6 Peritoneal Dialysis Nursing Care Plans

July 13, 2013

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

This post contains six (6) nursing care plans (NCP) and nursing diagnosis for peritoneal dialysis:

Risk for Trauma

Risk for Trauma: The state in which an individual is at risk of accidental tissue injury (e.g., wound, burns, fracture).

Risk factors may include

Catheter inserted into peritoneal cavity
Site near the bowel/bladder with potential for perforation during insertion or by manipulation of the catheter

Possibly evidenced by

Not applicable. Existence of signs and symptoms establishes an actual nursing diagnosis.

Desired Outcomes

Experience no injury to bowel or bladder.

Nursing Interventions	Rationale
Have patient empty bladder before peritoneal catheter insertion if indwelling catheter not present.	An empty bladder is more distant from insertion site and reduces likelihood of being punctured during catheter insertion.
Anchor catheter and tubing with tape. Stress importance of patient avoiding pulling or pushing on catheter. Restrain hands if indicated.	Reduces risk of trauma by manipulation of the catheter.
Note presence of fecal material in dialysate effluent or strong urge to defecate, accompanied by severe, watery diarrhea.	Suggests bowel perforation with mixing of dialysate and bowel contents.
Note reports of intense urge to void, or large urine output following initiation of dialysis run. Test urine for sugar as indicated.	Suggests bladder perforation with dialysate leaking into bladder. Presence of glucose-containing dialysate in the bladder will elevate glucose level of urine.
Stop dialysis if there is evidence of bowel and bladder perforation, leaving peritoneal catheter in place.	Prompt action will prevent further injury. Immediate surgical repair may be required. Leaving catheter in place facilitates diagnosing and locating the perforation