PERITONEAL DIALYSIS

Peritoneal Dialysis involves repeated cycles of instilling dialysate (a specially prepared

electrolyte solution) into the peritoneal cavity, allowing time for substance exchange, and then
removing the dialysate. The procedure is useful for both ARF and ESRD and for fluid and
electrolyte imbalances.

INDICATIONS:

1. Typically used for clients with severe cardiovascular disease, especially those whose
problems would be worsened by the rapid changes in urea, glucose, electrolytes and fluid
volume that occurs during hemodialysis.

2. For diabetic clients to reduce the risk of retinal hemorrhage associated with the heparin used
during hemodialysis.

3. Dialysis treatment of choice for children because it seems to have less effect on growth.

IMPORTANCE:

1. It removes the end products of protein metabolism, such as urea and creatinine, from the
blood.

2. It maintains a safe concentration of serum electrolytes

3. It corrects acidosis and replenishes the bicarbonate levels of the blood

4. It removes excess fluid from the blood

COMPLICATIONS:

1. PERITONITIS. Meticulous aseptic technique is not maintained during handling of catheter,

tubing, and dialysate solution. Bacteria may enter the peritoneal cavity through contaminated
dialysis fluid, a contaminated catheter lumen, or the catheter insertion site.

2. CATHETER-RELATED COMPLICATIONS. This Includes displacement and obstruction.

Obstruction may be due to malposition, adherence of the catheter tip to the omentum, or
infection. Reduced catheter flow is due to constipation possibly because peristalsis facilitates
outflow. Also be aware of the possibility of bowel perforation, which is most likely to occur in
cachectic (profoundly ill and malnourished) clients or those who have abdominal adhesions.
Bladder perforation can also occur if the bladder has not been emptied before catheter
insertion.

3. DIALYSIS-RELATED COMPLICATIONS. Pain during dialysis may result from rapid

instillation, incorrect dialysate pH or temperature, diasylate accumulation under the diaphragm,
or excessive suction during outflow. Hypotension may result from too rapid removal of fluid.
Overhydration, from insufficient fluid removal, may manifest as heart failure and pulmonary
edema. Hypoalbuminemia leading to hypovolemia often occurs because the peritoneal
membrane allows the passage of albumin, as much as 100g/day if the client is infected.
Hyperglycemia may occur in diabetic clients as a result of absorption of glucose from the
dialysate and electrolyte changes. Respiratory difficulties may occur during dwell time
because of pressure on the diaphragm. Weight gain may occur because of the high
concentration of glucose in the diasylate.

FREQUENCY/CYCLES:

The number of dialysis cycles depends on the normalization of body fluids and blood
chemistries, as indicated by laboratory studies. Peritoneal clearance is influenced by several
factors, including the size of the membrane area, blood flow to the peritoneum, and alterations
in the permeability of the peritoneal membrane.