Escolar Documentos
Profissional Documentos
Cultura Documentos
DIALYSIS
BASIC PRINCIPLES, COMPLICATIONS
AND NURSING RESPONSIBILITIES
The most important members of that team are the
NURSES,
Who must be effective teachers,
Knowledgeable, flexible,
and committed to ensuring good outcomes.
Beth Piraino, MD
BASIC PRINCIPLES
PERITONEAL MEMBRANE
dialyzer
Parietal peritoneum most
important in peritoneal
dialysis
o Effectiveness depends on
the vascularity of the
peritoneum
PERITONEAL TRANSPORT MODEL
CLINICAL APPLICATION
APPARATUS AND MODALITIES OF PD
DIALYSIS CATHETER
APPARATUS AND MODALITIES OF PD
Lactate based
Acetate based
Bicarbonate based
MODALITIES
Organisms:
s. Aureus 78%
p. Aeruginosa - 11%
Others 8%
EXIT SITE CLASSIFICATION
PREVENTION OF EXIT SITE INFECTION
PERITONITIS
*signs and symptoms*
1. Cloudy effluent- > 100wbc/mL
2. >50% neutrophils
3. With or without fever
4. With or without tenderness
RELAPSING PERITONITIS
PD RELATED INFECTIONS
COMPLICATIONS OF
PERITONITIS
Temporary reduction of UF
Increased protein loss
Catheter removal
Adhesions
Transfer to HD
Death
KEYS TO LOW EXIT SITE AND PERITONITIS
RATES
Experienced personnel
Adequate patient and relative
training
Proper hand washing techniques
Continuous monitoring of rates
and organisms
TROUBLESHOOTING COMMON CLINICAL
PERITONEAL DIALYSIS PROBLEMS
WHAT SHOULD YOU DO IF THE FLUID IN THE
DRAIN BAG IS NOT CLEAR?
NURSES RESPONSIBILITIES
ASSESS!!
Hook to oxygen support
Obtain saturation
If with signs and symptoms of congestion
REFER
TROUBLESHOOTING COMMON CLINICAL
PERITONEAL DIALYSIS PROBLEMS
HIGHLY ELEVATED BLOOD PRESSURE
NURSES RESPONSIBILITIES
Instruct to restrict amount of fluids and salt in diet
If persists ASSESS and REFER
TROUBLESHOOTING COMMON CLINICAL
PERITONEAL DIALYSIS PROBLEMS
DECREASED BLOOD NURSES RESPONSIBILITIES
PRESSURE Instruct to stand and sit
*signs and symptoms gradually
Weak
Hold PD if too low
Prevent fall episode
Dizzy and light-headed
Leg cramps
sweating
OTHER COMMON CLINICAL PERITONEAL
DIALYSIS PROBLEMS
ANEMIA NURSES RESPONSIBILITIES
*caused by low iron Assess for fatigue and body
level and uremia weakness
TREATMENT
erythropoeitin
COMMON MECHANICAL PERITONEAL DIALYSIS
PROBLEMS
LEAKING DIALYSATE BAG NURSES RESPONSIBILITIES
- Moisture is normally seen but if Remove clamps or transfer
with mL of fluid is noted set
DISCARD
Position the patient
Fill bag should be higher
SLOW DRAINING OR FILLING than the abdomen
*inflow obstruction blockage such The drainage bag should be
as clamps or kinks lower
*outflow obstruction constipation
or catheter entrapment
COMMON MECHANICAL PERITONEAL DIALYSIS
PROBLEMS
FLUID LEAKING OUT AROUND THE EXIT SITE