Peritoneal dialysis: Difference between revisions
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Peritoneal dialysis is typically done in the patient's home and workplace, but can be done almost anywhere; a clean area to work, a way to elevate the bag of dialysis fluid and a method of warming the fluid are all that is needed. The main consideration is the potential for [[infection]]. [[Peritonitis]] is the most common serious complication, but with good technique can usually be avoided. Infections of the catheter's exit site or "tunnel" (path from the [[peritoneum]] to the exit site) are less serious. Because of this, patients are advised to take a number of precautions against infection. | Peritoneal dialysis is typically done in the patient's home and workplace, but can be done almost anywhere; a clean area to work, a way to elevate the bag of dialysis fluid and a method of warming the fluid are all that is needed. The main consideration is the potential for [[infection]]. [[Peritonitis]] is the most common serious complication, but with good technique can usually be avoided. Infections of the catheter's exit site or "tunnel" (path from the [[peritoneum]] to the exit site) are less serious. Because of this, patients are advised to take a number of precautions against infection. | ||
== | ==Types == | ||
There are three types of peritoneal dialysis: <ref name="pmid14582053">{{cite journal |vauthors=Teitelbaum I, Burkart J |title=Peritoneal dialysis |journal=Am. J. Kidney Dis. |volume=42 |issue=5 |pages=1082–96 |date=November 2003 |pmid=14582053 |doi= |url=}}</ref><ref name="pmid25587214">{{cite journal |vauthors=Hauch AT, Lundberg PW, Paramesh AS |title=Laparoscopic techniques enable peritoneal dialysis in the difficult abdomen |journal=JSLS |volume=18 |issue=4 |pages= |date=2014 |pmid=25587214 |pmc=4283101 |doi=10.4293/JSLS.2014.002334 |url=}}</ref> | There are three types of peritoneal dialysis: <ref name="pmid14582053">{{cite journal |vauthors=Teitelbaum I, Burkart J |title=Peritoneal dialysis |journal=Am. J. Kidney Dis. |volume=42 |issue=5 |pages=1082–96 |date=November 2003 |pmid=14582053 |doi= |url=}}</ref><ref name="pmid25587214">{{cite journal |vauthors=Hauch AT, Lundberg PW, Paramesh AS |title=Laparoscopic techniques enable peritoneal dialysis in the difficult abdomen |journal=JSLS |volume=18 |issue=4 |pages= |date=2014 |pmid=25587214 |pmc=4283101 |doi=10.4293/JSLS.2014.002334 |url=}}</ref> | ||
* '''Continuous ambulatory peritoneal dialysis''' ('''CAPD'''), the most common type, needs no machine and can be done at home. Exchanges of fluid are done throughout the day, usually four exchanges a day.<ref name="pmid16813998">{{cite journal |vauthors= |title=Clinical practice guidelines for peritoneal dialysis adequacy |journal=Am. J. Kidney Dis. |volume=48 Suppl 1 |issue= |pages=S98–129 |date=July 2006 |pmid=16813998 |doi=10.1053/j.ajkd.2006.04.006 |url=}}</ref> | * '''Continuous ambulatory peritoneal dialysis''' ('''CAPD'''), the most common type, needs no machine and can be done at home. Exchanges of fluid are done throughout the day, usually four exchanges a day.<ref name="pmid16813998">{{cite journal |vauthors= |title=Clinical practice guidelines for peritoneal dialysis adequacy |journal=Am. J. Kidney Dis. |volume=48 Suppl 1 |issue= |pages=S98–129 |date=July 2006 |pmid=16813998 |doi=10.1053/j.ajkd.2006.04.006 |url=}}</ref> | ||
* '''Continuous cyclic peritoneal dialysis''' ('''CCPD''') uses a machine and is usually performed at night when the person is sleeping.<ref name="pmid14582053" /><ref name="pmid16813998" /> | * '''Continuous cyclic peritoneal dialysis''' ('''CCPD''') uses a machine and is usually performed at night when the person is sleeping.<ref name="pmid14582053" /><ref name="pmid16813998" /> | ||
* '''Intermittent peritoneal dialysis''' ('''IPD''') uses the same type of machine as CCPD - if done overnight is called Nocturnal intermittent peritoneal dialysis (NIPD)<ref name="pmid14582053" />. | * '''Intermittent peritoneal dialysis''' ('''IPD''') uses the same type of machine as CCPD - if done overnight is called Nocturnal intermittent peritoneal dialysis (NIPD)<ref name="pmid14582053" />. | ||
== Indications: == | |||
== ContraIndications: == | |||
==Advantages and disadvantages of Peritoneal dialysis== | ==Advantages and disadvantages of Peritoneal dialysis== | ||
Revision as of 15:00, 2 July 2018
- Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2]
Overview
Peritoneal dialysis is a method for removing waste such as urea and potassium from the blood, as well as excess fluid, when the kidneys are incapable of this (i.e. in renal failure). It is a form of renal dialysis, and is thus a renal replacement therapy.
Peritoneal dialysis works on the principle that the peritoneal membrane that surrounds the intestine, can act as a natural semipermeable membrane (see dialysis), and that if a specially formulated dialysis fluid is instilled around the membrane then dialysis can occur, by diffusion. Excess fluid can also be removed by osmosis, by altering the concentration of glucose in the fluid.
