About this topic
The kidneys are bean-shaped organs in the back of your belly, just above your waist. They filter your blood and get rid of waste products and extra fluid from your body. The waste is turned into urine. Sometimes, your kidneys do not work well. Then, you may need a procedure to replace the work of your kidneys. � �
Peritoneal dialysis, or PD, takes over the work of your kidneys. It removes extra water, wastes, and chemicals from your body when your kidneys are not working as usual. This type of dialysis uses the lining of your belly to filter the wastes from your blood. This lining is called the peritoneal membrane or peritoneum. � �
A peritoneal dialysis is made up of a cleansing solution or dialysate, a tube or PD catheter, and a bag or container to drain the fluid. You may also need a small machine to do dialysis while you sleep. The tube that goes into your belly has about 6 to 12 inches outside the belly. The solution enters your body through the tube and then drains out through the same tube. The solution that drains out has all the waste in it. The solution going in and then draining out is called a PD exchange. � �
The PD exchange is done 2 to 3 weeks after the tube is put in, which lets the area around the tube heal before PD is started. � �
There are a few types of PD: � �
- Continuous ambulatory peritoneal dialysis or CAPD is done 3 to 5 times during the day.
- Continuous cycler peritoneal dialysis or CCPD uses a small machine called a cycler. The exchanges are done 3 to 5 times while you sleep at night.
- Manual intermittent PD is done a few times during the day. The solution is put in and drains out at the same time.
- Automated cycler intermittent PD is a machine that does exchanges at set times. It is most often done 6 to 7 times a week.
What care is needed at home?
Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do. � �
Long-term care of the catheter site: � �
- Keep the area around the tube clean and dry.
- Wash your hands before and after touching your tube.
- Clean the area around the PD tube each day:
- Use a soap that kills germs or an antiseptic solution.
- Do not remove any scabs or crusts.
- Hold the tube during cleaning to stop it from being pulled out.
- Use a clean cotton-tip swab to put on the ointment or cream that your doctor gives you.
- Put plastic wrap over the dressing when you shower and make sure it does not get soaked. Gently towel-dry the area around the tube. Replace the wet dressing with a dry one after taking your shower.
- Use dressings and tape that lets the skin get air.
- Tape your tube to your belly so it does not dangle.
- Use tapes and dressings that will let air enter the skin.
Your PD Treatment � �
- Do the exchange in a clean room and close all doors, vents, and windows. Keep pets out of the room.
- Keep your PD supplies in a clean, dry space. Wash your hands before handling your PD supplies.
- You will be taught how to do your PD exchange. You will also learn how often they need to be done.
- Place the dialysate or solution in a warmer 30 to 90 minutes before doing the exchange.
- Go to the bathroom to empty your bladder and then weigh yourself before the exchange. Record your weight.
- Wash your hands before handling the PD supplies. Make sure all supplies you need are on a clean table beside you. Wipe the opening of the solution bag and your tube with an alcohol wipe. Connect the tube from the bag to your PD tube. Put the bag on the I.V. pole or on a clean table. Sit in a comfortable chair during the exchange.
CAPD � �
- Fill your belly with the solution and let it stay in there for up to 4 hours. After 4 hours, reconnect the PD tube to the bag, and put the bag lower than your belly. This will let gravity drain the solution out of your belly.
- Repeat the process at night but let the solution stay in your belly while you sleep. Drain the solution out in the morning.
CCPD � �
- Connect the cycler to your PD tube before you lie down to sleep at night. The cycler will put the solution in and out of your belly while you sleep.
- You can disconnect your PD catheter from the machine in the morning.
Manual Intermittent PD � �
- Fill your belly with the solution and let it stay in there for 60 to 90 minutes. After 90 minutes, reconnect the PD tube to the bag, and put the bag lower than your belly. This will let gravity drain the solution out of your belly.
- Connect the bag with solution and the bag for draining to your PD tube at the same time.
- You will do this a few times each day.
- Repeat the process at night but let the solution stay in your belly while you sleep. Drain the solution out in the morning.
Automated Cycler Intermittent PD � �
- The exchange is the same as for CAPD, but done a few times a day. The solution stays in your belly for 60 to 90 minutes. Connect the bag with solution and the bag for draining to your PD tube at the same time.
What follow-up care is needed?
- Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits. You may need to have more blood tests.
- Your doctor may tell you to have your dialysis in a hospital, clinic, or dialysis center until you are able to use your catheter for PD, or if your doctor needs to give you a drug through your PD exchange.
What drugs may be needed?
The doctor may order drugs to: � �
- Help with pain
- Prevent infection
Will physical activity be limited?
- You need to limit your movements when your belly is full.
- You may have to limit your activity. Talk to your doctor about the right amount of activity for you.
- Try not to go to crowded places where your belly can easily be bumped.
What changes to diet are needed?
Your doctor may have you meet with a dietitian to look at your diet. Some common diet changes may include: � �
- Eat food rich in fiber, like fruits and veggies, to avoid hard stools.
- Eat foods rich in protein like eggs, milk, meat, chicken, and fish.
- Eat less food high in phosphorus. Some examples are dairy products, cheese, dried beans, liver, nuts, and chocolate.
- Limit your salt intake. Stay away from table salt, sauces, salted snacks, and cured foods.
What problems could happen?
- Infection
- Bleeding
- Anemia
- Upset stomach and throwing up
- A bulge in the bellys muscle. This is a hernia.
- Bone weakening
- Too much sugar in the body known as hyperglycemia
- Weight gain
When do I need to call the doctor?
- Signs of infection. These include a fever of 100.4 � �F (38 � �C) or higher, chills.
- Signs of catheter infection. These include swelling, redness, warmth around the catheter; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the catheter site; catheter site opens up.
- Signs that your catheter is not working right. The dialysate may not be flowing into the catheter or it is not draining.
- Accidentally pulled on your catheter
- Cloudy or bloody dialysis solution
Helpful tips
- Loop your PD tube to make a "C " � shape before putting the dressing on. This will give a little support if you accidentally pull on your tube.
- Wear loose clothing that will not rub on your tube.
- Ask your doctor about underwear and belts made for people with PD tubes.
- Do not warm your PD solution in a microwave.
- Schedule when you need to get supplies so you do run out of them.
Teach Back: Helping You Understand
The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly. It also helps to explain things that may have been a bit confusing. Before going home, make sure you are able to do these: � �
- I can tell you about condition.
- I can tell you how to care for my dialysis site.
- I can tell you what changes I need to make with my diet.
- I can tell you what I will do if I have swelling, redness, or warmth around my catheter site.
Where can I learn more?
Kidney Dialysis Information Centre � �
http://www.kidneydialysis.org.uk/peritoneal-dialysis.htm � �
National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) � �
http://kidney.niddk.nih.gov/kudiseases/pubs/peritonealdose/index.aspx � �
Consumer Information Use and Disclaimer
This information is not specific medical advice and does not replace information you receive from your health care provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or life-style choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care providers advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you. � �
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Copyright � � 2015 Clinical Drug Information, LLC and Lexi-Comp, Inc. � �