Dialysis-CAPD
Permanent catheter is inserted into the peritoneum allowing dialysis to be undertaken by the patient outside the hospital. DO NOT TOUCH PD CATHETER.
Peritoneum acts as a dialysis membrane.
Standard Prescription
1. Infusion of 2 L vol of 1.5% dextrose conc. peritoneal dialysis solution into peritoneal cavity x 10 min
2. Allow solution to dwell for 2 1/2 hours - 4 hours
3. Drain effluent solution x 20 min
**Repeat steps 1 - 3. In ARF PD exchanges performed qhr. CAPD involves 3 - 5 day time exchanges (manual), and with Continuous cycling PD
Peritoneal equilibrium test use within 2 months of starting PD. Measures transfer rate of solutes (urea and creatinine) across peritoneal membrane. Pt's are classified: low, low-average, high average and high transporters.
- Weekly KT/V >2, Cr.Cl: >65 L/wk/1.73 m2 (collect the spent dialysate and urine x 24 hr)
- PD is better tolerated than HD in Pts with DCM
- Neutrophil count >100 cells/uL in the dialysate in Dxtic of PD associated peritonitis. Cefazolin + Ceftazidime to PD fluid - dwell for 5 - 6 hrs. Check gram stain of peritoneal fluid.
- Hyperglycemia may occur 2° absorption of glucose from PD fluid. Give insulin SC in DM Pts on PD.
- Hypoalbuminemia, hypertriglyceridemia, and anemia are common.