Peritoneal dialysis

Peritoneal dialysis (for every die-AL-uh-sis) is a method of removing waste items from your blood whenever your kidneys are no longer capable of doing so. This method filters the blood differently from the more commonly used blood-filtering process called hemodialysis.

A cleaning solution travels throughout a tube (catheter) into a portion of your abdomen during peritoneal dialysis. The peritoneum (its lining of the abdomen) acts as a filter, eliminating waste from your blood.After a certain period of time, the fluid containing the filtered waste materials drains from your abdomen and is eliminated.

These treatments may be performed at home, at work, or while on the road. However, peritoneal dialysis is not a solution for everyone suffering from renal failure. You must have dexterity and the capacity to care for yourself at home, and you must rely on a dependable caregiver.

Why is it done?

If your kidneys are no longer functioning properly, you will require dialysis. Kidney damage often worsens over time as a result of brief diseases such as:

  • Diabetes
  • Their blood pressure is high.
  • Inflammation of the kidneys (glomerulonephritis)
  • Kidney cysts in abundance (polycystic kidney disease)

During hemodialysis, blood is taken from the body, purified by a machine, and then restored to the body.

Hemodialysis is normally performed in a clinic or hospital, such as with a dialysis clinic or hospital, however, it can occasionally be performed at home.

Although both forms of dialysis may successfully filter your blood, peritoneal dialysis has the following advantages over hemodialysis:

  • Greater freedom and independence in one’s lifestyle. These are especially useful if you work, travel, or reside a long distance away from a hemodialysis center.
  • A less constrained diet. Peritoneal dialysis is more continuous than hemodialysis, resulting in less potassium, sodium, and fluid buildup. This permits you to have a much more varied diet than you can even if you were on hemodialysis.
  • Longer-lasting residual renal function. Peritoneal dialysis patients may have a slightly longer functional status than hemodialysis patients.

Consult your doctor over what form of dialysis is appropriate for you. Consider the following factors:

  • Your kidney performance
  • Your general health
  • Your individual tastes
  • Your living circumstances
  • Your way of life

Peritoneal dialysis may have been a better choice if you:

  • Can’t stand the abrupt fluctuations in fluid balance that come with hemodialysis.
  • Do you want to reduce the disturbance to your regular activities?
  • Want to be able to work or move more easily?
  • Have some renal function left

Peritoneal dialysis may not be effective if you have:

  • Your abdomen has several surgical scars.
  • A wide region of abdominal muscular weakness (hernia)
  • Inability to care for oneself or maybe even a lack of caregiver help
  • Inflammatory bowel illness or recurrent diverticulitis

People who use peritoneal dialysis are also more likely to experience a loss in kidney function that necessitates hemodialysis or a kidney transplant.

complications

Peritoneal dialysis complications might include:

  • Infections. Peritonitis (infection of the abdominal lining) is a frequent consequence of peritoneal dialysis. Infections can also form when the catheter is implanted to transport the cleaning fluid (dialysate) into or out of your abdomen. If the individual performing the dialysis is not trained properly, the danger of infection increases.
  • Gaining weight. Sugar is present in the dialysate (dextrose). Absorbing part of the dialysate may cause you to consume hundreds of additional calories every day, resulting in weight gain. Excess calories can also result in elevated blood sugar levels, especially if you do have diabetes.
  • Hernia. Long periods of holding liquids in your abdomen may cause muscular strain.
  • Dialysis is insufficient. After a few years, peritoneal dialysis might become ineffective. You may need to start hemodialysis.

If you are on peritoneal dialysis, you must avoid the following foods:

  • Several prescribed and over-the-counter medicines, such as nonsteroidal anti-inflammatory drugs, might harm your kidneys.
  • Sitting in a bathtub or heated pool, and diving in a river, pond, river, or non-chlorinated pool – all of these activities raise the chance of infection. Showering and bathing inside a chlorinated pool were usually fine.

Preparation:-

A surgical will be required to place the catheter that transports the dialysate into and out of your abdomen. The insertion might be performed under local or general anesthesia. The tube is normally put around your belly button.

