peritoneal dialysis

Peritoneal dialysis




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For other uses of this term, see Dialysis (disambiguation).
Peritoneal dialysis.

Peritoneal dialysis (PD) is a procedure that allows purifying liquids and electrolytes in patients suffering from renal failure. Peritoneal dialysis uses a natural membrane - the peritoneum - as a filter. The dialysis fluid is introduced into the peritoneal cavity through a peritoneal dialysis catheter that is placed through minor surgery through the wall of your abdomen into the peritoneal cavity. Part of this catheter remains outside the abdomen and is named the Transfer Line and is your permanent access for peritoneal dialysis. This way you can connect to the dialysis solution bags. The catheter is hidden under clothing. The installed catheter is known as a dialysis catheter but its name is Tenckhoff catheter in honor of the doctor who described this type of dialysis system.

Peritoneal dialysis removes organic substances, products of metabolism, when the kidneys do not work properly, eliminates toxic substances from the body, as well as excesses of endogenous fluids, which would be excreted by the kidneys if they function properly, help correct electrolyte imbalances as well than to decrease the edema.

While the fluid is in the peritoneal cavity, dialysis occurs: excess fluid and waste products pass from the blood, through the peritoneal membrane, to the dialysis fluid.

The solution is changed periodically and this process is called "exchange". There are two types of peritoneal dialysis (Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis).

When performing peritoneal dialysis, in any of its modalities, it is important to make the exchanges in a clean area free of air current, since there is a risk of infection. Peritonitis is the most common serious complication. Infections from the catheter exit site or the "tunnel" (path from the peritoneum to the exit site) are less serious but more frequent.

Types of peritoneal dialysis

There are three types of peritoneal dialysis.

    Continuous ambulatory peritoneal dialysis (CAPD) is called continuous because there is always fluid in the peritoneum and ambulatory because the patient does it at home. It is done manually and after the exchange is completed the bag system is discarded. The majority of patients in this modality need to perform 3 or 4 daily exchanges. It consists of three phases:
    Draining the liquid requires between 20 to 30 minutes.
    Infusion of the new solution between 10 minutes and 15 minutes, depending on the permeability of the catheter.
    Permanence that is the time that the dialysis solution remains inside the cavity, until the next change.
    Learning requires between one and two weeks.
    The treatment is carried out without leaving home, it is flexible and can be adjusted to different needs and schedules.

    Automated peritoneal dialysis (APD) is done at home, at night, while you sleep. A machine controls the time to carry out the necessary exchanges, drains the solution used and introduces the new dialysis solution into the peritoneal cavity. When it is time to go to bed, you just have to turn on the machine and connect the catheter to the line team. The machine will carry out the exchanges for 8 or 9 hours, while it is sleeping. In the morning, the patient will only have to disconnect from the machine. Automated Peritoneal Dialysis machines are safe, easy to handle and can be used wherever there is electricity. It is an ideal treatment option for people who are active in the workplace, for children of school age and for those who need help to get dialysis.

    Intermittent peritoneal dialysis (IPD) This type of dialysis is performed in the hospital area, in newly diagnosed patients who require emergency dialysis, a rigid catheter is placed first and 30 baths are performed, leaving them in a cavity for 30 minutes each. They are also performed on patients who do not have adequate conditions to perform CAPD.

All these types of peritoneal dialysis use the Tenckhoff catheter.

    Types of concentration of dialysis bag in Mexico are used 3 types of dialysis fluid concentrations to 1.5% (contains 1.5 g of glucose per 100 ml), 2.5% (contains 2.5 g of glucose per 100 ml) and the 4.25% (contains 4.25 g of glucose per 100 ml) which differentiates them from each other is the amount of glucose that each has, and the function of this is to ultrafiltrate more, the greater the amount of glucose, the more fluid is extracted from the patient , because they are hypertonic solutions and reduce the edema that may occur in these patients.

Advantages and disadvantages of peritoneal dialysis
Advantages

    It can be done at home.
    It requires extreme hygiene to avoid contamination of the catheter.
    Relatively easy to learn.
    Easy to travel, the solution bags are easy to take on vacation.
    Fluid balance is usually easier than in hemodialysis.
    Because it is continuous or performed at least for many more hours than hemodialysis, it does not require as many dietary restrictions as hemodialysis, in which it is necessary to maintain restrictions until the next session (two or three days later).
    Theoretically better to start with dialysis, because the native output of urine is maintained longer than in hemodialysis.
    It is cheaper than hemodialysis, not only for its own price, but also because it does not require trips to the hospital, anemia is better controlled with lower doses of erythropoietin, and the patient can work with fewer limitations than being subjected to hemodialysis.

Disadvantages Edit

    It requires a degree of motivation and attention to extreme cleanliness while exchanges take place.
    In elderly patients, or with visual and / or physical limitations, a family support network is needed, because self-care is not possible in them.
    There are complications (see below).

Side effects and complications

Peritoneal dialysis requires access to the peritoneum. Because this access breaks down normal skin barriers, and since people with kidney failure generally have a mildly depressed immune system, infections are relatively common. The DP liquid contains glucose, so if the cleaning of the technique is not taken care of, it can favor the growth of germs. The frequency of infection of peritoneal fluid in the PD Units that have experience is one infection per patient every two or three years. Infections can be localized, such as at the exit site of the catheter or in the tunnel area under the skin, where the infection is limited to the skin or soft tissue around the catheter; or they can be potentially more severe, if the infection reaches the peritoneum. In this case it is called PD peritonitis, which may require antibiotics and supportive care (usually does not require admission to the Hospital) or, if the peritonitis is severe, removal or replacement of the catheter and a change in the modality of renal replacement therapy to hemodialysis. Very exceptionally, severe peritonitis can be a threat to life.

