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SKILLS - CONTINUOUS AMBULATORY PERITONEAL DIALYSIS

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WHAT IS IT?

Abstract

 

VOL: 99, ISSUE: 29, PAGE NO: 29

 

WHAT IS IT?
- Continuous ambulatory peritoneal dialysis (CAPD) is a method of renal replacement therapy.

 


 

- A soft (Tenckhoff) catheter is surgically implanted into the lower abdomen, the tip reaches down into the peritoneum.

 


 

- Using a ‘no-touch’ technique, a bag containing a measured amount of warmed, dextrose-based hypertonic solution (dialysate) is drained into an empty peritoneum via a catheter and then disconnected.

 


 

- In four to six hours osmotic pressure draws excess fluid, electrolytes and harmful toxins through the semipermeable membrane. Note: there is always some dialysate in the peritoneal cavity.

 


 

- A new ‘set’ is connected. The fluid is drained from the abdomen into the empty bag and fresh dialysate run in. The bags are disconnected.

 


 

- Three to five dialysate ‘exchanges’ are carried out daily, the last one remaining in overnight. If someone requires five exchanges they will need automated PD.

 


 

- After disconnection, record the bag’s weight to provide a guide to fluid status and enable adjustments to be made to the strength and timing of subsequent exchanges.

 


 

- Patients may need weighing at the same time each day after the draining out has been completed.

 


 

CONSIDERATIONS
- An intact peritoneum and a reasonable degree of manual dexterity are required.

 


 

- CAPD is gentler, reduces hospital visits and aids independence and physical well-being.

 


 

- Costs less than haemodialysis.

 


 

- Visual impairment does not prohibit CAPD.

 


 

NURSING CONSIDERATIONS
- Immunocompromised patients with impaired kidney function are prone to infection, although most use a closed system.

 


 

- The exit site and the catheter’s inner lumen can be contaminated.

 


 

- Clean hands thoroughly.

 


 

- Cloudy dialysate, abdominal pain and pyrexia may indicate peritonitis.

 


 

- Local policies determine treatment but dialysate samples help isolate the organism.

 


 

- Treat dialysate as other bodily fluids.

 


 

- Refer to local policy for exit site care. Pulling or movement of the catheter causes excoriation and precipitates infection. The distal end should be secured.

 


 

- Reliance on strong dialysate causes sclerosing of the peritoneum, membrane thickening, adhesions, possible small bowel obstruction and loss of permeability.

 


 

- Constipation hinders drainage and potassium excretion. Record fluid balance, bowel and dietary habit.

 


 

- Fibrin clots (like strands of egg white) may block the catheter necessitating heparinisation of dialysate.

 


 

- The catheter tip may lodge in the omentum. Encourage repositioning during the exchange to aid drainage. The catheter may need replacing.

 


 

- Cold dialysate causes discomfort and should be warmed in a designated fluid-warming cupboard.

 


 

- Altered body image can cause complex psychological issues. Counselling and involvement of the multidisciplinary team should be part of the standard treatment package.

 


 

- Chronic renal failure can affect physical and mental well-being. It is important to allow patients time to express their feelings. Referral for community follow-up.

 


 

RESEARCH AND DEVELOPMENT
National Service Framework for End-Stage Renal Failure Delivery due at the end of 2003. (see www.doh.gov.uk/nsf/renal.htm)

 


 

 


 

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