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 Excess Fluid Volume
- Risk for Excess Fluid Volume
- Inadequate osmotic gradient of dialysate
- Fluid retention (malpositioned or kinked/clotted catheter, bowel distension; peritonitis, scarring of peritoneum)
- Excessive PO/IV intake
- Demonstrate dialysate outflow exceeding/approximating infusion.
- Experience no rapid weight gain, edema, or pulmonary congestion.
|Maintain a record of inflow and 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 and plugs.||Slowing of flow rate and presence of fibrin suggests partial catheter occlusion requiring further evaluation and intervention|
|Check tubing for kinks; note placement of bottles and 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 and obstructed by the omentum.|
|Note abdominal distension associated with decreased bowel sounds, changes in stool consistency, reports of constipation.||Bowel distension and 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 crackles, rhonchi. Fluid overload may potentiate HF and pulmonary edema.|
|Evaluate development of tachypnea, dyspnea, increased respiratory effort. Drain dialysate, and notify physician.||Abdominal distension and 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.|
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