| Interventions | Rationale |
| Maintain a record of inflow/outflow volumes and cumulative fluid balance | In most cases, the amount drained should equal or exceed the amount instilled. A positive balance indicates need of further evaluation. |
| Record serial weights, compare with I&O balance. Weigh patient when abdomen is empty of dialysate (consistent reference point). | Serial body weights are an accurate indicator of fluid volume status. A positive fluid balance with an increase in weight indicates fluid retention. |
| Assess patency of catheter, noting difficulty in draining. Note presence of fibrin strings/plugs. | Slowing of flow rate/presence of fibrin suggests partial catheter occlusion requiring further evaluation/intervention |
| Check tubing for kinks; note placement of bottles/bags. Anchor catheter so that adequate inflow/outflow is achieved. | Improper functioning of equipment may result in retained fluid in abdomen and insufficient clearance of toxins. |
| Turn from side to side, elevate the head of the bed, apply gentle pressure to the abdomen. | May enhance outflow of fluid when catheter is malpositioned/obstructed by the omentum. |
| Note abdominal distension associated with decreased bowel sounds, changes in stool consistency, reports of constipation. | Bowel distension/constipation may impede outflow of effluent. |
| Monitor BP and pulse, noting hypertension, bounding pulses, neck vein distension, peripheral edema; measure CVP if available. | Elevations indicate hypervolemia. Assess heart and breath sounds, noting S3 and/or crackles, rhonchi. Fluid overload may potentiate HF/pulmonary edema. |
| Evaluate development of tachypnea, dyspnea, increased respiratory effort. Drain dialysate, and notify physician. | Abdominal distension/diaphragmatic compression may cause respiratory distress. |
| Assess for headache, muscle cramps, mental confusion, disorientation. | Symptoms suggest hyponatremia or water intoxication |
| Alter dialysate regimen as indicated. | Changes may be needed in the glucose or sodium concentration to facilitate efficient dialysis |
| Monitor serum sodium | Hypernatremia may be present, although serum levels may reflect dilutional effect of fluid volume overload. |
| Add heparin to initial dialysis runs; assist with irrigation of catheter with heparinized saline. | May be useful in preventing fibrin clot formation, which can obstruct peritoneal catheter. |
| Maintain fluid restriction as indicated. | Fluid restrictions may have to be continued to decrease fluid volume overload. |
Nursing Diagnosis
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