Peritoneal dialysis fact sheet.
Peritoneal dialysis (PD) is a dialysis option for patients with chronic kidney disease (CKD). An alternative treatment to hemodialysis, this form of dialysis is usually performed by the patient at home. PD occurs inside the body using the peritoneal membrane (the lining of the abdomen) as a filter. This membrane also covers the organs that lie within the abdominal cavity. The peritoneal membrane is semipermeable, allowing certain size substances to pass through it.
How Peritoneal Dialysis Works
A soft tube, known as a catheter, is surgically placed through the abdominal wall. The catheter can generally be used 2 weeks after it is inserted. Sterile dialysis solution (2-3 liters) will flow into the peritoneum through the catheter. The volume of solution used depends upon the size of the patient. Through the process of diffusion, waste products are removed from the blood. Excess fluid is removed by the process of osmosis using a hypertonic glucose solution. Both waste products and excess fluid are transported across the peritoneal membrane into the dialysis solution. The used dialysis solution is drained from the peritoneal cavity and replaced with new solution.
Types of Peritoneal Dialysis
There are two types of PD. One is CAPD (continuous ambulatory peritoneal dialysis). The other is CCPD (continuous cycling peritoneal dialysis).
CAPD. This type of self-dialysis is done 7 days a week. Four to five exchanges of new solution are done each day. During an exchange, which takes about 30 minutes, the solution that was inside the peritoneal cavity is drained and new solution is instilled. The new solution remains in the cavity for 4 to 6 hours; this is called the dwell time. The last evening's exchange dwells overnight to allow for an uninterrupted night's sleep.
CCPD. During this type of dialysis, the exchange of dialysis solution is performed by a machine while the patient sleeps. Each exchange is referred to as a "cycle." Patients are taught how to set up the machine and generally connect to the cycler at bedtime, 7 days a week, for 8 to 10 hours each night. The machine controls the three phases of the cycle: draining used solution, re-filling with new solution, and monitoring the dwell time. In the morning, the machine does a "final fill," which remains in the patient throughout the day.
Advantages and Disadvantages of Peritoneal Dialysis
Patient involved in self-care
Control over schedule/freedom
Less restricted diet
Typically, once a month clinic visits
More steady blood levels
Preservation of kidney function
Four exchanges per day (CAPD)
Nightly cycles with machine (CCPD)
Permanent external catheter
Some risks of infections
Potential weight gain
Storage space at home is needed
Body image changes
PD as a Dialysis Option
What the Patient Needs to Know
* Options for renal replacement therapy (hemodialysis, PD, and transplantation) should be presented by a knowledgeable professional who can address issues and questions about each option.
* The option of PD can be presented in either an individual or group setting, and should include family members and significant others.
* A description of PD should include:
--Introduction to the supplies (bags, tubing and catheter).
--Demonstration of exchange.
--Examples of exchange schedule and daily routines.
* Prospective patients should be offered the opportunity to network with established PD patients.
PD Patients: Who are Likely Candidates?
The success of PD depends on the patient's motivation, physical and mental capability to complete procedures, and the desire for independence. If there are any clinical or psychological contraindications, the nephrologist and PD nurse will discuss these concerns with the patient and family.
* Potential candidates are patients who:
--Desire self-care and independence.
--Have cardiovascular disease.
--Are pediatric patients.
--Are pre-transplant candidates.
Home What the Patient Needs to Know
* Location and function of the peritoneal membrane
* Short and long-term complications of uremia
* Aseptic technique in the home
* Catheter care
* Dialysis solution exchange procedure
* Fluid balance guidelines
* Addition of medication
* Self-monitoring of vital signs (B/P and wt.) and maintaining home dialysis records
* Monthly clinic visits and review of current medications, procedures, and techniques
* Individual activity and exercise regimen
* Nutritional needs assessed and modified by renal dietitian
* Social and emotional needs assessed by renal social worker
* Incorporating the patient's need for relationships and sexual identity in plan of care
* Monitoring and inventory of supplies
* Understanding and recognizing complications of PD:
--obstruction of flow
--exit site infection
--exit site leak
--catheter related pain
Caring for the PD Patient
The Role of the PD Nurse
The role of the PD nurse provides a unique opportunity to be an autonomous, innovative, and resourceful professional.
The PD nurse functions in several capacities:
* Care coordinator
* Leader of health care team
* Patient advocate
* The most consistent member of the health care team who is involved with the PD patient is the nurse. The relationship that develops is crucial for the well being of the patient and family and the success of PD for the patient.
* As a responsible professional, the PD nurse is pivotal in coordinating a consistent and clear plan of care for the patient.
* Using professional competency and communication skills, the PD nurse can establish a trusting relationship with the patient and the entire health care team.
* This commitment is crucial in empowering the PD patient.
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|Publication:||Nephrology Nursing Journal|
|Date:||Jul 1, 2004|
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