PERITONEAL
DIALYSIS
AIDA I. BAUTISTA PhD. MAN. RN.
LEARNING OBJECTIVES
Explain the purpose of dialysis
Differentiate peritoneal dialysis and
hemodialysis
Appreciate the process of peritoneal
dialysis
Compare the two types of peritoneal
dialysis
Understand the series of exchanges or
cycles in peritoneal dialysis
DIALYSIS
Dialysis is a treatment that does some of the things done by healthy
kidneys. It is needed when the kidneys can no longer perform its
functions
PERITONEAL DIALYSIS
HEMODIALYSIS
Cleans the blood with the use of a Collects waste from the blood by washing the
machine. empty space in the abdomen (peritoneal cavity).
Done 3 to 5 times a week. Performed in a daily basis.
Done usually in a dialysis center. Done at home.
The hemodialysis access is in the A peritoneal dialysis access is
arm through an AV Fistula. the PD catheter surgically
An AV fistula is a surgical placed in the lower abdomen
procedure where a vein and an under laparoscopic guidance
artery is directly connected as a by surgeon.
permanent access for hemodialysis A small piece of tubing is left
outside of the body that can be
covered when not in use.
INDICATIONS of PERITONEAL DIALYSIS
1. Patient’s preference
Those unable or unwilling to
undergo hemodialysis
2. Medical conditions
heat conditions, ustable blood
pressure
3. Limited access to dialysis
centers
4. Those who are at risk for
adverse effects of systemic
heparin.
PERITONEAL SITE
PERITONEAL DIALYSIS PROCESS
Peritoneal dialysis involves a
series of exchanges or cycles.
Infusion
Dwell
drainage
PERITONEAL DIALYSIS PROCESS
During the INFUSION, a DIALYSATE, also called dialysis fluid,
cleansing fluid (dialysate) is dialysis solution or both, is a solution
infused through a tube (PD of pure water, electrolytes and salts,
catheter) into the peritoneal such as bicarbonate and sodium.
cavity. The purpose of dialysate is to pull
toxins from the blood into the
dialysate through the process of
diffusion and osmosis.
PERITONEAL DIALYSIS PROCESS
The lining of the abdomen
(peritoneum) acts as a filter and
removes waste products from the
blood.
INFUSION : In adults, 2 to 3 L
(in children, 30 to 40 mL/kg) of
dialysate, warmed to 37° C, is
infused over 10 to 15 minutes.
DWELLING
The PD fluid is allowed to
dwell in the peritoneal cavity
for a period of 4 to 6 hours per
each of three daytime
exchanges and 8 to 10 hours
during the overnight exchange.
Patients will usually carry PD
fluid in the peritoneum
continuously, 24 hours a day.
DRAINAGE
The tube is unclamped and the fluid with
the filtered waste products (EFFLUENT)
drains from the peritoneal cavity between
30 to 40 minutes.
The removal of excess water during
peritoneal dialysis is achieved by using a
hypertonic dialysate with a high dextrose
concentration such as Dextrose solutions of
1.5%, 2.5%, and 4.25%.
TYPES OF PERITONEAL DIALYSIS
Continuous Ambulatory CAPD is "continuous," machine-free and
Peritoneal Dialysis (CAPD) done while you go about your normal
activities
This is done by hooking up a plastic bag of
cleansing fluid to the tube in the belly.
Raise the plastic bag to shoulder level causes
gravity to pull the fluid into the belly.
When the dialysate is empty, the plastic bag
is removed and discarded
Performed in upright position
TYPES OF PERITONEAL DIALYSIS
Continuous Ambulatory
When an exchange is doned and the fluid is
Peritoneal Dialysis (CAPD)
drained , the plastic bag is removed and
discarded.
This process usually is done 3-5 times in a
24-hour period while the patient is awake
during normal activities.
Each exchange takes about 30 to 40
minutes.
Performed in upright position
TYPES OF PERITONEAL DIALYSIS
Automated Peritoneal Dialysis (APD)
APD uses automated
machine (cycler) to deliver
and drain the cleansing
fluid.
The treatment usually is
done at night while the
patient is asleep.
Performed in supine
position
DAILY ROUTINE OF PATIENT
PREPARING THE PATIENT .
