When your kidneys are healthy, they clean your blood. If your kidneys fail, you will need a life-saving treatment, this is when dialysis takes place. Dialysis is the process of removing fluid and waste products from the body, a function usually performed by the kidneys, through artificial means. Two types of dialysis: hemodialysis and peritoneal dialysis. Peritoneal dialysis accomplishes the removal of waste and excess fluid by using the abdominal lining, called the peritoneal membrane, as a filter a membrane across which fluids and dissolved substances (electrolytes, urea, glucose, albumin and other small molecules) are exchanged from the blood.
Peritoneal dialysis is similar in principle to hemodialysis. Both of these forms of renal replacement therapy depend upon the passive movement of water and dissolved substances (solutes) across a semipermeable membrane. This process is called diffusion. The direction of movement of solute is determined by the relative concentration on each side of the membrane, so that a substance goes from the side of greater to lesser concentration.
The peritoneum serves as the semipermeable membrane permitting transfer of nitrogenous wastes/toxins and fluid from the blood into a dialysate solution. Peritoneal dialysis is sometimes preferred because it uses a simpler technique and provides more gradual physiological changes than hemodialysis.
The manual single-bag method is usually done as an inpatient procedure with short dwell times of only 30–60 minutes and is repeated until desired effects are achieved. The most commonly used type of peritoneal dialysis is continuous ambulatory peritoneal dialysis (CAPD), which permits the patient to manage the procedure at home with bag and gravity flow, using a prolonged dwell time at night and a total of 3–5 cycles daily, 7 days a week. No machinery is required.
Continuous cycling peritoneal dialysis (CCPD) mechanically cycles shorter dwell times during night (3–6 cycles) with one 8-hr dwell time during daylight hours, increasing the patient’s independence. An automated machine is required to infuse and drain dialysate at preset intervals.
Nursing Care Plans
- Risk for Deficient Fluid Volume
- Risk for Ineffective Breathing Pattern
- Risk for Infection
- Acute Pain
- Risk for Trauma
- Risk for Excess Fluid Volume
Risk for Infection
Risk factors may include
- Contamination of the catheter during insertion, periodic changing of tubings/bags
- Skin contaminants at catheter insertion site
- Sterile peritonitis (response to the composition of dialysate)
Possibly evidenced by
- Not applicable. Existence of signs and symptoms establishes an actual nursing diagnosis.
- Identify interventions to prevent/reduce risk of infection.
- Experience no signs/symptoms of infection.
|During peritoneal dialysis,position the patient carefully. Elevate the head of bed.||To reduce pressure on the diaphragm and aid respiration.|
|Be alert for signs of infection (cloudy drainage, elevated temperature) and, rarely, bleeding.||Cloudy effluent is suggestive of peritoneal infection.|
|Observe meticulous aseptic techniques and wear masks during catheter insertion, dressing changes, and whenever the system is opened. Change tubings per protocol.||Prevents the introduction of organisms and airborne contamination that may cause infection.|
|Change dressings as indicated, being careful not to dislodge the catheter. Note character, color, odor, or drainage from around insertion site.||Moist environment promotes bacterial growth. Purulent drainage at insertion site suggests presence of local infection. Note: Polyurethane adhesive film (blister film) dressings have been found to decrease amount of pressure on catheter and exit site as well as incidence of site infections.|
|Observe color and clarity of effluent.||Cloudy effluent is suggestive of peritoneal infection.|
|Apply povidone-iodine (Betadine) barrier in distal, clamped portion of catheter when intermittent dialysis therapy used.||Reduces risk of bacterial entry through catheter between dialysis treatments when catheter is disconnected from closed system|
|Investigate reports of nausea and vomiting, increased and severe abdominal pain; rebound tenderness, fever, and leukocytosis.||Signs and symptoms suggesting peritonitis, requiring prompt intervention.|
|Monitor WBC count of effluent||Presence of WBCs initially may reflect normal response to a foreign substance; however, continued and new elevation suggests developing infection.|
|Obtain specimens of blood, effluent, and drainage from insertion site as indicated for culture and sensitivity.||Identifies types of organism(s) present, choice of interventions|
|Monitor renal clearance: BUN, Cr||Choice and dosage of antibiotics are influenced by level of renal function.|
|Administer antibiotics systemically or in dialysate as indicated.||Treats infection, prevents sepsis|
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