Dialysis is a process that removes waste and excess water from the blood when the kidneys fail. It uses the peritoneum as a natural membrane to remove wastes and water from the blood into a dialysate solution in the abdominal cavity. There are two main types of peritoneal dialysis - continuous ambulatory peritoneal dialysis (CAPD) which is done manually throughout the day, and automated peritoneal dialysis (APD) which uses a machine at night. The peritoneal dialysis procedure involves infusing dialysate into the abdominal cavity, allowing it to dwell to enable diffusion and osmosis, then draining the used fluid and repeating the cycles. Nursing care focuses on infection prevention, assessing

1. Dialysis

2. Dialysis
• (from Greek dialusis,"", meaning dissolution, dia, meaning
through, and lysis, meaning loosening or splitting)
• is a process for removing waste and excess water from
the blood and is used primarily as an artificial
replacement for lost kidney function in people with
kidney failure.

3. Purpose of Dialysis
• is used to remove fluid and uremic waste
products from the body when the kidneys cannot
do so.
• It may also be used to treat patients with edema
that does not respond to treatment, hepatic coma,
hyperkalemia, hypercalcemia, hypertension,
and uremia.

4. Indications for Dialysis
• The need for dialysis may be acute or chronic.
1. Acute dialysis is indicated
A.when there is a high and rising level of serum potassium, fluid
overload, or impending pulmonary edema, increasing acidosis,
pericarditis, and severe confusion.
B.to remove certain medications or other toxins (poisoning or
medication overdose) from the blood.
2. Chronic or maintenance dialysis is indicated in chronic
renal failure, known as end-stage renal disease (ESRD

5. Two main types of dialysis
1. Hemodialysis
2. Peritoneal Dialysis

6. Peritoneal Dialysis
• wastes and water are removed from the
blood inside the body using the
peritoneum as a natural semipermeable
membrane.
• Wastes and excess water move from the
blood, across the peritoneal membrane,
and into a special dialysis solution, called
dialysate, in the abdominal cavity

7. Types of peritoneal dialysis
• The first is manually through continuous ambulatory
peritoneal dialysis (CAPD).
• The second is automatically through automated peritoneal
dialysis (APD) which uses a cycler machine at night while
the patient sleep.

8. 1. CAPD is "continuous," machine-free and done while you go
about your normal activities such as work or school. You do
the treatment by placing about two quarts of cleansing fluid
into your belly and later draining it. This is done by hooking
up a plastic bag of cleansing fluid to the tube in your belly.
Raising the plastic bag to shoulder level causes gravity to
pull the fluid into your belly. When empty, the plastic bag is
removed and thrown away.
When an exchange (putting in and taking out the fluid) is
finished, the fluid (which now has wastes removed from
your blood) is drained from your belly and thrown away.

9. This process usually is done three, four or five times in a 24-hour
period while you are awake during normal activities. Each
exchange takes about 30 to 40 minutes. Some patients like to do
their exchanges at mealtimes and at bedtime.
2. APD differs from CAPD in that a machine (cycler) delivers and
then drains the cleansing fluid for you. The treatment usually is
done at night while you sleep.

10. Indications for Peritoneal
Dialysis
• Peritoneal dialysis may be the treatment
of choice for patients with renal failure
who are unable or unwilling to undergo
hemodialysis or renal transplantation.
• patients with diabetes or cardiovascular
disease,
• many older patients, and those who may be
at risk for adverse effects of systemic
heparin

11. Procedure for
Peritoneal dialysis
PREPARING THE PATIENT .
1. The nurse explains the procedure to the
patient and obtains signed consent for it.
2. Baseline vital signs, weight, and serum
electrolyte levels are recorded.
3. The patient is encouraged to empty the
bladder and bowel to reduce the risk of
puncturing internal organs.
4. Broad-spectrum antibiotic agents may be
administered to prevent infection.

12. Procedure for Peritoneal dialysis
PREPARING THE EQUIPMENT
(apply Strict Aseptic technique )
1. Consults the physician to determine the
concentration of dialysate to be used and the
medications to be added to it. (Heparin , Potassium
chloride , Antibiotics’ Insulin) .
2. Before medications are added, the dialysate is
warmed to body temperature to prevent patient
discomfort and abdominal pain and to dilate the
vessels of the peritoneum to increase urea clearance.
Solutions that are too cold cause pain and
vasoconstriction and reduce clearance. Solutions
that are too hot burn the peritoneum.

13. 3. Assemble the administration set and tubing.
Fill the tubing with the prepared dialysate to
reduce the amount of air entering the catheter
and peritoneal cavity, which could increase
abdominal discomfort and interfere with
instillation and drainage of the fluid.
INSERTING THE CATHETER
• Ideally, the peritoneal catheter is inserted
in the operating room to maintain
surgical asepsis and minimize the risk of
contamination. In some circumstances,
however, the physician inserts the catheter
at the bedside under strict asepsis.

