Peritoneal Dialysis (PD)

Indication of PD

Fluid overload Oligo anuria pul Edema

Electrolyte disturbances Hyperkalemia Acidosis Hypo- hypernatremia

Uremic manifestations Pericarditis CNS symptoms

Contraindications:

Absolute: lack of an adequate peritoneal cavity E.G. Omphalocele, gast Roschisis, D.Hernia

Relative: Recent abd. Surgery Urinary diversions Gastrostomy, colostomy Polycystic kidneys

Factors affecting PD

Concentration gradient

Osmotic gradient

Surface area of vascular peritoneum

Peritoneal capillary blood flow

Volume of dialysate

Dwell time

Types of catheters

Temporary catheters: Peritocath, wygon, Jms

Permanent catheter

Methods of insertion

At the bed side under local anesthesia

Surgical placement under general anesthesia: Peritoneoscopic insertion, Open surical insertion

 

Procedure Continued

Stab incision with 11 number blade

Hold the catheter(with trocar) Like a pen & insert it with screwing motion

Remove the trocar. (Warm fluid for nb) Attach with inflow tube & start inflow

Start outflow

First 8 cycles without dwell.

Dialysis prescription :

Inflow:

TIME: 10-15 mins

Volume: 30-40 ml/kg

Pd fluid: heparin, Potassium, Glucose, Insulin

Dwell: 30 mins

Out flow: 10-15 mins

Monitoring:

Daily weight

Daily cbc, elecrolytes, bun, creat, blood sugar

Proper charting of intake & output

Intake: Ad lib if adequate negative balance Otherwise 400ml/m2 Plus negative bal.

Accommodate colloids on pd

Complications of pd:

Mechanical : obstruction (clot, fibrin, omentum) bleeding Leakage Abdoninal wall or scrotal edema

Infection

Metabolic: Hyperglycemia, Hypokalemia, Hyper/hyponatremia

Pulmonary: Pleural effusion, Ateletasis, Decreased vital capacity

Cardiovascular: Volume contraction, Hypotension