Indication:

1. If ang patient naay difficulty sa vascular access. Ma handle pa niya ang in-depth surgery of
waiting for a fistula or graft to form. Cause diba, sa hemodialysis, to get a graft or fistula, it
takes six months for it to heal. Whereas sa PD, dili na maghulat ug 6 months because we can
go and get the catheter place and use it a lot sooner.
2. Naa ba siIay chronic infections, do they have unstabIe hypertension, where their
hypertension is going so high and then if they were getting HD, it wouId bring their pressure
down so Iow that they wouId have issues?
Or, is their some underIying issues where maybe they can’t handIe anticoaguIants therefore,
HD is not a good choice.
3. Is the patient still able to be independent? because when we get peritoneal dialysis there is
a level of independence where they can stay at home and do it at their home at their will.

Acute and chronic kidney faiIure

Diabetic patients, cardiovascuIar disease

Because of the rapid and intermittent removal of solutes and water and the extracorporeal circulation
inherent to HD, it can frequently be associated with dialysis-induced hypotension, coronary ischemia,
and arrhythmia [9], possibly leading to a worsening cardiovascular status in these patients.

PD avoids aggressive fluid shifts offering a better hemodynamic tolerance.

In addition, the lack of a need to create an arteriovenous fistula, which increases cardiac load,
accelerating heart failure, may also be a potential benefit of PD in diabetic patients.

So when we're talking about peritoneal dialysis,

the setup here is that we will not be utilizing the machine but utilizing gravity.

and what happens with the patient is we will have the dialysis solution in this bag we will attach it to the
catheter right,

we'll unclamp the dialysate soIution and put that in.

This would be the first time so we're gonna put the dialysate in, dialysate wIll sit and dwell, so we call
this the dwelling time so as it flows in by gravity, we'll have this dwelling time and

DweII Time: The length of time the cleansing fluid remains in your body.

Continuous ambulatory peritoneal dialysis (CAPD). With this, you do your own exchanges 3 to 5 times
per day, each with a dwell time of about 4 to 6 hours

then once dwell time is over we will then unclamp the drainage bag and then let that drain out and then
collect our waste.
Then after every subsequent peritoneal treatment from this, we wiII drain after the dweIl time, drain our
waste first and then instill our diaIysate and let that dwell again.

this is how we use gravity, there is no fluid or no machines that we need to pump the fluids in and
remember when we are doing this dialysate soIution bag is above or at shoulder height and the drainage
bag is below waist the waste bag is below the waist.

- our pre procedure, make sure the patient had consent sign and did everything with that prior to
getting surgery, right after surgery is completed, which is pag insert sa catheter, diIi Iang nato I
assess how patients can handle this, but make sure aIso that we're teaching them as well,

so for the first procedure, gonna do the same thing as hemodialysis,

- check their weight check their labs and make sure that their blood sugar and everything else is
looking normal for us
- and there were also get a dry weight and the dry weight is essentially meaning the patient
doesn't have any solution in them right now, so they're dry, there's no hypertonic solution in
them, no dialysate within them so they are considered dry
- check that vascular access because they just got an access point completed and we want to
make sure that it's looking healthy it's looking nice and clean, there's no drainage, there's no
leakage and then it's actually able to be utilized so we're gonna assess our catheter.

the intra procedure essentially where we're just monitoring this patient,

- we're making sure that there's no leakage at that access point,

- we're making sure that they're vital signs and everything is looking stable.

this is where we can sit and talk with our patient about things that we want to make sure they can do
and can't do because we wanna make them as independent as we can when we're utilizing this in the
bedside so showing them what proper technique is how they're going to set things up put things on and

- checking for is the access site, red, leaking, is there any type of drainage in the waste that's
coming out having any discoloration or any problems, blood clots, anything that we need to
utilize and look for
- make sure they're not spiking any fevers cause the biggest thing with intra procedure and post
procedure is to making sure that we don't have any developing infections coming along.

- looking at that drainage, we make sure that it's pale it's clear and maybe a little bit of yellow
right

- make sure that whatever we're putting in, make sure that that output is coming out, so the
amount of our drainage
 - make sure they have proper technique of hooking up, they know their drainage and dwell time
and then we also want to make sure that the solution has been warmed to prevent chiIIing, and
to diIate the peritoneaI bIood vesseIs thus, faciIitating substance exchange.

For this I wanna call this and then we also want to keep in mind here that we're keeping our waist bag
lower than our waist our gravity bag is either higher than our shoulders but if they're on the ABA PD that
they're just able to utilize the machine cause that'll take over gravity for us and then.

when we go into our post procedure

- make sure that we just understand for this patient how they are going to take care of their body
when they are not getting this dialysis so it's very similar always mirrors our pre procedures
we're going
- to make sure the vital signs the labs all look good and then their blood sugar looks good as well
and
- it's really important with blood sugar to make sure that we're checking these patients because
they can have hyperglycemia which can be a complication
- checking their weight again and then we're going to explain this patient what their care is gonna
look like
- make sure they know how to properly clean around their catheter
- make sure that they're aware of any types of signs and symptoms they should reporting like
fevers redness, drainage from that catheter site.

complications and then our patient education the first complication that we're going to be worried about
is an

1. infection
- when we talk about infections we're talking about patient maybe has some underlying infection
like a pneumonia or UTI or there could be infections around the catheter site there were also
going to be particularly honing in on the signs and symptoms of that would be redness at the
catheter site cruel and drainage of the catheter site leaking during dialysis or any other
indication to us that may not be showing that the catheter is working properly in the area of
2. there might be an infection going on with this patient bouncing off of the infections we are very
particularly concerned about catheter site infections because those could lead to us having
peritonitis
- when we were taking care of these patients some indications for us that they may have some
peritonitis would be the drainage bag changing colors - seeing something darker in color, cloudy
having purulent looking, presence of blood that's coming out, anything that is showing an
indication that it is changing and it's not that nice clear pale yellow that we might have an
infection within our abdomen and
3. hyperglycemia, the dialysate that we use is hypertonic for a lot of patients that can cause issues
with them to be able to control their blood sugar
- make sure to check blood sugars cause we don't want this patient to have any other issues
 - is a patient starting to have any type of symptoms that are showing us, are they having some
turf sweaty moment, dizziness,
- simple thing to do is to first check the blood sugar so this is something that we can educate our
patients
- make sure you check your blood sugar

our patient education

- how they are going to attach and disconnect and clean their areas right because if we look at our
complications they're all mostly stemming from an infection to that area so for patient education
-
1. the cleaning of the area is very important
- make sure that they are cleaning our catheter correctly right they're able to use
- catheter cap nice and clean and sterile and then they're keeping their dialysate nice and sterile
so
- it's aseptic technique with cleaning and washing the hands the sterile technique to just adhere
the dialysis