Maintenance Peritoneal Dialysis - Term Paper Example

Peritoneal Dialysis Institution Name Date Maintenance peritoneal dialysis Introduction Kidneys are vital in the body as they eliminate waste products by filtering them from blood. However, sometimes, the kidneys may fail to carry out their normal functions hence the need to seek alternative ways of excreting such wastes from the body. On such alternative is peritoneal dialysis whose traits resemble those of a healthy kidney. Maintenance peritoneal dialysis is a routine process that involves using a dialysate and tubes which are inserted in the patient’s abdomen so that waste products are pulled out of blood. The process takes advantage of the patient’s peritoneum whose permeability makes it possible for urea and glucose to diffuse out of or blood respectively. Peritoneal dialysis is usually undertaken at home hence saving the patient and caregivers plenty of resources which could have been spent in hospital visits. This process is sensitive and a lot of caution should be maintained throughout as a way of minimizing complications which may arise. This research paper identifies the nature of equipment used, how they are used, and requirements for treatment as well as complication arising in the cause of peritoneal dialysis. Discussion Equipment Dialysis solution The dialysis solution that is used by the patient is contained in a 2.5 liter bag as the capacity of their abdomen cannot hold a large amount of fluid. The solution is highly concentrated as it contains the monosaccharide dextrose. This simple sugar is efficient in drawing extra fluid from the patient’s blood through osmosis that is the large number of water molecules present in blood shift to the dextrose solution which contains fewer water molecules. By use of the principle of osmosis, the extra water which is usually used to make urine is extracted from the patient’s body hence regulating their osmotic pressure. Consequently, the kidneys will not be required to eliminate the water as well as urea and other toxins present in blood (Mayo Clinic, 2010). Dialysis solution types that may be used Other dialysis solutions contain high levels of sodium chloride or bicarbonate which are used to create a concentration gradient so that one side of the peritoneal membrane has a higher concentration of fluids than on the other side. The nature of dialysis solution used depends on the type of solute used and the patient’s nutritional status. However, the major reason as to why the dialysis solution is used is as a way of establishing hyperosmolarity that makes it easier to drain fluids from the body (Mayo Clinic, 2010). System used The patient has a complete peritoneal dialysis machine that comprised of various parts for instance there is a transfer set which is basically a tube which acts as a connection between the bag containing the dialysis solution and the catheter. This catheter has a cap on it which prevents infection on the part of the abdomen where it will be connected to the patient. This cap is changed every time the patient is undertaking dialysis. The catheter is the tube which transports the dialysis solution from its bag and into the patient’s abdomen. The transfer set creates a passage through which the dialysis solution can be introduced into the patient’s body much easily (Mayo Clinic, 2010). A cycler is also part of the equipment used in peritoneal dialysis and its role is to carry out automatic emptying and filling of the abdomen with dialysis solution. This cycler is always programmed especially at night so that it can drain and fill the abdomen without any assistance from the caregiver. This reduces disturbance especially at night so that the patient can sleep without worrying about their condition (Mayo Clinic, 2010). A storage bag is also part of the equipment and it acts as a temporal storage for the dialysis solution before it is pumped into the patient’s body. This reduces the caregiver’s workload as they do not have to add more solution during the night. A heater bag is attached to the solution bag so that before the solution gets into the patient’s abdomen, it its temperature is warmed to be equivalent to that of the other body fluids (Rabindranath, et al. 2007). The cycler has a time that acts as a fluid meter to signal the onset of drainage so that used solution is drained from the patient’s body. The timer is useful as it has the ability to measure the total amount of fluid drained as well as the amount of fluid supplied and the difference shows degree of efficiency attributed to the dialysis. This time enables the caregiver to get a clear picture of the amount of fluid removed from the body as per the treatment requirements (Trudie, 2008). The drained fluid is emptied into a drain line that is connected to the cycler which drains into the toilet. This saves time as urine does not accumulate in any container hence no bad smells which cold lead to infections. However, an alarm is necessary so as to provide warnings incase the process or equipment fail to function normally. This system that is used by the patient is not only reliable as it has the capability to work automatically, but it also has other advantages such as minimizing possible infections. The fact that new caps are used each time the patient undertakes dialysis as well as immediate disposal of drained fluid cuts down on infections (Mayo Clinic, 2010). Access Management before and after insertion Peritoneal dialysis often involves insertion of a catheter inside the abdomen of the patient which can be done by use of open surgery. The doctor inserting the catheter can decide to use general anesthesia for open surgery of local anesthesia where a minor cut is to be made on the abdomen. The opening for insertion of the catheter is made on the side of the navel after the area has been sterilized