Peritoneal dialysis (PD) is a treatment for severe chronic kidney failure that uses the peritoneum in the abdomen as a membrane to exchange fluids and dissolved substances between the blood and dialysis fluid introduced into the abdomen. Fluid is introduced through a permanent abdominal catheter and removed periodically, either continuously throughout the day or automatically at night. PD provides an alternative to hemodialysis by allowing treatment without visiting a medical facility but carries risks like infection from the permanent catheter. Nursing management of PD includes monitoring for complications, supporting nutrition, managing discomfort, and providing health teaching.

1. Presented to :-
Mrs. Joshana Bhagat.
Community Health Nursing
KIMS college of nursing
Hubballi

2. INRODUCTION
Peritoneal dialysis (PD) is a treatment for patients
with severe chronic kidney failure.
The process uses the patient's peritoneum in the
abdomen as a membrane across which fluids and dissolved
substances (electrolytes, urea, glucose, albumin and other
small molecules) are exchanged from the blood.
Fluid is introduced through a permanent tube in the
abdomen and flushed out either every night while the
patient sleeps (automatic peritoneal dialysis) or via regular
exchanges throughout the day (continuous ambulatory
peritoneal dialysis).

3. CONT…
PD is used as an alternative to hemodialysis
though it is far less common.
It has comparable risks and expenses,
with the primary advantage being the ability to undertake
treatment without visiting a medical facility.
The primary complication with PD is a risk of
infection due to the presence of a permanent tube in the
abdomen

4. DEFINITION:-
Peritoneal dialysis (PD) is a type of
dialysis that uses the peritoneum in a person's
abdomen as the membrane through which fluid
and dissolved substances are exchanged with the
blood. It is used to remove excess fluid, correct
electrolyte problems, and remove toxins in those
with kidney failure.

6. TYPES:-
 Continuous Ambulatory Peritoneal Dialysis (CAPD).
With CAPD, you do the exchanges yourself three
to four times a day.
 Automated Peritoneal Dialysis (APD). :-
With APD, a machine called a cycler does the
exchanges automatically while you sleep. You may also
need to do one exchange during the day if your kidney
function decreases further.

7. CONTRAINDICATION:
 Abdominal surgery(leads to
peritonitis).
 Previous peritonitis(increases risk of
perforation and increase adhesion)
 Abdominal injuries(RTA,burn,scald)
 Extreme obesity(relative
contraindication)

8. EQUIPMENTS:-
 Dialysis administration set.
 Peritoneal dialysis solution as requested.
 Supplemental drugs are requested.
 Local anesthesia .
 Central venous pressure monitoring equipment.
 Suture set.
 Sterile gloves.
 Skin antiseptic.

9. PROCEDURE:-
 The abdomen is cleaned in preparation for surgery, and
a catheter is surgically inserted with one end in the
abdomen and the other protruding from the skin.
 Before each infusion the area must be cleaned, and flow
into and out of the abdomen tested.
 A large volume of fluid is introduced to the abdomen
over the next 10 to15 minutes. The total volume is
referred to as a dwell while the fluid itself is referred to
as dialysate. The dwell can be as much as 2.5 liters, and
medication can also be added to the fluid immediately
before infusion.

10.  The dwell remains in the abdomen and waste
products diffuse across the peritoneum from the
underlying blood vessels.
 The lining of your belly (called the peritoneum) acts
as a natural filter. It lets the wastes and extra fluid in
your blood pass through it into the cleansing fluid. At
the same time, the lining of your belly holds back the
important things your body needs, like red blood cells
and nutrients.

11.  After a variable period of time depending on
the treatment (usually 4-6 hours), the fluid is
removed and replaced with fresh fluid. This
can occur automatically while the patient is
sleeping (automated peritoneal dialysis, APD),
or during the day by keeping two liters of fluid
in the abdomen at all times, exchanging the
fluids four to six times per day (continuous
ambulatory peritoneal dialysis, CAPD).

12.  The fluid used typically contains sodium, chloride,
lactate or bicarbonate and a high percentage of
glucose to ensure hyperosmolarity.
 The amount of dialysis that occurs depends on the
volume of the dwell, the regularity of the exchange
and the concentration of the fluid. APD cycles
between 3 and 10 dwells per night,
 while CAPD involves four dwells per day of 2-2.5
liters per dwell, with each remaining in the
abdomen for 4-8 hours
 There are several different shapes and sizes of
catheters that can be used.

