PERITONEAL DIALYSIS

Continuous Kathy Bunyan

Ambulatory November 2011

Peritoneal
Dialysis
Dialysis occurs 24 hours/day
Dialysis fluid infused into peritoneal space
via a permanent catheter
Peritoneal membrane is the filter
Dialysis takes place by osmosis and
diffusion
Glucose is used as the osmotic agent
Diffusion displacement of substances from
blood until equilibrium
4-5 exchanges a day
Starts with fluid in peritoneal cavity
DRAIN- through a closed system the fluid is
drained by gravity
FLUSH - small mount flushed into drain bag
to clear line
FILL – new fluid run into peritoneal cavity via
the closed system
DWELL – fluid dwells 4-6 hours
APD

Alternative to CAPD
Pt has cycler machine
Dialysis takes place over night usually 10 hr
Can use much greater volumes thus achieve
better dialysis
Usually better for someone that works
COMMON CAUSES FOR ED
PRESENTATION
Cloudy bag
Abdominal pain /fever
Fluid overload
Blocked catheter
CLOUDY BAG
Patient should be able to see through the
effluent bag
Full bag of effluent to lab for microbiology
If possible use micro forms from Waikato
If pt does not present with a bag will need to
do an exchange
If on APD and they bring in the drain bag will
need to do an exchange manually to send
to lab
ABDO PAIN/FEVER

May be other causes but most usually

peritonitis
Needs bag to lab for micro
Check for constipation
May be UTI – not all pts are anuric
Do not use morphine analgesia
Methadone or Fentanyl can be used
Need to instigate peritonitis treatment protocol
following Waikato guidelines
Starting A/B’s IP Cephazoline and Gentamycin
Vancomycin and Gentamycin if pt allergic to
penicillin or MRSA positive
If bag exchange being done to instill A/B’s must
flush before adding
Can always contact on call 0800772299 PD nurse
is on call 24/7
FLUID OVERLOAD

Pts all have a target weight

Usually use 1.5% or 2.5% dianeal
Treat pulmonary congestion with fluid
removal use frequent exchanges using
4.25% dianeal
Treat hypertension with fluid removal
Use of 4.25% dianeal
Extra exchanges
BLOCKED CATHETER

Do not disconnect catheter

Attempt usual bag exchange
Use heparin
Call on call nurse
During normal work hours please call PD
nurse pg76 or ex 8159 or alternatively on
cell ph via telephone operator
BLOOD RESULTS REFERENCE

Biochemistry
Na 135 – 145 mmol/l
K 3.2 – 6.0 mmol/l
Cr 600 – 1200 mmol/l
Ur <25 mmol/l
Ca 2.15 – 2.57 mmol/l
PO4 < 1.80 mmol/l
 Haematology
Hb 110 – 120 g/l
Hct 0.33 – 0.36
WC 4.0 – 11.0
Platelets 150 - 400