IconPeritoneal Dialysis (PD)

Indication of PD

  • Fluid overload Oligo anuria pul Edema
  • Electrolyte disturbances Hyperkalemia Acidosis Hypo- hypernatremia
  • Uremic manifestations Pericarditis CNS symptoms
  • Contraindications:

  • Absolute: lack of an adequate peritoneal cavity E.G. Omphalocele, gast Roschisis, D.Hernia
  • Relative: Recent abd. Surgery Urinary diversions Gastrostomy, colostomy Polycystic kidneys
  • Factors affecting PD

  • Concentration gradient
  • Osmotic gradient
  • Surface area of vascular peritoneum
  • Peritoneal capillary blood flow
  • Volume of dialysate
  • Dwell time
  • Types of catheters

  • Temporary catheters: Peritocath, wygon, Jms
  • Permanent catheter
  • Methods of insertion

  • At the bed side under local anesthesia
  • Surgical placement under general anesthesia: Peritoneoscopic insertion, Open surical insertion
  •  

    Procedure Continued

  • Stab incision with 11 number blade
  • Hold the catheter(with trocar) Like a pen & insert it with screwing motion
  • Remove the trocar. (Warm fluid for nb) Attach with inflow tube & start inflow
  • Start outflow
  • First 8 cycles without dwell.
  • Dialysis prescription :

  • Inflow:
  • TIME: 10-15 mins
  • Volume: 30-40 ml/kg
  • Pd fluid: heparin, Potassium, Glucose, Insulin
  • Dwell: 30 mins
  • Out flow: 10-15 mins
  • Monitoring:

  • Daily weight
  • Daily cbc, elecrolytes, bun, creat, blood sugar
  • Proper charting of intake & output
  • Intake: Ad lib if adequate negative balance Otherwise 400ml/m2 Plus negative bal.
  • Accommodate colloids on pd
  • Complications of pd:

  • Mechanical : obstruction (clot, fibrin, omentum) bleeding Leakage Abdoninal wall or scrotal edema
  • Infection
  • Metabolic: Hyperglycemia, Hypokalemia, Hyper/hyponatremia
  • Pulmonary: Pleural effusion, Ateletasis, Decreased vital capacity
  • Cardiovascular: Volume contraction, Hypotension

  • Clinic : 102, Temple Avenue, 3rd Floor, Deodhar Road, Matunga (CR), Mumbai 400019

    Time: 4 to 6 pm (Mon. To Fri.)

    Tel no: 022 24117711 Mobile: 9821635917

    email: drmehtaks@kidskidneycare.in | drmehtaks@yahoo.co.in

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