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Non-Renal Indications:
Acute pancreatitis – Refractory heart failure
Significant hypo- or hyper-thermia – Liver Failure
Infusion of drugs by PD as supportive therapy
Contraindications:
Recent abdominal surgery – Diaphragmatic severe respiratory failure
Pleuroperitoneal communication – Pregnancy
Extremely hypercatabolic state – Severe GERD
Low peritoneal clearance – Fecal or fungal peritonitis
Abdominal wall cellulitis
Amy Neufeldt, RN, BscN April 2015, adapted from Lawton, 2013
3 Phases for each Dialysis Exchange:
Fill – when dialysate (fluid for dialysis) is going into peritoneal cavity (peritoneum)
Dwell – when the dialysate is remaining inside and filtration is occurring
Drain – when the dialysate (now effluent) is being removed from the patient
The volume in is measured positive and the volume out is negative, so when the volume
drained is greater than the volume put in, the balance is negative.
Osmosis: movement of water through a semi-permeable membrane from an area with low
solute concentration to an area of high solute
concentration
Convection: the solute that moves with
the water when moving by osmosis
These are characteristics of the ideal osmotic agent, let's see how glucose compares:
non-toxic (glucose is OK short term, but may be toxic to membrane long-term)
not absorbed from peritoneal cavity (no, Glucose is absorbed)
sustained osmotic effect (no, as filtration happens effectiveness decreases)
if absorbed, causes no harm (no, absorbed glucose can cause harm for diabetics)
biocompatible (no, the dialysate can cause complications: immune response,
peritoneal sclerosis, and neovascularization, all causing failure in filtration)
Amy Neufeldt, RN, BscN April 2015, adapted from Lawton, 2013
Ultrafiltration – water removal during PD due to osmosis
We want to choose the appropriate solution for the needed level of ultrafiltration. When
renal failure is quite progressed prior to treatment, doctors may use higher concentration
or shorter dwell times to more quickly correct fluid and electrolyte imbalances that have
built up. Due to osmosis, the most ultrafiltration occurs at the beginning of the dwell period.
Prescription includes:
1. Concentration of dialysate – how much D50 to mix into Lactated Ringer
2. Exchange volume – how much fluid to put in each time
In children, volumes will be smaller so use a scale to determine how much
fluid you are delivering.
3. Inflow and Outflow periods – how much time to allow to put fluid in, and to drain
4. Dwell time – how long the fluid stays inside the abdomen for each exchange
Typically 4 hours, but it may be less if the patient is extremely ill.
5. Any other additives, such as:
- Heparin - Insulin - Potassium - Antibiotics
6. Monitoring of fluid balance
Amy Neufeldt, RN, BscN April 2015, adapted from Lawton, 2013
Potential Complications
Basic signs of complication that the doctor should be notified of immediately:
change in colour of dialysate (especially bloody or cloudy)
patient notably hypotensive
increasing temperature
poor dialysate flow
positive balance twice in a row (greater volume “in” than “out”)
Amy Neufeldt, RN, BscN April 2015, adapted from Lawton, 2013
Edema - decrease dietary sodium
Weight gain and water
Excessive Fluid Thirst Hypertonic solution - Decrease concentration of
Loss Decreased BP solution
Inadequate Na and - increase dietary sodium
water intake and water
Peritonitis – Cloudy effluent Improper sterile - Antibiotic administration by
infection of the Fever technique PD catheter
peritoneum Abdominal pain - monitor blood work
Normal defense - fluid should improve within
Complications: mechanisms are 48 hours
Potential Note: inflammation compromised by - If fungal, may need to
permanent increases effective fluid in the remove catheter
damage to surface area, peritoneal cavity
peritoneum increasing filtration
Resources
Lawton, W.J. (May, 2013). Peritoneal Dialysis; Presentation: Mbingo Baptist Hospital.
[PowerPoint slides]. Obtained from personal communication.
Lawton, W.J. (May, 2013). Peritoneal Dialysis - Complications; Presentation: Mbingo
Baptist Hospital. [PowerPoint slides]. Obtained from personal communication.
Cormier, A. (2014). Peritoneal Dialysis Education Package. Alberta Health Services:
Canada.
Tobrocke, J. (2007). Care of the Hospitalized Peritoneal Dialysis Patient [Powerpoint
slides]. Retrieved from: www.ppt-search.net/1/peritoneal-ppt.html
Amy Neufeldt, RN, BscN April 2015, adapted from Lawton, 2013
Questions
What substances move by diffusion in PD?
For each of the following, state whether it moves primarily from the blood to peritoneum or
from the peritoneum to the blood and by what mechanism(s) the movement occurs.
Na+ K+
H20 BUN
Creatinine Glucose
What is ultrafiltration? What is it driven by? What are some problems with this osmotic
agent?
A patient is having increased difficulty breathing. What would you do? And what could be
happening?
You notice the patient's effluent is cloudy. What do you think it might be? What do you do?
Why might this have occurred? What other problems can result from this complication?
What treatment do you expect?
Amy Neufeldt, RN, BscN April 2015, adapted from Lawton, 2013