Peritoneal Dialysis

Published on 21/03/2015 by admin

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Last modified 21/03/2015

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Chapter 93 Peritoneal Dialysis

Peritoneal dialysis (PD) removes toxic substances, body wastes, and excess fluids using the peritoneum (a semipermeable membrane) as an exchange surface. Solutes move from the bloodstream into the peritoneum and then into the dialysate. This occurs through diffusion (movement from an area of higher concentration to one of lower concentration). The dialysate is a hypertonic dextrose solution with a concentration similar to plasma. A higher percentage of dextrose will lead to a greater osmotic effect and more fluid removal.

The PD catheter is placed through a small abdominal incision or through a trocar-induced puncture hole into the peritoneal cavity. This catheter is connected to a system of fluid bags and tubing. A PD exchange consists of three steps: (1) filling (fluid flows into the abdomen), (2) dwell or equilibrium time (fluid remains in the abdomen), and (3) drain (fluid flows out of the abdomen). The “fill” bag is raised above the patient. Opening the clamp allows fluid to flow into the abdomen (approximately 10 minutes). During the dwell time, equilibration between plasma and dialysis fluid leads to removal of solutes and excess fluid. Typically, this ranges from 15 to 60 minutes, but it can last several hours depending on the type of PD. After the prescribed dwell or equilibrium time, the “drain” bag is placed below the patient to enable gravity drainage of the PD fluid (approximately 10 minutes). Fill and drain times will be affected by patency of the catheter, height of the fluid bags, patient position, and other factors. The type of dialysate, equilibrium times, and number of exchanges per day will be prescribed. It is important to maintain an accurate record of the exact amount of fluid instilled and drained.

PD is an alternative to hemodialysis in the treatment of acute and chronic renal failure in children. PD may be contraindicated for use or used with extreme caution with the following conditions:

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