Today our topic of discussion is Procedure of Peritoneal Dialysis.
Procedure of Peritoneal Dialysis
Procedure
- Wash your hands
- Inspect the warmed dialysate which should appear clear and colorless
- Put on a sterile face mask.
- Prepare to add any prescribed medication to the dialysate
- Prepare the dialysis administration set
- Close the clamps on all lines.
- Place the drainage bag below the patient to facilitate gravity drainage
- At this point the doctor puts on a mask and a pair of sterile gloves.
- He cleans the patient’s abdomen with povidone solution and drapes it with a sterile drape
- Wipe the stopper of the lidocaine vial with povidone iodine and allow it to dry.
- Invert the vial and hand it to the doctor so he can withdraw the lidocaine, using the 3 ml. syringe with the 25 C 1″ needle
- The doctor anesthetizes a small area of the patient’s abdomen below the umbilicus.
- He then makes a small incision with the scalpel, inserts the catheter and sutures or tapes the catheter in place
- If the catheter is already in place, clean the site with povidone-iodine solution in a circular outward motion, according to your facility’s policy before each dialysis treatment
- Connect the catheter to the administration set, using aseptic technique to prevent contamination of the catheter and the solution, which could cause peritonitis
- Open the drain dressing and the 4″ x 4″ gauze pad pack ages.
- Put on the other pair of sterile gloves.
- Apply the precut drain dressings around the catheter.
- Cover them with the gauze pads and tape them securely
- Unclamp the lines to the patient.
- Rapidly instill 500 mL of dialysate into the peritoneal cavity to test the catheter’s patency . Clamp the lines to the patient.
- Immediately unclamp the lines to the drainage bag to allow fluid to drain into the bag.
- Outflow should be risk .
- Having established the catheter’s patency, clamp the lines to the drainage bag and unclamp the lines to the patient to infuse the prescribed volume of solution over a period of 5-10 minutes.
- As soon as the dialysate container empties, clamp the lines to the patient immediately to prevent air from preventing entering the tubing.
Complications
- Peritonitis, the most common complication, usually follows contamination of the dialysate, but it may develop if solution leaks from the catheter exit site and flows back into the catheter tract.
- Respiratory distress may result when dialysate in the peritoneal cavity increases pressure on the diaphragm, which decreases lung expansion
- Protein depletion may result from the diffusion of protein in the blood into the dialysate solution through the peritoneal membrane.
- As much as 1/2 (14 g) of protein may be lost daily-more in patients with peritonitis
- Constipation is a major cause of inflow-outflow problems, therefore to ensure regular bowel movements, give a laxative or stool softener as needed
- Excessive fluid loss from the use of 4.25% solution may cause hypovolemia, hypotension, and shock.
- Excessive fluid retention may lead to blood volume expansion, hypertension, peripheral edema and even pulmonary edema and congestive heart failure
- Other possible complications include electrolyte imbalance and hyperglycemia, which can be identified by frequent blood tests.
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