Peritoneal dialysis

Working with your health care team for success with peritoneal dialysis

Peritoneal dialysis (PD) is a dialysis treatment that uses the thin membrane, called the peritoneum, which lines the abdomen to perform dialysis treatments. During treatments, a fluid called dialysate is put into your abdomen through a small, flexible tube called a PD catheter.

The dialysate pulls the waste and extra fluid from your blood into the peritoneal cavity. The dialysate remains in the abdomen for a specified amount of time before it is drained and replaced with fresh dialysate. When the dialysate is drained, the wastes and extra fluids are also drained, and fresh dialysate is added to clean the blood. This filling and draining process is called an exchange because the dialysate that has been in the abdomen is being exchanged for new, fresh dialysate. Exchanges can be done manually or with a machine called a cycler.

Preparing your home for PD

One of the first tasks your health care team will complete is an evaluation of your home to ensure your general surroundings and treatment area allows you to safely care for yourself at home.

• In your home, you should have running water, electricity and telephone service.
• You will need adequate space to store PD supplies.
• Some medications may require refrigeration.
• You should have the ability to close the door to your treatment area and control airflow. Microorganisms such as bacteria can enter through open windows and doors or heating and cooling ducts.
• If you are living with pets, it is recommended that they have no access to your supplies or treatment area. During automated PD, your PD solution bag is warmed on top of the cycler. Cats may love this comfortable warm “waterbed,” but their claws could puncture tiny holes into the bag and contaminate the solution inside, which can lead to infections.

PD training

Before you go home, you will be thoroughly trained at your local dialysis clinic to perform all aspects of your care safely. Your PD nurse will teach you how to perform your PD treatments and will go over subjects such as preventing infections, exit site care, foods to eat for a healthy diet and fluid control.

You will be taught how to document your daily treatments including your vital signs, your weight, the number of exchanges performed, the dialysis solution used and the amount of fluid weight lost. If you are on automated PD, a data card can be installed in the cycler and treatment information will be downloaded automatically.

Your PD catheter is your lifeline. Daily catheter exit site care is imperative for your well being. As you clean the site, you will learn to look for signs of infection such as redness, swelling, tenderness or drainage and report any abnormal findings to your home dialysis department. 

A PD treatment consists of three parts: the drain, flush and fill phase. You will learn how to recognize and deal with any mechanical problems that can occur during these phases. In addition, you should assess your drained dialysate for cloudiness or the presence of blood. Cloudiness together with stomach pain, fever and chills could be a sign of peritonitis. Blood could be present after a trauma to the abdomen or in female patients who had a recent menstrual period. Your training will also include other possible treatment complications, how to recognize associated symptoms and what to do about them.

Your PD supplies

The provider of your PD supplies will inform your PD nurse and health care team of the shipments you receive. This record allows your health care team to ensure that you are receiving the correct type and amount of supplies needed to perform your treatments as prescribed.

Monitoring your care on PD

Your home dialysis care team will monitor you and your treatments during your monthly clinic visits through a review of your treatment records and regular lab tests. A thorough assessment and review of the medicines you take will give your health care team a picture of your physical condition and health care needs. You will also have the opportunity to discuss any health concerns or ask questions during your monthly check-ups.

The peritoneal equilibration test (PET) gives your doctor information about your peritoneal membrane and how quickly fluid, waste products and other dissolved particles are transported across the membrane. Your doctor uses the results to tailor your dialysis prescription to your personal needs. A lab test called Kt/V is also used to examine whether you receive enough dialysis to keep you healthy.

Other lab tests measure your red blood cell count and the amount of iron in your body to assess for anemia. Nutritional markers such as albumin tell the dietitian whether your diet is adequate or needs some tweaking. Calcium, phosphorus and parathyroid hormone are important indicators for bone health. Potassium is a mineral that is important for healthy muscle and heart function.

Summary

Once you choose PD as your treatment option for kidney failure, you are responsible for your dialysis treatments at home, but you are never on your own. In addition to your regularly scheduled clinic visits, your home dialysis care team is just a phone call away to assist you at any time, day or night.