Long-term peritoneal dialysis can cause changes in the peritoneal membrane, causing it to no longer act as a dialysis membrane as well as before. This loss of function can manifest itself as a loss of capacity for dialysis, or a poorer fluid exchange (also known as ultrafiltration failure). Loss of function of the peritoneal membrane may suggest changes in technique such as CAPD (manual) step to automated techniques such as CCPD (see above Types of PD), or even step to Hemodialysis.

Other complications that can occur are leakage of fluids into the surrounding soft tissue, often the scrotum in males. Hernias are another problem that can occur due to the loading of abdominal fluid. These often require repair before peritoneal dialysis is recommended.
Step by step description of peritoneal dialysis (a CAPD exchange) Edit

The sources and materials needed for an exchange are collected in a clean place. Among these, the liquid bag (also called dialysis solution) is noteworthy, a solution consisting of a known amount of glucose dissolved in water. The strength of this solution determines the osmotic gradient, and therefore the amount of water that will be removed from the bloodstream. The common glucose concentrations are 0.5%, 1.5%, 2.5% and 4.25%. The 1.5% is approximately a neutral liquid; It neither adds nor removes liquid to the body and is used for patients interested mainly in the elimination of waste rather than in the regulation of fluids. Higher concentrations lead to greater water withdrawal. A higher concentration of dextrose moves more fluid and more waste into the abdominal cavity, increasing both the early exchange and the efficacy of the exchange. Eventually, however, the body absorbs dextrose from the solution. As the concentration of dextrose in the body becomes closer to that of the solution, dialysis becomes less effective, and fluid is slowly absorbed from the abdominal cavity. Electrolytes are also present in the fluid to maintain the proper levels of the body. Patients are weighed, and they measure the temperature and blood pressure daily to determine if the body is retaining fluid and thus know what force of fluid to use. The dialysis fluid is typically premixed in a disposable bag and tube apparatus; no additional equipment is needed. The device consists of two bags, one empty and one with liquid, connected via a flexible tube with a Y-shaped joint. The bag is heated to body temperature, to avoid causing cramps. Dry heat is used. Common methods include heating them through a thermostat supplied by the laboratory and having a temperature between 35 and 40 degrees continuously or a heating pad.

    The patient, who performs the entire procedure himself, puts on a disposable surgical mask, washes his hands with antibacterial soap, and inserts a clean towel in his pants belt to protect his clothes. The dialysis fluid bag is taken out of the protective packaging, and hung from an intravenous support or other elevated place. The tube attached to the liquid bag is unwound, and the second (empty) bag is placed on the floor. The Y-shaped connector is attached to the end of the catheter; A protective cap must be removed from both sides before making the connection, and the two connector parts are not allowed to touch anything to avoid possible contamination.

    Once connected to the system, the patient fastens with a clamp the tube connected to the bag full of dialysis fluid and then opens the valve located at the end of his catheter; this allows the fluid to flow in or out of the peritoneal cavity. Because the bag full of liquid has the clamp and the bag not empty, the effluent, (usually dialysis fluid), flows from within the peritoneum and can drain through the catheter to the lower waste bag. Emptying the abdomen of fluid takes approximately fifteen minutes, and the patient can perform tasks such as reading, watching television and surfing the Internet.

    When the abdomen has been drained, the lower bag is closed with the clamp. The catheter valve is also closed. The clamp is then removed from the upper tube, allowing the dialysis fluid to drain. The drain bag clamp opens briefly and a little fluid is drained directly from the upper bag to the bag below. This clears the air line and other impurities. Then the drainage line is secured with the clamp and the valve is opened at the end of the catheter. This allows the fluid to enter the peritoneum. Filling the abdomen with fresh fluid takes about fifteen minutes, and the patient enjoys the same freedoms as when he was draining.

    Once the contents of the liquid bag (an amount that varies based mostly on the body size, between 1.5 to 3 L) has been introduced into the abdomen, then the patient wipes his or her hands again ( typically with an antiseptic alcohol-based cleanser) and put on the surgical mask. The Y-connector is separated from the end of the catheter and a protective cap is placed at the end of the catheter.

    The effluent is examined after completing a dialysis exchange; A cloudy effluent indicates a probable peritoneal infection. The effluent is drained in a bath, and the different dialysis materials are thrown into the normal waste.


Catheter CareEdit

The peritoneal dialysis catheter is a small silicone tube that is inserted into the peritoneal cavity through surgery, the place where the catheter comes out is called the exit site. It is normal that shortly after installation, there is a slight bleeding or clear fluid at the exit site, around the catheter, this fluid should disappear between one and two weeks, as the exit site heals. so that long-term infectious complications do not exist, early postoperative care is required, which aims to prevent the growth of bacteria in the surgical wound and at the exit site. These cares include:

    Daily bath, without wetting the exit site, nor the surgical wound.
    Immobilize the catheter, to avoid pulling or twisting; because this favors that the exit site is damaged and subsequently infected.
    Keep the exit site and surgical wound dry, they should not get wet at least 10 days after the placement.
    Change dressings daily, this must be done by specialized personnel or trained family, using gloves, face masks and sterile technique.
    Never lift or remove scabs that will form at the exit site.
    Do not use chemicals to clean the catheter or the outlet site, such as alcohol, chlorinated substances, isodine, or ointments, as these could damage the catheter and cause infection in the peritoneum.
    You should not bathe in a tub, or use hot tubs, there are too many germs that can cause infections.
    You must not place the belt on the exit site.