Magtabog, Anna Christina A. NCM 102 Mr.

Ricardo October 4, 2010

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Assignment # 3

PERITONEAL DIALYSIS

Peritoneal dialysis is a way to remove waste

products from blood when the kidneys can
no longer do the job. During peritoneal
dialysis, blood vessels in the peritoneum fill
in for the kidneys, with the help of a fluid
(dialysate) washed in and out of the
peritoneal space.

Peritoneal dialysis differs from hemodialysis,

a more common blood-filtering procedure.
With peritoneal dialysis, treatments can be
given in the comfort of the patient’s home, at
work or while traveling. It can be used with fewer medications and less
restrictive diet than with hemodialysis.

Peritoneal dialysis is often done to manage kidney failure until a kidney

transplant is possible. Kidney failure itself usually results from a long-term
(chronic) disease that causes kidney damage over a number of years. Common
causes of kidney failure include:

 Diabetes
 High blood pressure (hypertension)
 Kidney inflammation (glomerulonephritis)
 Blood vessel inflammation (vasculitis)
 Polycystic kidney disease (cysts in the kidney)

Most people who require dialysis face a variety of serious health

problems, including diseases that cause kidney failure as well as kidney failure
itself. Dialysis prolongs life for many people, but life expectancy for those who
need the procedure is still much lower than that of the general population. The
main complications of peritoneal dialysis are:

Infections. The most common problem for people receiving peritoneal


dialysis is peritonitis, an infection of the peritoneum. An infection can also
develop at the site where catheter is inserted to carry the cleansing fluid into
and out of abdomen.
  Weight gain. The fluid used to clean blood in peritoneal dialysis
contains sugar (dextrose). Patient may take in several hundred calories each
day by absorbing some of this fluid, known as dialysate. The extra calories can
also lead to high blood sugar if the patient has diabetes.

Weakening of the abdominal muscles. Holding fluid in the


abdomen for long periods may strain belly muscles.

Other complications that can stem from dialysis or the underlying kidney
disease include:

 Anemia. Anemia — not having enough red blood cells in the

bloodstream — is a common complication of kidney failure. Failing kidneys
reduce their production of a hormone called erythropoietin, which stimulates
formation of red blood cells.

 Bone diseases. If the damaged kidneys are no longer able to use

vitamin D to absorb calcium, your bones may weaken. Overproduction of
parathyroid hormone — a common complication of kidney failure — can strip
calcium from your bones.

 High blood pressure (hypertension). High blood pressure is a

leading cause of kidney failure. Eating too much salt or drinking too much
fluid while being treated for kidney failure, high blood pressure may get worse
— which takes a toll in remaining kidney function. Left untreated, high blood
pressure can lead to a heart attack or stroke.

 Fluid overload. While holding the dialysis fluid in your abdomen for
long periods, your body may absorb too much fluid. This can cause life-
threatening complications, such as heart failure or fluid accumulation and
swelling in your the (pulmonary edema).

 Amyloidosis. Dialysis-related amyloidosis develops when proteins in

blood are deposited on joints and tendons, causing pain, stiffness and fluid in
the joints. The condition is common in people who have been on dialysis for
more than five years.

Many factors affect how well peritoneal dialysis works in removing wastes
and extra fluid from your blood. These factors include:

 Size of patient
 How quickly peritoneum filters waste (peritoneal transport rate)
 How much dialysis solution used (fill volume)

 The number of daily exchanges

  Dwell times
 The concentration of sugar (dextrose) in the dialysis solution

Health care team will perform several tests to check if dialysis is

removing enough waste products. These tests are especially important during
the first weeks of dialysis to determine whether the patient receiving an
adequate amount, or dose.

 Peritoneal equilibration test (PET). This test measures how much sugar
has been absorbed from a bag of used dialysis solution and how much of
two waste products; urea and creatinine, have entered into the solution
during a four-hour exchange.

 Clearance test. Samples of used dialysis solution and a blood sample are
collected to compare the amount of urea in the used solution with the
amount in the blood. If the patient’s kidneys still produces urine, a urine
sample may be taken at the same time to measure its urea
concentration.

If the test results show that the dialysis schedule is not removing enough wastes, the doctor
may change the prescription. This might involve changing the number of exchanges, increasing the
amount of solution you use for each exchange or using a dialysis solution with a higher
concentration of dextrose, a type of sugar.

