Nursing and Procedure Issues in Peritoneal Dialysis

Objectives

This chapter will:

1.
Describe the role of peritoneal dialysis in management of acute kidney injury (AKI).
2.
Describe the procedure for performing acute peritoneal dialysis (PD) in management of AKI.
3.
Discuss the role and importance of nursing team in acute PD.

The use of peritoneal dialysis (PD) remains relevant in the setting of acute kidney injury (AKI), particularly in the developing world. Various techniques of continuous PD are described in the literature. PD is a continuous form of renal replacement therapy and remains relevant in many situations such as lack of infrastructure for hemodialysis, hemodynamically unstable patients, in patients with marked cardiac dysfunction, in major calamities, and in seropositive individuals.

Procedure

PD is indicated for any patient needing renal replacement therapy (RRT). It is contraindicated in patients who have undergone recent abdominal surgery or are suffering from any acute abdominal illness. It is relatively contraindicated in patients with deranged coagulation profile or in the presence of abdominal hernia. In acute setting, PD can be performed using Tenckoff's catheter placed by percutaneous method, as in urgent-start PD. It also can be performed with a rigid catheter, described as acute intermittent PD (AIPD) in developing countries such as India. Steps of performing PD catheter placement are similar in both the methods:

Step 1: Preparation of the abdomen
Step 2: Creating ascitis
Step 3: PD catheter placement
Step 4: Dialysis exchanges

Step 1: Preparation of the Abdomen

Preparation of the abdomen involves shaving of the abdomen to clip abdominal wall hairs. The skin of all patients should be cleaned with chlorhexidine or povidone iodine. The abdomen should be draped properly to maintain sterility.

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