to minimize infection (Pina, 2010). The catheter is made of soft rubber hence it is comfortable to fix and only a minor cut should be made on the abdomen. Similarly, once the cut is made, a catheter is inserted though no dialysis solution is allowed to get in the patient’s body for two to three weeks until the wound has healed. As the wound heals, a scar tissue forms around the inserted catheter so that upon commencing of dialysis, the catheter will be held in position courtesy of the scar tissue. Consequently, after healing of the wound, the area should be sterilized each time a patient has to undergo dialysis (Pina, 2010). It is also vital for the caregiver and patient to minimize any handling of the catheter after it has been inserted into the abdomen. This is why the patient is always expected to reduce movement if dialysis is done during the day. Movement may loosen the clamp which holds the catheter in place and this can result in slipping or leakage of dialysis solution (Wood et al. 2008). Similarly, the caregiver and patient should always put on unused gloves each time they are handling the catheter or any other part of the peritoneal dialysis equipment. This also includes dipping the catheter as well as the transfer set in any antiseptic solution for about 5 minutes before making an insertion. This safety measure will kill any germs that could have piled on the set during storage or transportation (Trudie, Goers and Sean, 2008). Therefore, to accord appropriate management of access before and after insertion, adequate awareness should be availed to the patient. This includes health education on the significance of hand washing before touching the catheter especially when inserting so as to reduce transmission of germs into the device. The patient should also be educated on the essence of putting on surgical mask during insertion as the air they breathe out could contain bacteria that may spread on to the catheter (Daugirdas, Blake & Ing, 2006). The other peritoneal dialysis awareness that should be introduced to the patient includes teaching them the right way to carry out the exchanges. The doctor of nurse who is working on the patient’s case should ensure that they train the patient on the correct way to insert and remove the catheter. This form of education is vital as at times the patient will be on their own hence they may be required to undertake the task without additional help. Education is also required on possible infections which may occur in the course of dialysis. This requires outlining symptoms or signs which the patient or caregiver should be on the look out for so as to inform health personnel whenever they see the said symptoms (Black, 1994). The caregiver or nurse should also not allow the patient to carry out the exchange on their own until they are quite sure they understand how it is done. This is attributed to the fact that the patient may forget some of the precautionary measures that are linked to insertion hence end up causing more harm than good. Treatment requirements Peritoneal transport type The type of peritoneal exchange used by this patient is the Continuous Cycler-Assisted Peritoneal Dialysis (CCPD) which consists of a series of items which make it easier for patients to manage their condition at home. This transport mechanism is automated so that the patient can have up to six exchanges within one night and one during the entire day. The cycler that is connected to the machine enables it to drain and fill the abdomen automatically hence the patient does not have to wake up to make the exchange. Consequently, it has other accessories for instance a heater bag that warms the dialysis solution just before it is pumped into the abdomen (Rabindranath, et al. 2007). Exchange regime The peritoneal membrane is a highly permeable tissue present in the abdomen of human beings. The membrane has two vital parts; the viscera which is larger and accounts for two-thirds of the entire peritoneal membrane and the parietal peritoneum which is relevant to peritoneal dialysis as it is thinner. The thickness of peritoneal membrane is significance as during the exchange molecules are expected to move across the membrane into the other side where they are required. Therefore, the peritoneal membrane resembles a filter or sieve which allows molecules to move across it (Hanno, et. al, 2001). The dialysis solution which is usually highly concentrated with solutes such as simple sugars or sodium chloride is pumped into the peritoneal membrane via a catheter. Consequently, due to the hypertonic nature of dialysis solution that is subjected to the peritoneal membrane, excess water and other wastes are attracted from blood into the catheter. However, this is not immediate as the fluid is allowed to settle in the abdominal cavity for several hours. This time interval is known as ‘dwell time’ and it allows the dialysis solution to draw unwanted molecules from the body efficiently (NIDDK NIH, 2007). The time taken to clear blood of the wastes and excess fluid is dependent on various factors such as the size of molecules expected to move from blood into the peritoneal membrane. Similarly, the time taken by the dialysis solution to move from the peritoneal membrane into body organs and eventually into the lymphatic system is another determining factor (Daugirdas, 2006). The exchange process is accomplished when extra fluids and wastes have been cleared from the body and they move into the catheter for emptying. After emptying the catheter, it is sterilized and stored in readiness for the next exchange process. It is important to note that different patients require different exchange process in a day based on their diet and physiology. Therefore, patients should not compare their peritoneal dialysis amongst themselves as no two exchange processes are similar (NIDDK NIH, 