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Tehchoff catheter Cuffs attached to fix catheter in position, serve as a barrier against bacteria, prevent fluid leaks. Peritoneal dialysis Hypertonic dialysate filled with dextrose is infused into the peritoneum Via an in dwelling catheter Body surface area of the peritoneal membrane The peritoneal membrane is 1to 2 m² and approximates the body surface Icodextrin New dales eight solution does not contain dextrose employs a glucose Polymer and aids in greater fluid removal CA PD Patient performs approximately 4 to 6 exchanges throughout the day. Continuous ambulatory peritoneal dialysis CA PD drawback Patient must perform exchange every 4 to 6 hours Auto mated peritoneal dialysis Four types of automated peritoneal dialysis Continuous cycling peritoneal dialysis 3 to 5 nightly exchanges with the daytime infusion to aid in molecular Clarence
Nocturnal intermittent peritoneal dialysis 3 to 5 nightly exchanges with no daytime infusion this is prescribed in patients who hybrids you're the dextrose solution suffer from CHF or have hernias Intermittent peritoneal dialysis Exchanges are performed 3 to 5 times per week there is no leftover dialysate in peritoneum between exchanges. Tidal peritoneal dialysis Dialysate is initially infuse into the peritoneum. After predetermined time in the peritoneal cavity most of the dialysate is drain leaving some fluid behind. The fluid asked to increase Clarence. When the next exchange occurs a new dialysate is introduced tidal dialysis Permeability of the peritoneal membrane More permeable = better Clarence Volume of the exchange Higher volume = greater Clarence Dialysate glucose concentration Higher concentration = better clearance in fluid removal Dwell time Longer times allows for more diffusion Molecular size Small molecules are cleared more efficiently Peritoneal equilibration test PET A test to determine peritoneal membrane permeability. Peritoneum is infused with 2.5 dialysate
Absolute contraindications to PD CATHETERS hyper catabolism, patent opening between the peritoneal and pleural cavities, inadequate transfer surface area because of adhesions and scarring. Kinetics the peritoneal dialysis Diffusion, fluid removal, drug transport, individual membrane characteristics. Difusion in PD By directional movement of solute's across the peritoneal from higher solute concentration to lower solute concentration Osmosis in PD Movement of water across peritoneal membrane from an area of lower concentration of solute to higher concentration Osmosis Affecting factors Surface area, colloidal osmotic pressure, dextrose strength, dwell time Dextrose strength 1.5, 2.5, 4.25% Dextro strength The higher the number the more water removed Dextrose Osmotic agent Ultrafiltration Water removal related to an osmotic pressure gradient. Drug transport Intraperitoneal medication can be transported into the systemic circulation.
Absorption of drug transport Absorption is different dosage might need to be adjusted IP medications Regular insulin and antibiotics PD exit site care Liquid antibacterial soap and water, non-cytotoxic, non-irritating to individual skin. Prophylactic topical antibiotic Mupirocin cream, gentamicin cream Peritonitis Effluent WBC count of > 100 with > 50% polymorphonuclear cells. Symptoms of peritonitis Cloudy you effluent, abdominal pain, fever, nausea, vomiting, diarrhea. Treatment for peritonitis Antibiotics intraperitoneal, IV or Orally. Treatment 2 to 4 weeks Relapsing peritonitis An episode that occurs within four weeks of completion of antibiotic therapy for prior episode with the same organism. Recurrent peritonitis An episode that occurs within four weeks of completion of antibiotic therapy for prior episode with the different organisms. Refractory peritonitis Symptoms do not be after five days of appropriate therapy.
Contributes to the development of hernia in PD patients Increased intra-abdominal pressure Cause of poor dialysate outflow from PD catheter Constipation Symptoms of an acute PD EXIT site infection Fever and local swelling. Can also include abdominal pain. Care of inflamed or infected exit site Increased frequency of sight care, apply sterile dressing, gentamicin cream. Exit site infection is defined by Presence of Prielin drainage with or without erythema of the skin at catheter epidermal interface Pericatheter erythema Without Prielin drainage is sometimes an early indication of infection but can also be a simple reaction Positive culture for PD exit site Positive culture in the absence of abnormal appearance is indicative of colonization rather than infection Fibrin formation Occurs following peritonitis or local inflammation from previous affection. Fibrin clot or strands form during inflammation process. Diagnosed in fiber and strands white strands are seen in the effluent
Treatment for fibrin formation Heparin added to the dialysate Hemoperitoneum Blood in the peritoneal cavity Causes of hemoperitoneum Retro grade menstruation, drama with introducing dialysis catheter, rupture of ovarian cyst and peritonitis Treatment of hemoperitoneum Frequent flushes what sailing to prevent clot formation Pneumoperitoneum Air in the peritoneal cavity excess air can cause ball obstruction and peritonitis Diagnosis of pneumoperitoneum Excess bloating and shoulder pain. Abdominal films will confirm the diagnosis Treatment for pneumoperitoneum Draining the patient and Trendelenburg or need chest position. Rule out loose connections Dialysate leak Occurs when there is room around the catheter site or in subcutaneous tissue for dialysate to enter Symptoms of dialysate leak Abdominal pressure with clear fluid draining around the exit site or edema
PET TEST 2.5% dialysate infused. Samples of urea, glucose and creatinine are taken at 0,2,4 and 12 hours.