After the tube is implanted, your doctor will most likely advise you to wait up to a month before beginning peritoneal dialysis treatments to allow the catheter site to heal.

You will also be trained on how to use the peritoneal dialysis equipment.

Expectation

 The following during peritoneal dialysis:

  • The dialysate enters your belly and remains there for a set amount of time (dwell time), which is generally four to six hours.
  • Dextrose inside the dialysate aids in the removal of waste, chemicals, and surplus fluid from your blood by filtering it via microscopic blood vessels as in the lining of your belly cavity.
  • Whenever the delay is over, the mixture flows into a sterile collecting bag, along with waste materials taken from your blood.

Types

An exchange takes place by loading and then emptying your abdomen.The exchange timings for various peritoneal dialysis techniques varies.The two primary schedules are as follows:

  • Peritoneal dialysis on a continuous basis (CAPD)
  • Peritoneal dialysis on a continuous cycle (CCPD)

Peritoneal dialysis on an ongoing basis (CAPD)

You load the abdomen of dialysate, let it sit for a set amount of time, but then remove the fluid. The fluid is moved through to the catheters and into or out of your abdomen by gravity.

When dealing with CAPD:

  • You may require 3 to 5 exchanges during the day, as well as one with a prolonged dwell time while sleeping.
  • You can perform the swaps at home, work, or any other clean location.
  • You can go about your everyday activities while the dialysate is in your abdomen.

Peritoneal dialysis on a ongoing cycle (CCPD)

This approach, also known as automatic peritoneal dialysis (APD), employs a machine (automatic cycler) that makes several exchanges during the night while you sleep. The cycler constantly fills your belly with dialysate, enables it to linger there, and then drains this to a sterile sack that you remove in the early hours.

With the CCPD:

  • You must stay connected to the equipment for ten hours at night.
  • During the day, you are not linked to the machine. However, you begin one trade in the morning with a dwell period that lasts the whole day.
  • Since you connect and disengage from the dialysis equipment far less than with CAPD, you may be at a lesser risk of peritonitis.

Your doctor will examine your medical condition, lifestyle, and personal preferences to decide the optimal form of exchange for you. To personalize your treatment, your doctor may propose certain changes.

Getting to Know Our Peritoneal Dialysis (PD) Catheters

Peritoneal dialysis (PD) requires the insertion of a PD catheter into your belly, chest, or sternum. Your surgeon will collaborate with you to choose the best location.

A PD catheter is an elastic, tube-like- structure (about the length of a rule as well as the width of a pencil) that permits dialysis fluid (dialysate) to reach the abdominal cavity, extract toxins via the tiny blood veins coating the abdomen, and organ, and then drain in the dialysate.

Most patients regard PD catheter surgery to be a simple procedure, with few complications. Catheter placement is normally done under general anesthesia and takes less than an hour. Most folks may return home that day. A surgeon at a hospital normally performs surgery, however certain kidney physicians (nephrologists) and radiologists are also qualified to install PD catheters.

In general, the catheter should be implanted at least 2 weeks before starting PD. Your nephrologist and surgeons may also explore a buried PD catheter option, which allows for the early implantation of a PD catheter prior to usage.

In certain circumstances, PD may appear a few days following surgery. It is critical that you visit with your PD nurse to schedule your operation and follow-up appointments.

Insertion of the catheter procedure

Using local anesthetic, a clinician can insert a peritoneal dialysis catheter.

Some people prefer that a doctor insert the catheter while the patient is sleeping and are ignorant of the process.

How to Get Ready

Before receiving a peritoneal dialysis catheter, a doctor would normally advise the patient not to eat or drink any after midnight. This is particularly true if the patient will be sedated for the catheter implantation.

A person might need to make arrangements for transportation home following the treatment.

They should consult with a healthcare practitioner about the supplies required to care again for the catheter implant site.

During the operation

The process may differ depending on the method taken by the doctor.

However, the general stages are as follows:

  1. Before performing an incision, a doctor will wash the abdominal region.
  2. The surgeon will create an incision as in the belly, generally just below the belly button and to the right or left of it.
  3. The peritoneal dialysis catheter will be guided into the peritoneal cavity by a surgeon.