2007). Education required Patients should be educated on differences in the types of catheter sizes used which have no impact on the time taken during the exchange process. This will make it easier for them to accept their cases as unique hence reduce panic that may arise when some dwells take longer. There should also be awareness towards the fact that at times medication can be added into the dialysis solution as it will get to the targeted parts of the body faster than if the medication was administered orally. This creates an added advantage as a patient who is on medication does not forget to take medicine at the required time. Usually towards the end of a dwell, the patient may experience a mild ‘tugging’ feeling inside the abdominal cavity. This is no cause for alarm as it is a signal to show that the session is over as most of the fluid is usually cleared from the abdominal cavity at that time (Mayo Clinic, 2010). The other vital information that should be provided to caregivers and patients is on diet for the patient for as long as they are undergoing peritoneal dialysis. The patient’s diet can make peritoneal dialysis easier or complex based on the items they include in their diet. Generally dialysis is not as efficient as kidneys are in waste or toxic elimination, therefore, some diets may jeopardize the entire exchange process and they should be avoided with the help of a nutritionist (Daugirdas, 2006). Complications arising from peritoneal dialysis 1. Peritonitis Peritonitis refers to inflammation of the peritoneal membrane which could be due to wounds or injuries in the membrane. Peritonitis can be brought about by several factors among patients undergoing peritoneal dialysis. For instance, glucose or the simple sugar used as a dialysate is often highly concentrated so that when it gets into the abdominal cavity, it is bound to lower the PH level of blood or any other body fluids. These acidic conditions ‘eat’ or scorch the peritoneal membrane thus causing ulcerations. The other possible cause of peritonitis could be due to insertion of an infected catheter which transmits bacteria into the peritoneal tissue. The infection results in open wounds which start leaking (Perl, Nessim, & Bargman, 2011). Peritonitis is often exhibited by severe pain emanating from the abdominal cavity especially immediately after dialysis solution has been directed to the peritoneal membrane. Other symptoms include bowel perforation where urine or fecal material is observed in the abdominal cavity. Bleeding from the injured membrane can also be noted in the form of a pinkish tinge in the strained fluid as well as nausea (Strippoli, 2004). To manage the complication, the nurse is advised to check on the degree of concentration of the dialysate in relation to the PH level of the patient’s body fluids. Consequently, the nature of solute used should be changed so that other compounds which are not likely to lower the body’s PH are utilized. Similarly, adequate precautions should be undertaken by the patient to avoid diets with high protein or fat content while undergoing peritoneal dialysis as these two food groups produce highly acidic components when broken down. The other management element for peritonitis includes maintenance of personal hygiene in addition to sterilizing the catheter before insertion. This is critical towards minimizing bacterial transmission from the catheter to the peritoneal membrane (Wiggins, et, al, 2008). 2. Hernia A poorly inserted catheter may tamper with normal abdominal activities such as passage of digested food down the intestinal tracts. This may result in obstruction of normal movement which in turn makes the components of the intestines to swell until the push the intestinal walls out of the abdominal cavity. Similarly, sometimes, the fluid pumped into the abdominal cavity may increase its capacity hence it pushes some of the organs towards the skin. The opening made to create room for inserting the catheter acts as a weak wall through which internal organs can move in to whenever their previous position is occupied by another organ or object (Bittner et, al, 2008). Hernia usually occurs as a protrusion of an organ from the body cavity where it normally resides. In the case of peritoneal dialysis, hernia can arise after fluid accumulation in the abdominal cavity hence pushing the intestines outwards until they find their way outside via the opening made to accommodate the catheter. Hernia may or may not be accompanied by pain though the discomfort is always unbearable as well as nausea especially if the bowels have been obstructed (McPhee, Tierney & Papadakis, 2007). As a way of managing hernias, the nurse should guide the patient on the correct insertion procedure in addition to demonstrating the appropriate posture which will reduce pressure on the abdomen. Consequently, the patient should keep track of dwell time while at the same time avoid pumping a lot of dialysate at once so as to minimize fluid accumulation in the abdomen cavity (Bittner, 2008). Conclusion In conclusions, peritoneal dialysis can be effectively carried out at home with minimal attention from a medical doctor. However, adequate measures should be adhered to strictly as a way of reducing the fatal complications that can occur when precautions are not followed. Consequently, the client plays a vital role towards ensuring that maintenance peritoneal dialysis is successful towards improving their health condition. References Bittner JG, Edwards MA, Shah MB, MacFadyen BV, Mellinger JD. (2008), Mesh-free laparoscopic Spigelian hernia repair. Am Surg; 74(8):713-720 Black, M. A. (1994). Medical nursing (2nd ed.). Springhouse, Pa.: Springhouse Corp Crowley, LV (2009). An Introduction to Human Disease: Pathology and Pathophysiology Correlations. 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