Dialysis fluid is instilled via a peritoneal dialysis catheter, (the most common type is called a Tenckhoff Catheter) which is placed in the patient's abdomen, running from the peritoneum out to the surface, near the navel. Peritoneal dialysis catheters may also be tunneled under the skin and exit alternate locations such as near the rib margin or sternum (called a presternal catheter), or even up near the clavicle. This is done as a short surgery. The exit site is chosen based on surgeon's or patient's preference and can be influenced by anatomy or hygiene issues.
Peritoneal dialysis is typically done in the patient's home and workplace, but can be done almost anywhere; a clean area to work, a way to elevate the bag of dialysis fluid and a method of warming the fluid are all that is needed. The main consideration is the potential for infection. Peritonitis is the most common serious complication, but with good technique can usually be avoided. Infections of the catheter's exit site or "tunnel" (path from the peritoneum to the exit site) are less serious. Because of this, patients are advised to take a number of precautions against infection.
Types
There are three types of peritoneal dialysis: [1][2]
- Continuous ambulatory peritoneal dialysis (CAPD), the most common type, needs no machine and can be done at home. Exchanges of fluid are done throughout the day, usually four exchanges a day.[3]
- Continuous cyclic peritoneal dialysis (CCPD) uses a machine and is usually performed at night when the person is sleeping.[1][3]
- Intermittent peritoneal dialysis (IPD) uses the same type of machine as CCPD - if done overnight is called Nocturnal intermittent peritoneal dialysis (NIPD)[1].
Indications:
ContraIndications:
Advantages and disadvantages of Peritoneal dialysis
Advantages
The following are the advantages:[1][3][4]
- Can be done at home.
- Relatively easy to learn.
- Easy to travel with, bags of solution are easy to take on holiday.
- Fluid balance is usually easier than on hemodialysis
- Theoretically better to start dialysis on, as native urine output is maintained for longer than on hemodialysis.[4]
- Excluding kidney transplant, PD is method of the first choice in treating chronic kidney failure.
Disadvantages
- Requires a degree of motivation and attention to cleanliness while performing exchanges.
- Possible complications (see below)
Complications
Following are the complications associated with Peritoneal Dialysis:[1][3]
- Infection[3][5]
- Peritonitis[3][5][6]
- Hernias
- Accumulation of fibrin in the PD effluent[4]
- Damage to peritoneal membrane
- Diabetes because of the glucose levels that are in the 'bags'
- Fluid leaks into surrounding soft tissue, often the scrotum in males
CAPD exchange
Precautions:
- A disposable surgical mask
- Antibacterial soap
- IV stand or other elevated location, such as a coat hook. [3][1]
Materials needed:
- A dialysis fluid bag: contains glucose and electrolytes dissolved in water.[1][3]
- Two bags: one empty and one with the fluid, connected via flexible tubing to a Y-shaped fitting.
Process:
- Once connected to the system, the patient clamps the tubing connected to the full bag of dialysis fluid and then releases the twist valve located in the tip of their catheter; this permits fluid to flow into or out of the peritoneal cavity. Because the full bag of fluid is clamped off but the empty bag is not, the effluent (used dialysis fluid) from within the peritoneum can drain out of the catheter and into the lower, waste bag. Emptying the abdomen of fluid takes approximately fifteen minutes.[3]
- When the abdomen has drained, the lower drain-bag is clamped off. The twist valve in the catheter is also closed. The clamp is then removed from the upper tubing, permitting dialysis fluid to drain out into the abdomen. The clamp to the drain bag is briefly opened and some fluid is drained directly from the upper bag into the lower bag. This clears the line of air and other impurities. The drain line is then clamped off and the twist valve on the catheter end is opened. This permits fluid to enter the peritoneum. Filling the abdomen with fresh fluid takes about fifteen minutes, and the patient enjoys the same freedoms as while draining.
- Once the entire bag of fluid (an amount varying primarily based on body size, ranging from 1500 to 3000 mL) has been introduced to the abdomen, the patient then cleans their hands again (typically using an antiseptic alcohol-based cleanser) and puts the surgical mask on. The Y-connector is detached from the catheter tip and a protective cap is placed on the end of the catheter.[1]
- The effluent is inspected after a dialysis exchange is complete; a cloudy effluent indicates probable peritoneal infection. The effluent is drained into a toilet, and the various dialysis supplies are discarded with normal garbage.
See also
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Teitelbaum I, Burkart J (November 2003). "Peritoneal dialysis". Am. J. Kidney Dis. 42 (5): 1082–96. PMID 14582053.
- ↑ Hauch AT, Lundberg PW, Paramesh AS (2014). "Laparoscopic techniques enable peritoneal dialysis in the difficult abdomen". JSLS. 18 (4). doi:10.4293/JSLS.2014.002334. PMC 4283101. PMID 25587214.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 "Clinical practice guidelines for peritoneal dialysis adequacy". Am. J. Kidney Dis. 48 Suppl 1: S98–129. July 2006. doi:10.1053/j.ajkd.2006.04.006. PMID 16813998.
- ↑ 4.0 4.1 4.2 "PERITONEAL DIALYSIS-RELATED INFECTIONS RECOMMENDATIONS: 2010 UPDATE".
- ↑ 5.0 5.1
- ↑ "academic.oup.com".