By G.A. Coles
Peritoneal dialysis (PD) is in frequent use for the remedy of acute and protracted renal failure. a large amount of wisdom in regards to the a variety of tactics and difficulties linked to this manner of remedy has amassed over fresh years, rather because the advent of constant ambulatory peritoneal dialysis (CAPD). even if thus far the data in regards to the extra technical or functional elements of PD has been principally scattered in quite a few books and journals. There seems to be no effortless textual content all for those issues appropriate for recommending to junior medical professionals or nurses facing sufferers receiving this remedy. although in-house-training is of substantial price it takes time and i've spotted that on a few events in our personal unit, technical issues of PD haven't been handled quick due to lack of understanding within the employees on accountability. There hence looked as if it would me to be a necessity for a quick publication giving enterprise suggestion on how you can practice some of the strategies and the way to accommodate difficulties as they arose. This handbook is an try to fulfil that objective. firstly it was once attempted and confirmed at the renal unit within the Cardiff Royal Infirmary for three years. ahead of publishing it's been widely revised and updated.
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Additional resources for Manual of Peritoneal Dialysis: Practical Procedures for Medical and Nursing Staff
Example text
As in Section A there is a certain amount of deliberate duplication. Index for section B o set bag change Baxter Freeline (III) bag change Changing the tubing CAPD line change (Baxter system) Choice of tubing Adding medication to CAPD fluid Sampling Use of heparin Fibrin in fluid Flushing cannula Use of urokinase Pain in abdomen Bloodstained fluid Yellow or orange fluid Leakage of fluid Fluid leaks through the vagina Crusting around cannula Cuff erosion Selection of cannula Trolley setting for catheter insertion Contents of Silastic catheter pack Insertion of catheter Alternative sites Laparoscopic placement Dialysis after catheter insertion Alternative procedure Exit site care Cannula removal Replacing catheter Pre-peritoneal placement Changing the bag - general Changing the bag - (Baxter spike system) Alternative bag change - (Baxter system II) Baxter UVXD bag change 47 MANUAL OF PERITONEAL DIALYSIS Exit site infection Tunnel infection Cannula appears through skin Cloudy fluid Peritonitis Relapsing peritonitis Antibiotic dosage Presence of cells in the dialysate Contamination accidents Cracked or distorted connector Split cannula Re-use of catheter components Fluid will not run in Fluid will not run out Rotation of a faulty catheter position Cannulogram Fluid balance Failure to remove excess fluid Hydrothorax Oedema of abdominal wall or genitalia Hypotension Hypertension Dialysis with a stoma Peritoneal adhesions and sclerosis Insertion via laparotomy Dialysis after laparotomy Hypokalaemia Obesity Lack of subcutaneous fat Backache Temporary stopping Hernia Baths, showers, swimming Use of insulin How many cycles?
D Oedema of genitalia This has the same causes and requires the same management as oedema of the abdominal skin. e. the amount drained out is persistently less than that run in. If this appears to be happening try hypertonic cycles and if these fail replace the cannula. If fluid removal does not improve consider ultrafiltration using a haemodialysis system. An unusual cause of genital oedema is the presence of an inguinal hernia sometimes previously unrecognised. A herniorrhaphy will be necessary to cure the problem.
If, however, the patient requires urgent fluid removal, whatever the cause, consider using ultrafiltration with a haemodialysis system. D Oedema of abdominal skin This may be due to general fluid retention caused by renal failure in which case it will be evident on initial examination prior to cannula insertion. It will disappear if the dialysis is effective in removing fluid. 34 MANUAL OF PERITONEAL DIALYSIS Another possibility is tracking of the dialysis fluid into the abdominal wall. This is most likely to occur if the cannula is not advanced sufficiently to place all the side holes in an intraperitoneal position.