13. COMPLICATIONS:-
The volume of dialysate removed and weight of
the patient are normally monitored; if more than 500ml of
fluid are retained or a liter of fluid is lost across three
consecutive treatments, the patient's physician is generally
notified.
 Excessive loss of fluid can result in hypovolemic shock or
hypotension while excessive fluid retention can result in
hypertension and edema. Also monitored is the color of the
fluid removed: normally it is pink-tinged for the initial four
cycles and clear or pale yellow afterwards.

14.  The presence of pink or bloody effluent suggests
bleeding inside the abdomen while feces indicate a
perforated bowel and cloudy fluid suggests infection.
 The patient may also experience pain or discomfort if
the dialysate is too acidic, too cold or introduced too
quickly, while diffuse pain with cloudy discharge may
indicate an infection. Severe pain in the rectum or
perinium can be the result of an improperly placed
catheter.
 The dwell can also increase pressure on the diaphragm
causing impaired breathing, and constipation can
interfere with the ability of fluid to flow through the
catheter.

15.  Hypotension (due to excess fluid exchange and
sodium removal),
 Low back pain and hernia or leaking fluid due
to high pressure within the abdomen.
 Infection: exit site infection, peritonitis
 Mechanical: Hernia , fluid leak , back pain
 Metabolic: Obesity, hypertriglyceridemia,
protein loss
 Peritoneal membrane damage

16. RISKS AND BENEFITS:-
 PD is less efficient at removing wastes from the
body than hemodialysis, and the presence of the
tube presents a risk of peritonitis due to the
potential to introduce bacteria to the abdomen;
peritonitis is best treated through the direct
infusion of antibiotics into the peritoneum with
no advantage for other frequently used treatments
such as routine peritoneal lavage or use of
urokinase.

17.  The tube site can also become infected; the use of
prophylactic nasal mupirocin can reduce the number of
tube site infections, but does not help with peritonitis.
Infections can be as frequent as once every 15 months
(0.8 episodes per patient year).
 Compared to hemodialysis, PD allows greater patient
mobility, produces fewer swings in symptoms due to its
continuous nature, and phosphate compounds are better
removed, but large amounts of albumin are removed
which requires constant monitoring of nutritional status.

18.  The costs and benefits of hemodialysis and PD
are roughly the same - PD equipment is cheaper
but the costs associated with peritonitis are
higher.

19. NURSING MANAGEMENT:
 Monitor vital signs.
 Mask yourself and client.
 Remove old contaminated dressing of
catheter site.
 Assess the signs of infection.
 Use sterile technique/ care for catheter site.
 Dressing: use cotton swab in circular
motion(3 swabs).
 Monitor complications.

20.  Provide psychological support.
 Manage discomfort and pain.
 Protect vascular access.
 Health teaching-care of fistula, diet
 Nutrition:
 Protein:
 For growth and repair of muscle
 High protein food – egg, chicken, soy
milk, fish,etc.

21.  Low protein food – cereals, pulse,
legumes, nuts.
 AVOID red meat egg yolk, organ meat,
full fat milk.
 CHO:
 Main source of energy
 Controls blood sugar and cholesterol
 Fat:
 Concentrated source of energy
 Should be taken in prescribed amount
only
 Energy – 35 kcal/body wt

22.  Sodium:
 Avoid food high in sodium as it increases
thrist, causes the body to retain fluid, raises
blood pressure.
 AVOID food high in sodium e.g. fast food,
preserved meat, processed cheese, pappads
and pickles.
 Salt intake – 3 to 5gm /day
 Potassium:
 Excess potassium is dangerous may cause
heart to stop without warning & too little is
harmful.

23.  Food high in K potatoes, spinach,
mushroom, coconut, peach
 Food low in K- mango, green peas,
gourd, ganthgobi, turnip.
 Fluids:
 Too much fluid leads to high BP,
swelling, heart failure, breathlessness.

24.  Tips for fluid control:
 Drink only when you are thirsty
 Avoid excess intake of salt food
 Take medication with meal time liquid
& not with extra water.
 Ice cubes are more satisfying than
water as they last longer.