By G.A. Coles
Peritoneal dialysis (PD) is in common use for the therapy of acute and persistent renal failure. a large amount of wisdom in regards to the a number of methods and difficulties linked to this type of therapy has gathered over contemporary years, quite because the advent of constant ambulatory peritoneal dialysis (CAPD). despite the fact that thus far the knowledge in regards to the extra technical or sensible facets of PD has been mostly scattered in a variety of books and journals. There seems to be no elementary textual content desirous about those issues appropriate for recommending to junior medical professionals or nurses facing sufferers receiving this remedy. although in-house-training is of substantial price it takes time and i've spotted that on a couple of events in our personal unit, technical issues of PD haven't been handled fast due to lack of expertise within the employees on accountability. There therefore looked as if it would me to be a necessity for a quick booklet giving enterprise recommendation on the best way to practice many of the tactics and the way to house difficulties as they arose. This handbook is an try and fulfil that objective. before everything it was once attempted and demonstrated at the renal unit within the Cardiff Royal Infirmary for three years. ahead of publishing it's been largely revised and updated.
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Extra resources for Manual of Peritoneal Dialysis: Practical Procedures for Medical and Nursing Staff
Dialysis should be postponed until the situation has improved. Do not forget that in a uraemic patient as fluid is removed the need for hypotensive drugs usually decreases otherwise marked hypotension may occur. D Hypertension Hypertension does not commonly occur as a consequence of peritoneal dialysis unless there is a failure of fluid removal when fluid overload may cause a raised blood pressure. Pain and discomfort from the procedure may contribute to hypertension. If a patient requires peritoneal dialysis the blood pressure will almost always fall if sufficient fluid is removed.
Assemble syringe and needle. Wash hands. Put on non-sterile gloves. Wash gloved hands with alcoholic chlorhexidine (Hibisol). Allow first 100 ml outflow to drain. Close roller clamp between rubber and Y junction. Clean rubber port with alcohol wipe. Allow alcohol to dry. Aspirate 20 ml of fluid and transfer to sterile universal container. Aspirate further 10 ml of fluid and divide between standard aerobic and anaerobic blood culture bottles. Despatch to laboratory with request form. Open clamp and allow outflow to continue.
Ensure no potassium-containing drugs are being given and that there is no potassium being added to the PD fluid. Check that the diet or drinks do not contain excess potassium. If the problem persists then haemodialysis should be considered urgently. D HypokaJaemia Though peritoneal dialysis fluid containing potassium is available, most units start treatment with a potassium-free fluid as hyperkalaemia is a common indication for treatment. However, hypokalaemia can easily be produced. The electrolytes must be checked at least daily once dialysis has commenced and if the plasma potassium is falling then potassium chloride should be added to the fluid.