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How to do PDx - EuTRiPD

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How to do Peritoneal Dialysis
General principles
• Peritoneal Dialysis uses the natural peritoneal membrane as a semi-permeable
membrane for solute and fluid movement
• The peritoneal cavity is accessed with a PD catheter inserted through the
abdominal wall
• PD fluid is drained in – allowed to dwell and then drained out
• PD will always have two parts
– Short dwells
– Long dwell
• Training around technique is critical – at start of therapy and then constant
reminders
• Handwashing and then drying are the key to good PD technique
CAPD =
Continuous Ambulatory Peritoneal
Dialysis
22
24
2
4
6
8
10
12
14
16
Time (hours)
DAY
NIGHT
CAPD
18
20
22
CAPD : Daily Exchange
Drainage
Flush
+/-20’
Old dialysate
Fill
Dwell
+/-10’
New solution
4-10hrs
Disposables
thrown away
Solution is heated at body temperature
Comfort- Avoid pain on infusion
Enhances clearance- prevent vasoconstriction
Avoid decrease in body Temperature
Dialysis
IMPORTANT
Flush before fill:
Decreases risk of contamination of fluid
CAPD Procedure
• Wash hands and then dry
• Connection
• Outflow
• Flush before fill – removes spent dialysate
• Inflow
• Disconnection
• Tidy up and walk away
CAPD
Benefits
Volume
Continuous
Therapy
0
Limitations
24
Time
Optimum dialysis
Ambulatory
for low permeability
Anywhere
Can perform
anywhere
3 - 5 Exchanges
Long Night dwell
High transporters
will have poor UF
4 x per day
exchange
IP pressure with
large volumes
CAPD
• Manual therapy
• Prescription volumes standardized
1,500ml, 2000ml, 2500ml, 3000ml solution bags
• 6-12 hour long dwell period each night (depends on type of
membrane)
• 3-5 hr short dwell per day exchange
Day exchanges
Night dwell
APD =
Automated Peritoneal Dialysis
22
24
2
4
NIGHT
6
8
10
12
Time (hours)
14
16
DAY
18
20
22
Advantages of APD
1. Daytime freedom and comfort
2. Indictated for H/HA transporter – short dwells and
with icodextrin for long dwell
3. Reduced risk of intra-peritoneal pressure
complications:hernias, leak, back pain, reduced
appetite
4. Treatment of choice for children – avoids school
interruptions
5. Portable
6. Easy to monitor patient compliance at home
What the patient uses
Cassette and lines
Cycler
Single bags
Dialysate
Minicap
Connection shield
APD - Programming
Inputs required:
•
Total therapy volume
•
Total therapy time
•
Fill volume
•
Last fill for long dwell: volume, and same or different
glucose
Machine calculates:
• Number of cycles
• Estimated Dwell time per cycle
Typical APD prescription
Example therapy:
•
•
•
•
Total therapy volume = 12 000 ml
Total therapy time = 9 hours
Fill volume = 2000 ml
Last bag = 2000 ml, same dextrose or icodextrin
Machine calculates:
•
•
Number of cycles = 5 cycles
Estimated Dwell time per cycle = 1:19
APD procedure
• 1 time a day for set up- everyday
• 8-10 hours
• Preparation – about 10 minutes.
• PD solution should be heated before - 1 hour on the heater of the cycler.
• Usual hand washing and drying
APD Procedure
• Preparation
– Checking parameters of the cycler
– Changing (if needed)
• Preparation of the cycler
– Preparation of the line (organizer)
– Connection of bags
• PD overnight
• Disconnection in morning
Key messages
• CAPD and APD procedures are basically simple but need to be applied
rigorously on each day by the patient
• The long and the short dwells are important in PD
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