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Peritoneal Access

Peritoneal dialysis, or PD, is a daily treatment. PD is a procedure that removes wastes, chemicals and extra fluid from your body. This type of dialysis uses the thin, natural lining of your abdomen to filter your blood. The lining is called the peritoneal membrane. The peritoneal membrane surrounds the abdominal cavity, which contains your stomach, spleen, liver and intestines. The peritoneal membrane acts as the artificial kidney. Although it is there to protect your organs, it has many tiny holes, or pores, in it that can be used to filter waste products and other chemicals from your blood.

How does peritoneal dialysis work?

To prepare for PD, a surgeon places a permanent tube called a catheter into the lower abdomen to carry solution in and out of the abdomen. The solution is a germ-free mixture of minerals and sugar dissolved in water, called dialysate. The dialysate travels from the solution bag through the catheter and into your abdomen. The sugar in the solution, called dextrose, draws wastes, chemicals and extra fluid from your blood through the peritoneal membrane and into the dialysate solution that is in your abdomen. After several hours, the used solution containing the wastes from your blood is drained from your abdomen through the catheter and into an empty bag. Your abdomen is then refilled with fresh dialysate and the cycle is repeated. Each cycle of draining used dialysate and refilling with fresh dialysate is called an exchange. The amount of time the dialysate solution remains in the abdomen for waste and fluid removal is called the dwell time. The amount of fluid, the dwell time and the number of exchanges per day are prescribed by your nephrologist.

Types of Peritoneal Dialysis:

CAPD - Continuous Ambulatory Peritoneal Dialysis

  • C stands for continuous because toxins and excess fluid are being removed 24 hours a day, 7 days a week.
  • A stands for ambulatory because you can walk around even during the exchanges. You can do whatever you need to do while you are getting your blood cleaned.
  • P stands for peritoneal because it uses the peritoneal membrane as the filter to clean your blood.
  • D stands for dialysis or filtering of the blood.

In continuous ambulatory peritoneal dialysis (CAPD), the patient fills the abdomen with a fresh bag of dialysate. After four to six hours of dwell time, the patient empties the solution containing wastes out of the abdomen and into the drain bag. The patient then repeats the cycle with a fresh bag of dialysate at least four times a day. Each exchange takes about 20-40 minutes. The patient can move around and complete normal activities during the dwell time (four to six hours). The ability to complete the treatment by yourself and choose foods and fluids more freely than when on hemodialysis is a benefit that makes CAPD an option for many people. CAPD can be performed in any location (as specified by your training nurse) which makes traveling easier. CAPD does not require a machine; the process uses gravity to fill and empty the abdomen.

CCPD - Continuous Cycling Peritoneal Dialysis

  • C stands for continuous because toxins and excess fluid is being removed over six to eight hours continuously while you sleep.
  • C stands for cycling because it uses a machine called a cycler to fill and empty your abdomen with the dialysate solution while you are sleeping or in a resting position.
  • P stands for peritoneal because it uses the peritoneal membrane as the filter to clean your blood.
  • D stands for dialysis or filtering of the blood.

CCPD uses a machine called a cycler to fill and empty your abdomen with the dialysate solution while you are sleeping or in a resting position. The cycler fills the peritoneum with dialysate and is programmed to allow the fluid to remain in the abdomen for the prescribed dwell time. The machine then drains the used dialysate into an empty bag. This process is repeated three to five times. This method may offer freedom from daytime exchanges and, like CAPD, allows you to eat a less restrictive diet than those who choose hemodialysis.

Peritoneal Dialysis Training

If you choose peritoneal dialysis, you will come to the clinic daily for one to two weeks to learn how to care for yourself at home. You will be taught by a nurse who is experienced in training people to do their own dialysis.

Peritoneal Dialysis Supplies

Your doctor will write a prescription for the dialysis supplies you need. Your nurse will help you learn how to order and care for the supplies needed to do the dialysis. The nurse will come to your house to help you set up. Supplies will be delivered to your house once a month by a supplier. A delivery person will carry the supplies into your house. You will need room to store 25-50 boxes.

Risks of Peritoneal Dialysis

  • Infection is the most common problem for people on peritoneal dialysis (PD). Your health care team will show you how to keep your catheter bacteria-free in order to avoid exit site infection and/or peritonitis, which is an infection of the peritoneum. Improved catheter designs protect against the spread of bacteria, but peritonitis could still be a problem.
  • You may experience difficulty draining solution from the peritoneum due to the catheter floating out of place in the abdomen. Rarely, a catheter may be displaced requiring surgical relocation.
  • If you are a diabetic, you will have to monitor your blood glucose (blood sugar) levels very carefully due to the sugar in the dialysis solution. You may have a slight increase in your blood sugar levels which will require an insulin adjustment.
  • Hypotension (a decrease in blood pressure) can occur in hemodialysis and in peritoneal dialysis. It can cause you to feel weak, tired or dizzy.

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