Peritoneal dialysis

Views : 1911
Update time : 2017-11-06 15:12:00

Peritoneal dialysis (PD) is a type of dialysis that uses the peritoneum in a person's abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood.It is used to remove excess fluid, correct electrolyte problems, and remove toxins in those with kidney failure.Peritoneal dialysis has better outcomes than hemodialysis during the first couple of years. Other benefits include greater flexibility and better tolerability in those with significant heart disease.

Complications may include infections within the abdomen, hernias, high blood sugar, bleeding in the abdomen, and blockage of the catheter. Use is not possible in those with significant prior abdominal surgery or inflammatory bowel disease. It requires some degree of technical skill to be done properly.

In peritoneal dialysis, a specific solution is introduced through a permanent tube in the lower abdomen and then removed. This may either occur at regular intervals throughout the day, known as continuous ambulatory dialysis, or at night with the assistance of a machine, known as automated peritoneal dialysis. 


What is continuous ambulatory peritoneal dialysis?

Continuous ambulatory peritoneal dialysis (CAPD) is done to remove wastes, chemicals, and extra fluid from your body. During CAPD, a liquid called dialysate is put into your abdomen through a catheter (thin tube). The dialysate pulls wastes, chemicals, and extra fluid from your blood through the peritoneum. The peritoneum is a thin lining on the inside of your abdomen. The peritoneum works like a filter as the wastes are pulled through it. The process of filling and emptying your abdomen with dialysate is called an exchange. Exchanges may be done 3 to 5 times during the day, and once during the night.

Why do I need CAPD?

You may need CAPD if your kidneys are not working well, or if they have stopped working. Your kidneys remove wastes and extra fluid from your blood and leave your body through your urine. When your kidneys are damaged, they cannot remove wastes properly. This can cause serious problems in your body. You may need CAPD if you have acute (short-term) or chronic (long-term) kidney failure. During acute kidney failure, you may only need CAPD until your kidneys get better. If you have chronic kidney failure, you will need to have dialysis exchanges for the rest of your life.

How is a CAPD catheter put in?

A procedure will be done to place the catheter. Medicine will be given to make you relax and decrease pain. Your healthcare provider will make an incision below or beside your belly button, or just below your ribs. He will cut through your muscle and tissue to make a hole where the catheter will be placed. A catheter will be pushed into your abdomen through this hole. The end of the catheter may be placed just under your skin for 3 to 5 weeks. Your healthcare provider will put some liquid through the catheter to check that it works well. He may also put blood thinner medicine in it to help prevent your catheter from getting clogged. The catheter will be held in place with stitches, and the area covered with bandages.

How are CAPD exchanges done?

CAPD exchanges should be done in a well-lit room. There should be no pets, dander, strong breezes, or fans in the room. They can increase your risk of an infection.

  • Gather your supplies. Place the following supplies on a clean table close to where you will be doing your CAPD exchange:
    • Dialysate bag and waste product bag
    • Y-shaped tubing
    • IV stand (used to hang your dialysate bag)
    • Disposable medical gloves
    • Medical mask to wear over your face during CAPD
    • Tubing clamps
    • New plastic syringe without a needle (if needed)
  • Wash your hands with soap and water. Rub your hands together with soap for at least 15 seconds before rinsing them. Dry your hands with a clean towel or paper towel. Do not touch the tubing or catheter without washing your hands and wearing gloves. Keep your fingernails short and clean.
  • Put on your gloves and mask. Put your mask on so that it covers your mouth and nose. Do not touch anything but the catheter and your supplies after you put the gloves on.
  • Flush the tubing. Flush the tubing with dialysate liquid before your exchange to help prevent infections. Connect the lower end of the Y tubing to your catheter, and connect the 2 other ends of the tubing to the dialysate bag and the waste bag. Clamp the tubing that is attached to the catheter that goes into your abdomen. This will close off the tubing so that the dialysate does not go into your abdomen yet. Allow 100 milliliters (mL) of fresh dialysate to flow out of the bag, and down the tubing into the waste bag. After 100 mL of dialysate has drained, clamp the tubing that goes to the waste bag.
  • Let the dialysate flow into your abdomen. Hang the bag at a higher level than your abdomen. Take the clamp off of the tubing that is attached to the catheter that goes into your abdomen. Let the rest of the dialysate flow into your abdomen. This should take no more than 10 minutes. You may lie down, sit, or stand up while the dialysate flows in. After all of the dialysate is in your abdomen, wash your hands and put on new gloves. Disconnect your catheter from the tubing. Clamp your catheter closed. Leave the dialysate in your abdomen for 3 to 5 hours of dwell time.
  • Drain the dialysate out of your abdomen, and into the waste bag.
    • After the dwell time, follow the steps of washing your hands and putting on your mask. Be sure the supplies that you need are easy to reach and use. Connect the Y tubing to your catheter again. Do this in the same way as you did to put the dialysate into your abdomen. Clamp the tubing that goes to the dialysate bag so that it is closed. Hang the bag at a lower level than your abdomen. Remove the clamps from the tubing that leads to the waste bag. Let the dialysate drain from your abdomen into the waste bag.
    • If the dialysate is not flowing out well, change your body position. If this does not make the dialysate flow out better, disconnect the end of the tubing that is attached to your catheter. Use a syringe to gently suck the dialysate out of your abdomen. It should take less than 45 minutes to drain the dialysate out of your abdomen. The dialysate that drains out should be clear. After all the dialysate has drained out, close the waste bag and dispose of it as directed. Wash your hands.