Peritoneal dialysis (PD) is a medical treatment for kidney failure that utilizes the lining of the abdomen, called the peritoneum, to filter waste products and excess fluid from the blood. This process occurs inside the patient’s body, offering a home-based therapy option that can provide more flexibility compared to in-center treatments. It allows individuals to manage their dialysis on a schedule that often integrates into their daily lives.
Understanding Peritoneal Dialysis Types
Peritoneal dialysis primarily involves two distinct approaches: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD). CAPD is a manual method where patients perform exchanges throughout the day, typically three to five times, without the aid of a machine. Each exchange involves draining used fluid and infusing fresh dialysate, taking approximately 20 to 30 minutes.
APD, in contrast, uses a machine called a cycler to perform multiple exchanges overnight while the patient sleeps. The cycler automates the draining and filling processes, allowing for longer dwell times and often fewer daily interruptions. While the mechanics differ, both CAPD and APD rely on the same fundamental principles of diffusion and osmosis across the peritoneal membrane to cleanse the blood. The choice between CAPD and APD is based on lifestyle, medical condition, and patient preference, determined in consultation with a healthcare team.
Preparation for Peritoneal Dialysis
Preparation is essential for safely performing a peritoneal dialysis exchange and minimizing infection risk. Patients must wash their hands and forearms with antimicrobial soap, then dry them with a clean, lint-free towel. Wearing a surgical mask and, sometimes, clean gloves, further reduces contamination.
The exchange environment must be clean, dry, and well-lit, free from pets and open windows or fans that could stir dust. A dedicated, disinfected surface, like a sturdy table, should be prepared for supplies. These supplies include fresh dialysate solution bags, a drain bag, a transfer set, clamps, antiseptic wipes, and a waste receptacle.
Before starting, inspect each solution bag for clarity, leaks, particulate matter, and confirm its expiration date. The transfer set, connecting the catheter to the solution and drain bags, must also be checked. This preparation ensures the exchange proceeds smoothly and aseptically, safeguarding patient health.
Steps of a Peritoneal Dialysis Exchange
The peritoneal dialysis exchange begins by connecting the system, requiring strict aseptic technique to prevent infection. After preparing, the patient connects the fresh dialysate and empty drain bags to the Y-shaped transfer set, ensuring secure connections. The catheter exit site is cleaned according to medical guidelines, then the transfer set connects to the catheter.
Once connected, the draining phase begins, where used dialysate (effluent) flows from the abdominal cavity into the drain bag. This outflow takes 10 to 20 minutes, depending on volume and drainage characteristics. The drained fluid should be clear or slightly yellow; any cloudiness or unusual color could indicate a potential infection and warrants immediate medical attention.
After drainage, the filling phase begins, allowing fresh dialysate to flow from the new bag into the peritoneal cavity. This inflow takes 5 to 15 minutes, driven by gravity. Patients might experience fullness or mild pressure during this stage, which is normal.
After the new solution infuses, the system disconnects. The patient clamps the catheter extension tube, disconnects the transfer set, and caps the catheter with a sterile cap. The used drain bag and disposable materials are then disposed of as medical waste. The fresh dialysate remains in the abdominal cavity for a prescribed “dwell time,” ranging from 4 to 8 hours for CAPD, allowing continuous waste removal before the next exchange.
Monitoring and Troubleshooting
Monitoring during and after a peritoneal dialysis exchange is important for identifying issues. Patients should observe the drained fluid’s appearance, noting its clarity, color, and volume, as changes can signal complications. The catheter exit site also requires daily inspection for signs of infection, such as redness, swelling, pain, or pus, which should be reported to the healthcare team.
Patients might encounter issues like slow drain or fill times, which can be resolved by adjusting position or ensuring tubing is not kinked. Pain during the exchange, while due to a rapid infusion, could indicate peritonitis or other issues. If the drained fluid appears cloudy, this indicates peritonitis, a serious infection of the peritoneal lining, requiring immediate investigation.
Any persistent pain, fever, chills, or significant changes in the drained fluid’s appearance or volume warrant immediate contact with a healthcare professional or dialysis nurse. These symptoms require prompt medical evaluation to prevent severe complications. Patients are educated on specific warning signs and when to seek urgent medical advice to maintain their safety and treatment effectiveness.