14. PERFORMING THE EXCHANGE
(1 to 4 hours, depending on the prescribed dwell time. )
• Peritoneal dialysis involves a series of exchanges or
cycles which is repeated throughout the course of the
dialysis which is based on the patient’s physical
status and acuity of illness.
• An exchange is defined as the infusion, dwell, and
drainage of the dialysate.
INFUSION : The dialysate is infused by gravity into the
peritoneal cavity for a period of about 5 to 10 minutes to
infuse 2 L of fluid.
DWELL: (equilibration time) allows diffusion and
osmosis to occur. (peaks in the first 5 to 10 minutes )

15. DRAINAGE
• The tube is unclamped and the solution drains from the
peritoneal cavity by gravity through a closed system (10
to 30 minutes).
• The drainage fluid is normally colorless or straw-
colored and should not be cloudy. Bloody drainage
may be seen in the first few exchanges after insertion of
a new catheter but should not occur after that time.
• The removal of excess water during peritoneal dialysis
is achieved by using a hypertonic dialysate with a
high dextrose concentration that creates an osmotic
gradient ( Dextrose solutions of 1.5%, 2.5%, and 4.25%).

16. NURSING RESPONSIBILITY
Predialysis Care
• Document vital signs including temperature, orthostatic blood
pressures (lying, sitting, and standing), apical pulse, respirations,
and lung sounds. These baseline data help assess fluid volume status
and tolerance of the dialysis procedure. Hypertension, abnormal
heart or lung sounds, or dyspnea may indicate excess fluid volume.
Poor respiratory function may affect the ability to tolerate peritoneal
dialysis. Temperature measurement is vital, because infection is the
most common complication of peritoneal dialysis.
• Weigh daily or between dialysis runs as indicated. Weight is an
accurate indicator of fluid volume status.

17. • Note BUN, serum electrolyte, creatinine, pH, and hematocrit levels
prior to peritoneal dialysis and periodically during the procedure.
These values are used to assess the efficacy of treatment.
• Measure and record abdominal girth. Increasing abdominal
girth may indicate retained dialysate, excess fluid volume, or early
peritonitis.
• Maintain fluid and dietary restrictions as ordered. Fluid and diet
restrictions help reduce hypervolemia and control azotemia.
• Have the client empty the bladder prior to catheter insertion. Emptying
the bladder reduces the risk of inadvertent puncture.
• Warm the prescribed dialysate solution to body temperature (98.6° F or
37° C) using a warm water bath or heating pad on low setting. Dialysate
is warmed to prevent hypothermia.
• Explain all procedures and expected sensations. Knowledge helps
reduce anxiety and elicit cooperation.

18. Intradialysis Care
• Use strict aseptic technique during the dialysis procedure and
when caring for the peritoneal catheter. Peritonitis is a
common complication of peritoneal dialysis; sterile technique
reduces the risk.
• Add prescribed medications to the dialysate; prime the tubing
with solution and connect it to the peritoneal catheter, taping
connections securely and avoiding kinks. This allows dialysate
to flow freely into the abdominal cavity and prevents leaking or
contamination.

19. • Instill dialysate into the abdominal cavity over a period of
approximately 10 minutes. Clamp tubing and allow the
dialysate to remain in the abdomen for the prescribed dwell
time. Keep drainage tubing clamped at all times during
instillation and dwell time.
Dialysate should flow freely into the abdomen if the peritoneal
catheter is patent. Dialysis, the exchange of solutes and water
between the blood and dialysate, occurs across the peritoneal
membrane during the dwell time.

20. values are used to assess the effectiveness of dialysis
• Troubleshoot for possible problems during dialysis.
a. Slow dialysate instillation. Increase the height of the container
and reposition the client. Check tubing and catheter for kinks.
Check abdominal dressing for wetness, indicating leakage around
the catheter. Slow dialysate flow may be related to a partially
obstructed tube or catheter.
b. Excess dwell time. Prolonged dwell time may lead to water
depletion or hyperglycemia.
c. Poor dialysate drainage. Lower the drainage container, reposition,
check for tubing kinks. Check abdominal dressing. Tubing or
catheter obstruction can also interfere with dialysate drainage.

21. Postdialysis Care
• Assess vital signs, including temperature. Comparison of
preand postdialysis vital signs helps identify beneficial and
adverse effects of the procedure.
• Time meals to correspond with dialysis outflow. Scheduling
meals while the abdomen is empty of dialysate enhances intake
and reduces nausea.
• Teach the client and family about the procedure. The client
may elect to use peritoneal dialysis at home to manage
endstage renal disease and prevent uremia.

22. Complications of Peritoneal Dialysis
• PERITONITIS (inflammation of the peritoneum) is the
most common and most serious complication;
characterized by cloudy dialysate drainage, diffuse
abdominal pain, and rebound tenderness.
• LEAKAGE of dialysate through the catheter site may
occur immediately after the catheter is inserted
• BLEEDING - common during the first few exchanges after
a new catheter insertion because some blood exists in the
abdominal cavity from the procedure.
LONG-TERM COMPLICATIONS
• Hypertriglyceridemia ; abdominal hernias (incisional,
inguinal, diaphragmatic, and umbilical), hemorrhoids.
Reference: Brunner and Suddarth’s Medical surgical Nursing 10th Edition