The patient should contact the care canter immediately if he notices a cloudy discharge in the pouch. Subsequently, the number of leukocytes in the dialysate is determined, and its culture is carried out. In case of very severe abdominal pain, the administration of significant analgesics (opioids) may be necessary.
The amount of peritoneal rinsing fluid and the frequency of dialysate change should not usually be increased in the case of peritonitis since defensive cells and opsonins are eliminated too quickly from the abdominal space through such a cleansing treatment. Dr. Q Khan provides the best nephrology physicians in the USA. Therefore, patients must maintain the usual rhythm of dialysis fluid exchange.
For the treatment of peritonitis, antibiotics are administered directly into the dialysate and via the general so or vein); antibiotic therapy must be sufficiently protract, with suitably high and long dosages; it must be continue for 10-14 days and at least up to about one week after the last positive culture test for the presence of bacteria.
As for the antibiotics to be used and the possible associations between them, each center has its own experiences; a combination of cephalosporin and aminoglycoside is generally administered into the peritoneal cavity.
In case of allergy to penicillin, for example, 1 g of vancomycin every week intravenously is considered an alternative.
Since adhesions and displacements of the catheter can quickly occur in the case of peritonitis, heparin (500 international units / l) must necessarily be added to the dialysate during this period. Of course, the processes underlying peritonitis (for example, catheter tunnel infections) must be treated (for example, by removing the catheter and replanting it on the opposite side, possibly performing hemodialysis in the interval between the two surgeries).
Prevention of peritonitis
Conditions of sterility
- Strictly observe the hygiene regulations when changing the bag or connecting and disconnecting the dialysis device!
- If there is the possibility of bacterial pollution during the change, any further procedure must be interrupted until the basic “sterile” conditions are re-established again.
- The changes must occur in an environment where adequate hygienic conditions are ensured: doors and windows must be closed, and sufficient lighting conditions must also be guaranteed!
Accessories required for bag change and bag change
- Deposit plan.
- Supports for infusion solutions with two hooks.
- Scales (spring balance for bags, scales).
- Soap dispenser.
- Waste bucket.
- Dialysis diary, with everything you need to write …
The pouch change technique in CAPD is briefly summarized below. Of course, we will skip all the steps due to the specific dialysis set as, of course, the instructions for Use provided by the manufacturer must be followed.
Bag change technique
- Close doors and windows.
- Prepare the accessories: in particular: disinfectant container, disinfectant sprays, swabs, tablets, bag with extra drain, mask, pliers, scales, buckets for waste, etc.
- Heat the bag.
- Drain the dialysis fluid.
- Clean the work surface with a disinfectant.
- Put on the mask.
- Wash hands for 3 minutes with water, soap, brush, and a disinfectant substance; then dry your hands with a clean towel.
- Take the new bag from the packaging and check its integrity, clarity, expiration date, the presence of any defects, and the composition of the contents.
- Open the crushing cone in the dialysis bag, open the forceps, and start pouring in the fresh dialysate.
- After completing the inflow of dialysate, complete the removal maneuver according to the instructions in the set.
- Check the dialysate consumed by holding the bag up to the light. It must be assessed whether the dialysate is clear, cloudy, or hazy; slight haze indicates the presence of fibrin threads.
- If the dialysis fluid is clear, the used bag must be emptied; if there is turbidity, the old dialysate bag must be kept and taken to the treatment center, which must be informed and consulted immediately.
- Fill the dialysis diary
This is just an example of the bag changing technique, which can differ from system to system; in any case, the manufacturer’s instructions must be considered.
significance of the quantity of dialysate
Authentic learning of the bag changing technique is of great importance for the patient; every movement must be calculate, and it must be ensured that patients acquire a perfect mastery of the technique.
Once the patient has mastered the pouch changing technique, he is informed about further measures need:
- Use of the dialysis diary: the relationships between the introduction and discharge of liquids and the need to record any changes in these fluids and weight changes, residual diuresis, and blood pressure checks should be explained.
- Information should be provide on the significance of the quantity of dialysate and its glucose and potassium concentration. The composition of the peritoneal dialysis solution depends on the patient’s clinical picture; usually, in adult patients treated with CAPD, four bag changes (i.e. one every 6 hours) each of 2 liters takes place daily. Dr. Q Khan provides the best Clinical Consultation in the USA. Depending on whether or not potassium elimination is require, a solution free of potassium or contains this element can be use.
About the need for liquid absorption, solutions with different glucose content are use (CAPD bag, for example, with glucose content from 0.5 to 4.25%).
Using solutions with a high glucose content, 3 to 6 l of liquid can be remove every 24 hours from highly hypervolemia patients.
During the patient training phase, the optimal composition of the solution will be established. Attention should also be drawn to the intake of many calories when using solutions with high glucose concentrations.
- It is necessary to provide the patient with detailed information on possible complications, the importance of checking the expiration date of the dialysate, and what to do when a sterile object falls to the ground during the change.
As in the case of extracorporeal hemodialysis
The presence of a fistula is necessary, so for peritoneal dialysis. It is necessary to place a catheter, which is placed in the abdominal space using a minor surgical intervention under local anesthesia. The tip of the catheter is left free in the abdominal cavity, typically in the Douglas space.
The presence of the catheter constitutes a first disadvantage of the peritoneal dialysis. Procedure since the permanent visibility and tangible sensation of the catheter. Represents a tremendous psychological problem for many patients on peritoneal dialysis. And their partner, as frequently emerges from confidential dialogues with the majority of patients. Part of the patients. The existence of the catheter is in any case less bearable than the presence of a fistula in extracorporeal dialysis.
The patient can bathe. However, the catheter must first be wrapped with a waterproof sheet: the surgical drapes use on this occasion have given good results.