According to the NIDDK, a person should aim to have this operation 3 weeks before first transfer, and the catheter will operate better if it has 10-20 days to recover before the first usage.

Training

To perform any form of peritoneal dialysis at home, a person will need to be trained. A dialysis doctor will instruct a person for 1-2 weeks on Trusted Source. You will know how to set up the cycler, insert the drain line, and link the dialysis bags.

A person can bring a family member or friend to the training.

Even if a person uses APD, they need to learn how to execute an exchange without a machine in the event of a power outage or machine malfunction.

Infection control is critical in peritoneal dialysis, thus those who use it must be well-versed in sterile procedures.

Performing a transaction

While accessing the dialysis catheter, a person should properly wash their hands and wear a face mask.

They could then use a specific connector known as a transfer set to attach the catheter to the dialysis bag.

To do a hand exchange, the dialysis bag must be warmed to body temperature. This is something that everyone can do:

  • making use of an electric blanket
  • letting the bag soak in warm water
  • If the bag has a protective outer layer, you can microwave it.

The bag should then be hung on a pole and connected to the transfer tube in order for the solution to enter their body.

The machine will warm the bag if they are using APD. A user may set the machine to perform a specified cycle at night.

Both procedures include the use of a catheter to drain the fluid from the abdomen. In the evening, those that use APD may have a larger transferring setup which drains into a bathroom, tub, or another container

The volume and kind of dialysis solution used is determined by the individual’s health and the doctor’s prescription.

What Exactly Is a Peritoneal Dialysis Unit?

Peritoneal dialysis (PD) filters and cleans your blood by using your body’s peritoneal membrane and dialysate fluid exchanges. You can make your exchanges manually during the day or at night with a peritoneal dialysis machine, commonly known as a cycler. Continuous cycler peritoneal dialysis (CCPD) or automated peritoneal dialysis are terms used to describe PD performed on a machine (APD).

What is the operation of a peritoneal dialysis machine?

Once you’ve connected your peritoneal catheter to your PD cycler and are ready to go, your pulse will do the number of changes required in 1 session across an 8-to-10-hour period. Most people prefer to ride their bikes at night while sleeping in order to have their weekdays free.

Each exchange is a three-step process: a dialysate liquid is injected into your peritoneal cavity, it “dwells” there just for the period required to purify your blood & remove excess fluid, and the solution is drained. This process is repeated by your cycler until you have finished the number of exchanges advised by our nephrologist, which might be 3 to 5 cycles.

Indications

Many people with end-stage renal illness can benefit from chronic peritoneal dialysis.

The following are strong indications of peritoneal dialysis: 

  • Failure of vascular access
  • Hemodialysis intolerance
  • Heart failure with congestive edema
  • Valvular disease of prosthetic valves
  • Children aged 0 to 5
  • Preference of the patient
  • The distance between you and a hemodialysis center
  • Inadequate cardiac function
  • Vascular disease of the peripheral

Contraindication

The following are contraindications to peritoneal dialysis

  • Failure of type II ultrafiltration has been documented.
  • Inflammatory bowel disease that is severe
  • Diverticulitis with acute active inflammation
  • Abscess in the abdomen
  • Ischemic bowel illness that is active
  • Particularly serious active psychotic disorder
  • Significant intellectual disability
  • Pregnant women in her third trimester

The following are relative contraindications to peritoneal dialysis: 

  • Malnutrition is severe.
  • Several abdominal adhesions
  • Ostomy
  • Proteinuria more than 10 g/day
  • Upper limb amputation with no assistance at home
  • Personal hygiene issues
  • Dementia
  • Homelessness

following conditions, peritoneal dialysis is preferred: 

  • Diathesis of Bleeding
  • Myeloma multiplex
  • Diabetes mellitus labile
  • Infections that persist
  • Renal transplantation may be possible in the near future.
  • Age range: 6 to 16 years
  • Anxiety about needles
  • Active way of life

 

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