HEMODIALYSIS
Hemodialysis is the most common method
of dialysis. Hemodialysis is used for patients
who are acutely ill and require short-term
dialysis (days to weeks) and for patients with
ESRD who require long-term or permanent
therapy. A dialyzer (also referred to as an
artificial kidney) serves as a synthetic
semipermeble membrane, replacing the
renal glomeruli and tubules as the filter for
the impaired kidneys.

For patients with chronic renal

failure, hemodialysis prevents death, although it does not cure renal disease
and does not compensate for the loss of endocrine or metabolic activities of the
kidneys. Treatments usually occur three times a week for 3 to 4 hours per
treatment. Patients receive chronic or maintenance dialysis when they require
dialysis therapy for survival and control of uremic symptoms. The trend in
managing ESRD is to initiate treatment before the signs and symptoms
associated with uremia become severe.

The objectives of hemodialysis are to extract toxic nitrogenous

substances from the blood and to remove excess water. In hemodialysis, the
blood, laden with toxins and nitrogenous wastes, is diverted from the patient to
a machine, a dialyzer, where toxins are removed and the blood is returned to
the patient.

Diffusion, osmosis, and ultra filtration are the principles on which

hemodialysis is based. The toxins and wastes in the blood are removed by
diffusion—that is, they move from an area of higher concentration in the blood
to an area of lower concentration in the dialysate. The dialysate is a solution
made up of all the important electrolytes in their ideal extra cellular
concentrations. The semi permeable membrane impedes the diffusion of large
molecules, such as RBC’s and proteins.

Excess water is removed from the blood by osmosis, in which

water moves from an area of higher solute concentration (the blood) to an area
of lower solute concentrations (the dialysate bath). In ultra filtration, water
moves under high pressure to an area of lower pressure.

The body’s buffer system is maintained using a dialysate bath

made up of bicarbonate (most common) of acetate, which is metabolized to
form bicarbonate. The anticoagulant heparin is administered to keep blood
from clotting in the dialysis circuit. Cleansed blood is returned to the body. By
the end of the dialysis treatment, many waste products have been removed,
the electrolyte balance has been restored to normal, and the buffer system has
been replenished.

There are three types of hemodialysis: conventional hemodialysis, daily

hemodialysis, and nocturnal hemodialysis.
1. Conventional hemodialysis
The procedure of conventional hemodialysis are: patients attached to a
dialysis machine; the function of a dialysis machine is to push blood to circulate
through the patient’s body and machine, at the same time, monitor
temperature, blood pressure and time of the procedure; if patient is using
fistula or graft, two huge-gate needles on patients’ side: one brings wastes- full
blood from patients’ body to the dialyzer, while another needle carries clean
blood back to the body; it is offered three times a week and 3 or 4 hours per
session. Patients are required to follow their rigid schedule.

2. Daily hemodialysis
The procedure of daily hemodialysis is similar to the conventional
hemodialysis except it is performed six days a week and about 2 hours per
session.
3. Nocturnal hemodialysis
The procedure of nocturnal hemodialysis is similar to conventional
hemodialysis except it is performed six nights a week and six-ten hours per
session while the patient sleeps.

A nephrology nurse should perform:

Hemodialysis Vascular Access: Assess the fistula/graft and arm

before, after each dialysis or every shift: the access flow, complications Assess
the complication of central venous catheter: the tip placement, exit site,
complications document and notify appropriate health care provider regarding
any concerns. Educates the patient with appropriate cleaning of fistula/graft
and exit site; with recognizing and reporting signs and symptoms of infection
and complication.

Hemodialysis adequacy: Assesses patient constantly for signs and

symptoms of inadequate dialysis. Assesses possible causes of inadequate
dialysis. Educating patients the importance of receiving adequate dialysis.

Hemodialysis treatment and complications: Performs head to toe

physical assessment before, during and after hemodialysis regarding
complications and access’s security. Confirm and deliver dialysis prescription
after review most update lab results. Address any concerns of the patient and
educate patient when recognizing the learning gap.

Medication management and infection control

practice: Collaborate with the patient to develop a medication regimen. Follow
infection control guidelines as per unit protocol.