adherence to dialysis schedules.
2. Intra-Procedure Nursing Care
Monitoring During Dialysis Exchange
 Observe for signs of pain, discomfort, or complications during filling and draining.
 Ensure the patient maintains a comfortable position to facilitate fluid exchange.
 Check for cloudy dialysate (may indicate peritonitis).
 Monitor for excessive drainage or poor outflow (may indicate catheter obstruction).
Preventing Complications
 Encourage slow infusion of dialysate to prevent abdominal discomfort.
 Avoid kinks or twists in the catheter tubing.
 Monitor for respiratory distress (if excessive dialysate is instilled).
3. Post-Procedure Nursing Care
Assess & Record Findings
 Document dialysate inflow and outflow (amount, color, consistency).
 Monitor vital signs and watch for infection or fluid imbalances.
 Observe the peritoneal catheter site for signs of redness, swelling, or discharge.
Patient Care & Health Promotion
 Encourage the patient to maintain a high-protein diet to compensate for protein loss.
 Educate on early signs of peritonitis (abdominal pain, fever, cloudy drainage).
 Teach how to properly clean and dress the catheter site.
Psychosocial Support
 Address patient concerns or anxiety about the procedure.
 Provide emotional support and connect the patient with support groups if needed.
COMPLICATION
o Peritonitis (Infection of the Peritoneal Cavity)
o Exit-Site & Tunnel Infections (Infection Around the Catheter)
o Catheter-Related Issues
o Hernias (Umbilical, Inguinal, or Abdominal Wall Hernias)
o Dialysate Leakage
o Hyper-glycemia (High Blood Sugar)
o Electrolyte Imbalances
o Protein Loss & Malnutrition
o Encapsulating Peritoneal Sclerosis (EPS)

CONCLUSION
Peritoneal Dialysis (PD) is an effective, home-based renal replacement therapy for patients with end-
stage renal disease (ESRD) and selected cases of acute kidney injury (AKI). It offers greater
flexibility, better hemodynamic stability, and improved quality of life compared to hemodialysis.
However, successful PD requires strict aseptic technique, regular monitoring, and patient education to
prevent complications such as peritonitis, catheter-related infections, and metabolic imbalances.
Nurses play a critical role in the management of PD by providing patient education, monitoring for
complications, ensuring proper catheter care, and offering psychological support. Early detection and
prompt management of complications improve treatment outcomes and enhance the patient’s overall
well-being.
With proper training, adherence to hygiene protocols, and regular follow-ups, PD can be a safe,
effective, and sustainable option for long-term dialysis therapy.
BIBLIOGRAPHY
 MP Sharma, medical surgical nursing, AITBS publication, 3 edition, Page no -333-335.
 Pk Panwar ,Medical Surgical nursing, AITBS publication 6th edition, page no 179-181.
 Javed Anshari, medical surgical nursing, Jaypee brothers publication, 7th edition, page No.
452-454