Peritoneal Dialysis

Question 1

Peritonitis

Answer 1

Major complication of PD. Most commonly caused by connection site contamination. To prevent perform meticulous sterile technique when caring for the catheter and connecting/disconnecting it.
With peritonitis, effluent will appear cloudy or opaque. If this happens, obtain a sample and send it to the lab.

Question 2

Pain

Answer 2

Common when first started, typically with inflow. Pain usually goes away after 1-2 weeks. Cold dialysate solution increases pain, so using warm bags of fluid is best. Assist with repositioning client for comfort. Modify/decrease flow rate to help decrease pain.

Question 3

Exit-site Infection/Tunnel Infection

Answer 3

1. Are both serious. Exit-site from the PD catheter should be clean, dry, and without pain or inflammation – infections here are difficult to treat and can become chronic (lead to peritonitis, catheter failure). Perform gram stain and culture if infection suspected.
2. Tunnel infection occur in the catheter path from skin to cuff. Treat with microbials, if deep enough may require catheter removal.

Question 4

Poor Dialysate Flow

Answer 4

Related to constipation – to prevent, administer power prep or enema. High fiber diet and stool softeners also used. Other causes are kinked or clamped connection tubing, patient positioning, catheter displacement, and fibrin clot. If a position problem, turn patient side to side and keep good body alignment. Patient should lay supine in low-Fowler position to reduce pressure in the abdomen. Keep drainage bag lower than patient’s abdomen so that gravity helps with drainage.

Question 5

Dialysate Leakage

Answer 5

Clear fluid comes from catheter exit site – may take 1-2 weeks to tolerate a full 2-L exchange without leaking. Leakage occurs more often in obese patients, patients with diabetes, older adults, and patients on long-term steroids. Sometimes may require HD support.

Question 6

Bleeding

Answer 6

Bleeding is expected when catheter is first placed and when first started outflow may be bloody or blood-tinged – will normally clear in 1-2 weeks

Question 7

Bowel Perforation

Answer 7

Serious complication when catheter lodges in bowel. Effluent may be brown to indicate this complication. Treat with broad-spectrum antibiotics and convert to HD until cleared.