Peritoneal dialysis is an alternative to hemodialysis that allows patients with kidney disease the ability to be flexible and maintain a high quality of life, while receiving dialysis. Continuous ambulatory peritoneal dialysis (CAPD), intermittent peritoneal dialysis (IPD), and continuous cycling peritoneal dialysis (CCPD) are some of the options available to these patients and although they are all different they operate on the same premise. A permanent, indwelling catheter will be inserted into the peritoneum and using aseptic technique, the indwelling catheter is hooked up to a large bag of dialysate. The fluid is then infused into the peritoneal cavity either by machine or by gravity. Through diffusion and osmosis extra fluid and waste products enter the dialysate fluid and are removed from the body when the fluid is drained. The process involves a specific fill, dwell and drain time which altogether equals one exchange. The choice of fluid type, treatment, and exchange time are based on the specific needs of the patient (Lippincott, Williams and Wilkins, 2014). In order to be able to utilize this type of dialysis a patient must not have extensive abdominal adhesions, or multiple abdominal surgeries, and they must not have a cognitive deficit that would impair their ability to carry out the set procedures necessary to safely perform the treatment (Mendelssohn, et al., 2009). There are many benefits to this method of dialysis, but there are also several serious risks involved such as peritonitis, severe protein loss, fluid volume overload, catheter site infections and abdominal hernias. A patient may not be able to completely avoid complications, but they can significantly reduce their risk with proper education and utilization of that education (Lippincott, Williams and Wilkins, 2013).
Patients who are beginning peritoneal dialysis for the first time need to be thoroughly educated and then assessed for deficient knowledge, but the need for education does not stop there. According to The Journal of Renal Care, the longer a patient undergoes home peritoneal dialysis the less they properly utilize the knowledge and skills that they have acquired to perform this procedure. It is almost as if they become complacent and begin to cut important corners. Because of this it is important that education be repeated at designated intervals (Savas, Yucel, Guvenc, Ekiz, & Kazancioglu, 2009). There is a vast amount of information that these patients need to be familiar with including, but not limited to; catheter exit site care, signs and symptoms of fluid volume deficit or excess, aseptic technique, how and when to perform treatment, what to monitor before, during and after treatment. All of this information must be taught, their knowledge level must be assessed and the patient’s knowledge and adherence to procedures should be reassessed over time.
Diagnosis and Planning
Risk for infection is a major concern for these patients. They are at a...