Nursing care plan peritoneal dialysis PD

I. Procedure
a. Requires a surgically placed abdominal catheter and uses
the peritoneum to filter toxins and excess fluid from the
body
b. Fluid removal is controlled by adjusting the dextrose
concentration in the dialysate (e.g., 1.5%, 2.5%, 4.25%) to
create an osmotic gradient for water with higher dextrose
concentrations and more frequent exchanges increasing the
rate of fluid removal.
c. May be preferred over hemodialysis because it uses a
simpler technique and provides more gradual physiological
changes
d. Long-term PD typically calls for four exchanges a day
(or night), each with a dwell time of 4 to 6 hours.
e. Manual single-bag method is usually done as an inpatient
procedure with short dwell times of only 30 to 40 minutes
and is repeated until desired effects achieved.

II. Types
a. Continuous ambulatory peritoneal dialysis (CAPD)
i. Most commonly used type of long-term PD, allowing
client to manually manage the procedure at home with
bag and gravity flow
ii. Some clients experience problems with the long overnight
dwell time because, as dextrose in the solution crosses
into body, it becomes glucose and starts to draw fluid
from the peritoneal cavity back into the body, thereby
reducing the efficiency of the exchange and requiring a
mini-cycler machine during the night.
b. Automated peritoneal dialysis (APD)
i. Continuous cycler-assisted peritoneal dialysis (CCPD)
1. Allows individual to walk around during extended
daytime cycle with solution in abdomen
2. May be method of choice for younger individuals
engaged in school or work activities
ii. Nocturnal intermittent peritoneal dialysis (NIPD)
1. Usually reserved for individuals with substantial
remaining renal function
2. May improve uremia-associated sleep apnea
(Perl & Chan, 2007)

III. Statistics
a. Morbidity: In 2005, more than 25,000 Americans received
PD (National Kidney and Urologic Diseases Information
Clearinghouse [NKUDIC], 2008).
b. Costs: In 2002, Medicare payments for outpatient PD were
approximately $200 million (U.S. Renal Data System
[USRDS], 2004).

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