PERITONEAL

DIALYSIS
Prepared by:
JOWALDEN DELOS TRINOS LAYLAY, RN
ARIANE JAKE C. FERNANDEZ, RN, MSN
Clinical Instructors – ISUE CON
PERITONEAL DIALYSIS
• The removal of toxic substances from the body using the peritoneum as the
semi-permeable membrane.
• This is a form of dialysis which uses the peritoneal cavity as membrane that
separates 2 fluids containing compartments
blood in the peritoneal capillaries (which contain the excess urea, crea,
K+)
Dialysis solution in the peritoneal cavity which contains the Na+, Cl+,
lactate, glucose.
PERITONEAL DIALYSIS
 PD is a dialysis self-care treatment that patients can do alone, at home,
after just a week or two of training by a nurse.

 PD lets patients fit their treatment into their lives, not fit their lives into a
center’s schedule.

 PD is work-friendly. It is flexible and portable.

 PD allows a more normal diet with fewer fluid limits than in center HD.

 People who do PD may not feel like they are “sick”.

PERITONEAL DIALYSIS
• Indwelling catheter is implanted into the peritoneum.
• A connecting tube is attached to the external end of peritoneal catheter T-tube
• Plastic bag of dialysate solutions inserted to the end of T-tube, the other end is
recap
• Dialysate bag is raised to shoulder level and infused by gravity in the peritoneum
cavity
• Infusion time = 10 minutes/ 2 liters, dwelling time is 4-6 hours depending on
doctor’s order
PERITONEAL DIALYSIS
• At the end of dwelling time, dialysis fluid is drained from the peritoneal cavity by
gravity.
• Draining time is 10-20 minutes / 2 liters
• Repeat the procedure when necessary.
How long does peritoneal dialysis take to
drain?
• It takes about 10 to 20 minutes to drain. When
the solution is drained, a new bag of dialysate is
connected to the catheter and the steps are
repeated. These 3 steps are done about 4 times
each day with meals and at bedtime. Each cycle
takes 20 to 40 minutes.
How long can a dialysis catheter stay in?
• Non-cuffed tunneled catheters are used for
emergencies and for short periods (up to 3
weeks). Tunneled cuffed catheters, a type
recommended by the NKF for temporary access,
can be used for longer than 3 weeks when: An AV
fistula or graft has been placed but is not yet
ready for use.
How big is a dialysis catheter?
• Tunneled cuffed catheters are inserted under
fluoroscopic guidance into the subclavian vein.
For catheters placed through the internal jugular
vein or subclavian vein, the optimal tip location is
at the junction of the superior vena cava and right
atrium, and catheters around 15cm in length are
appropriate.
TEACHING PD
 Set up a place to do an exchange.
 Wash hands thoroughly to remove bacteria and help prevent infection.
 Care for your catheter and clean and dry your exit site.
 Connect your catheter to a PD bag in a sterile way to prevent infection.
 Add medicine to your PD bag if you need to.
 Drain out used PD dialysate and put in fresh dialysate. This is known as an
exchange.
 Keep good treatment records.
 Have enough supplies of each type to last a month.
 Safely dispose of medical wastes.
•The volume of dialysate removed as well as patient's weight are
monitored.
•Complications:

 loss of fluid can result in hypovolemic shock or hypotension .

 excessive fluid retention can result in hypertension and edema.

 Alsomonitored is the color of the fluid removed: normally it is pink-

tinged for the initial four cycles and clear or pale yellow afterwards.

 The presence of pink or bloody effluent suggests bleeding inside

the abdomen
Complications:

 Feces indicates a perforated bowel.

 Cloudy fluid suggests infection.

 Patient may also experience pain or discomfort if the dialysate is too

acidic, too cold or introduced too quickly.

 Severe pain in the rectum or perineum can be the result of an improperly

placed catheter. 

 The dwell can also increase pressure on the diaphragm causing impaired

breathing.

 Low back pain and hernia or leaking fluid due to high pressure within the
abdomen.
3 Phases of PD:
1. Inflow Time- inflow is by gravity and usually requires 10 minutes.
Dictated by the volume to be infused and the height of the solution is
above the patient abdomen.

2. Dwell Time- the time during which the total exchange volume is
presented in the peritoneal cavity.

3. Outflow Time- outflow of spent dialysis by gravity and the outflow

depends on the total volume to be drained, the resistance to outflow
and the difference in the height between the patient’s abdomen and the
drainage bag.
Diffusion is created by having a concentration gradient
on either side of a semipermeable membrane. Solutes
move from an area of greater concentration to less
concentration.
The formal definition of diffusion in dialysis is movement
of solutes as a result of random molecular motions
across a semipermeable membrane down its
concentration gradient. With dialysis most of the toxin
removal is accomplished by diffusion.
Ultrafiltration is the removal of fluid from a
patient and is one of the functions of the kidneys
that dialysis treatment replaces. Ultrafiltration
occurs when fluid passes across a semipermeable
membrane (a membrane that allows some
substances to pass through but not others) due to a
driving pressure.
Adsorption is a method for removal of
molecules from blood or plasma by
attachment to a surface incorporated in a
module within an extracorporeal circuit.
Types of Peritoneal Dialysis (PD)

1.CAPD – Continuous Ambulatory Peritoneal Dialysis

2.CCPD – Continuous Cyclic Peritoneal Dialysis

3.CIPD – Continuous Intermittent Peritoneal Dialysis

WATCH: https://youtu.be/kBX4bD10MXM
Continuous Ambulatory Peritoneal Dialysis (CAPD)

 The patient can perform peritoneal dialysis

treatments manually.
 No machine needed.
 Exchanges 30 minutes.

https://www.youtube.com/watch?v=IWufgduExvE
 Continuous Cyclic Peritoneal Dialysis (CCPD)

 The patient performs peritoneal dialysis

treatments using a machine called a cycler.
 Done at nighttime.
 Applicable in children.
 Exchange is 8-10 hours

https://www.youtube.com/watch?v=y_IS9npw6WU
Hospital Setting:

Continuous Intermittent Peritoneal Dialysis (CIPD)

 Usually done twice a week.

 Dwell time: 30 minutes.
 No. of exchanges: 60 exchange/session.
 Use bottled or plasco PD solution.
NURSING CONSIDERATION:
1. Dialysate must be room-warmed before use (for better absorption)
2. Drugs (heparin, potassium and antibiotics) must be added in advance
3. Allow the solution to remain in the peritoneal cavity for the prescribed
time
4. Check outflow for cloudiness, blood and fibrin (early peritonitis)
5. NEVER PUSH THE CATHETER IN
6. Monitor vital signs regularly
NURSING CONSIDERATION
7. Keep a record of patient’s fluid balance (daily weighing)
8. Monitor blood chemistry
9. Turn the patient side to side if drainage stop
10. Observe for abdominal pain (cold solution, dialysate leakage, prevent
infection)
11. Intake must be equal to output
THANK YOU FOR
LISTENING!