1. Explains the procedure and obtains signed consent .
2. Baseline vital signs
3. Empty the bladder and bowel
4. Broad-spectrum antibiotic agents may be administered
- Cefazolin
- Tobramycin
- Cotrimoxazole
- Vancomycin
PREPARING THE EQUIPMENT
1. Verify physician’s order to determine the concentration of
dialysate to be used and the medications to be added to it.
2. Before medications are added, the dialysate is warmed to body
temperature to prevent patient discomfort and abdominal pain
and to dilate the vessels of the peritoneum to increase urea
clearance.
3. Gather the materials
4. Assemble the administration set and tubing.
5. Fill the tubing with the prepared dialysate to reduce the
amount of air entering the catheter and peritoneal cavity.
Equipment Needed for Continuous Ambulatory Peritoneal Dialysis (CAPD)
A chair to do the exchanges Scale – used to help track the patient’s
Table – a clean surface to place weight and progress during treatment
supplies Disinfectant – used to keep the patient
I.V. stand – to hang the dialysate and the surface clean
bags Masks – use to minimize the risk of
Heating pad – to bring the infection
dialysate up to body temperature. Gloves – use to protect self
This provides both comfort and
helps to speed along the exchange Dialysis supplies (dialysate, waste bags,
of fluids. connection devices)
Equipment Needed For Automated Peritoneal
Dialysis (APD)
Automated cycling machine.
Dialysis supplies (larger bags of PD
solution, drain bag or drain line,
and tubing and other connection
devices)
Space for the machine and supplies
Masks
Disinfectant
Scale
Table
NURSING RESPONSIBILITY
1. Strict aseptic technique 5. Monitor for complications
2. Vital signs, weight, (peritonitis, bleeding,
intake and output respiratory difficulty, and
leakage of peritoneal fluid).
3. Monitor the patient for
6. Abdominal girth
edema.
4. Checking the patency of 7. The catheter should never
the catheter be pushed in to prevent bowel
perforation
8. Use a flow sheet
PERITONEAL DIALYSIS FLOW CHART
NAME:_____________________________________________
DATE:_______________ TIME:_______
AGE:______________________
WEIGHT:__________________
Abdominal girth:____________
Creatinine: _________________
Dialysate concentration:____________________________
Medication added:______________________________
FIRST CYCLE:
Vital Sign: BP_________ RR ________ PR_________ TEMP __________
Time of infusion (10-15 min): From_7: 20 AM____Finished____7:35 AM____
Exchange Volume:_____1, 500 ML_____
Dwell time (4 to 5 hours): From _____7:35 AM_____to ___11:35 AM_________
Drain time (30 min): From _____11:35 AM____ to ______12:05 PM_________
Dialysate fluid balance for the exchange (fluid lost or gained):
_1,600____(LOST )
Vital Sign: BP_________ RR __________ PR_________TEMP _____________
SECOND CYCLE:
Time of infusion (10-15 min): From__12:05 PM_________ Finished__12:20
PM______ Exchange Volume:__1, 500 ML_________
Dwell time (4 to 5 hours): From __12:20 PM____to _____4:20 PM___________
Drain time (30 min): From __4:20 PM____________ to _____4:50 PM__________
Dialysate fluid balance for the exchange (fluid lost or gained): _1, 500 ML______
Vital Sign: BP_________ RR __________ PR_____________ TEMP ___________
THIRD CYCLE:
Time of infusion (10-15 min): From_4:50 PM___ Finished__5:05 PM___
Exchange Volume:___1, 500 ML____
Dwell time (4 to 5 hours): From __5:05 PM____to ____9:05 PM_____
Drain time (30 min): From _____9:05 PM_____ to ____9:35 PM________
Dialysate fluid balance for the exchange (fluid lost or gained): __1,400_________
Vital Sign: BP_________ RR __________ PR_____________ TEMP
_____________
CUMULATIVE FLUID BALANCE:
Total fluid infused:__4, 500_____Total Fluid drain:____4,500_______
REMARKS:_______________________________________________
__________________________________________________________
_
Aida I. Bautista PhD. MAN. RN.
Nurse on Duty
REFERENCES
Smeltzer, S, Bare, B et al. (2010) Brunner & Suddarth’s Textbook
of Medical-Surgical Nursing 12th Edition, Lippincott Williams and
Wilkins
Berman. A. Snyder, S., & Frandsen, G. (2016) Kozier and Erbs
Fundamentals of Nursing 10th Edition. Pearson
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