Peritoneal dialysis (PD) is a type of dialysis that uses the lining of your abdomen to filter waste from your blood. PD is done at home everyday.


How does it work?

  • Catheter tube is surgically placed in the belly
  • Tube will have one end INSIDE your abdomen and one end OUTSIDE
  • Outside tube is attached to a bag of cleansing solution
  • By holding the bag high, the abdominal cavity is filled
  • Fluid cleanses for 2-3 hours: This is called a “dwell”
  • After the dwell cleanses waste, fluid is drained

The entire process is called an “exchange” and is repeated several times depending on your doctor’s prescription. During an exchange, the cleansing solution (dialysate) has a high glucose level and draws out water from the blood vessels along with urea, creatinine and electrolytes. Diabetics may need to monitor their blood sugars more closely and adjust their medications.

TYPE 1: Continuous Ambulatory Peritoneal Dialysis (CAPD)

The exchanges are done manually 4-5 times a day without a machine. An exchange can be done almost anywhere—home, work, vacation—even in a car. That’s why it’s called ambulatory.

 

Filling and draining take about 30 minutes apiece, and the dwell time is 2-3 hours.

The entire exchange can be done while you are at home or work. It should be done 3-5 times a day, so mealtimes and bedtime are common choices.

TYPE 2: Continuous Cycling Peritoneal Dialysis (CCPD)

The basic process works the same as CAPD, but it is done via a cycler machine while you sleep. The cycler takes 8-10 hours so you don’t have the hassle of doing your exchanges manually through the day.

Requirements

  • Peritoneal catheter is surgically placed, needs 2-6 weeks to heal
  • Peritoneal dialysis solution (3 types with varying concentration of GLUCOSE)
  • 1.5% (yellow bag, lowest glucose or sugar level)
  • 2.5% (green bag, middle concentration)
  • 4.25% (red bag, highest glucose or sugar concentration)
  • Adequate storage space to store the dialysis solution
  • Clean hygienic home environment

PD Catheter Insertion & Care

Before PD can begin, a tube must be surgically placed. The catheter can be used right away but it’s safer if given time to heal. Your infection risk is highest immediately after surgery. You should not touch or wet the post-surgical gauze for 7-10 days. Unfortunately for those around you, that means NO SHOWERING! Hygiene is limited to a washcloth or sponge. Let the area rest as much as possible, and know that dressing changes need to be done by a trained nurse.

  • Nurse will train you how to clean exit site
  • Wash exit site daily with antiseptic/antibacterial soap from its original bottle
  • Do NOT use hydrogen peroxide or alcohol
  • Wash your hands with soap and put on clean, fresh gloves before cleaning
  • If the skin is firm, red, painful or has pus, there may be an infection

Take good care of the catheter, it is your life line!

Complications of Peritoneal Dialysis

Affects the skin around the tube. Exit site becomes red, painful, hard, and/or may drain pus. Treat with oral antibiotics and/or creams; if that doesn’t work, your catheter may have to be removed.
An infection created by bacteria inside your abdomen. This can be life threatening if left untreated.

Symptoms include:

  • Abdominal pain 
  • Fever
  • Cloudy fluid

PD fluid should be clear enough for you to read print through the bag. Call your doctor immediately if your PD fluid is cloudy, or if you have fever or pain.

If you do have an infection, you may transition to hemodialysis temporarily.

PD fluid creates pressure inside your abdomen and puts you at higher risk for a hernia, which is a swelling or a painless lump. It may appear near the belly button, groin, or catheter exit site. Treatment requires surgery.

Living with PD

Diet: Each exchange takes away protein, so steal it back by eating MORE protein! Think meat, milk, chicken, eggs, fish… Also, limit food with a lot of phosphorus like dairy products, cheese, liver, nuts, and chocolate.

Weight Gain: You must weigh yourself daily. Diabetics may need to have their medications adjusted because of the high glucose level in the dialysate.

Constipation: This can create a hernia. Take stool softeners or laxatives as needed.

Physical activity: Don’t exert yourself with fluid in your belly.

Time requirements: It is important to perform each exchange and dwell exactly as recommended. You may have to cut back on some responsibilities to avoid illness and hospitalization.