The first 90 days are critical for patients on Peritoneal Dialysis

After Peritoneal Dialysis (PD) training, four weeks of follow-up and periodic home visits reinforce the lessons. Re-training should occur at regular intervals and after any episode of peritonitis or catheter infection, prolonged hospitalization, or any interruption in PD.1 Medicare expects periodic monitoring of patient technique and adaptation to home dialysis. 2

Optimizing outcomes

Proper placement of the catheter and postoperative care of the healing site are key to establishing a successful permanent peritoneal access. Early intervention and treatment of peritoneal catheter related complications, if they do occur, are essential to maintaining the peritoneal access for prolonged successful PD.

We have published “Access Care and Complications Management,” a 60-page guide to helping clinicians improve access care in the adult patient. Download. Here is just a sampling of the information it contains:

Catheter site care

Postoperative management
  • Review postoperative instructions with patient
    • Maintain clean, dry, securely taped sterile dressing
    • Protect site from gross contamination and wetness
    • Immobilize catheter
    • Practice good hygiene
    • Take no shower or bath until healed
    • Avoid heavy lifting, stair climbing, straining and constipation until catheter healed (two to six weeks)
    • Notify PD unit in case of blood or other drainage, pain or tenderness, trauma to abdomen
  • Restrict dressing changes following implantation to experienced PD staff or trained patients
  • Educate patients who perform postoperative dressing changes to:
    • Recognize early signs of infection such as redness, tenderness and discharge
    • Use aseptic technique with face mask and gloves
    • Inspect exit site and palpate tunnel
    • Maintain stability of catheter during inspection
    • Cleanse with nonirritating solutions when instructed by nurse

 

Daily routine care

  • Inspect catheter, exit site and tunnel before catheter care
  • Showers recommended; avoid immersion in tub
  • Cleanse exit site with liquid antibacterial soap
  • Cleansing agent should be nonirritating, nontoxic, antibacterial and in liquid form
  • Do not transfer cleansing agent between containers to avoid cross-contamination
  • Soften crusts and scabs with saline or soap and water. Never forcibly remove crusts and scabs
  • Apply antibiotic cream or ointment for prophylaxis using a cotton swab. Do not apply directly from tube
  • Avoid mupirocin ointment with polyurethane catheters
  • Immobilize catheter with tape or immobilization device at all times
  • Apply dressing to protect from contamination
  • Healed site may be left uncovered but should be kept dry
  • In case of prophylactic antibiotics, a nonocclusive dressing may be suitable
  • Perform exit-site care if exit site becomes wet or grossly contaminated
  • Report trauma of exit site or catheter
  • Maintain regular soft bowel movements

 


Abdominal discomfort during infusion and drain

Teach patients causes and interventions
  • Rapid inflow—reduce infusion rate
  • Too rapid a transition to larger dialysis fill volumes—slowly increase fill volumes
  • Dialysis solution too warm or too cold—warm to body temperature
  • Potential cause and interventions for PD catheter malposition
  • Peritonitis prevention
  • Medication administration
  • Training for Automated Peritoneal Dialysis

 


Blood loss into the peritoneal cavity

The most common cause of hemoperitoneum in women includes retrograde menstruation and ovulation. Mild bleeding can be caused by catheter-induced trauma, strenuous exercise and the formation of abdominal adhesions. Any bleeding, however, needs to be carefully monitored for severity and potential serious causation.
  • Instruct women of reproductive age about the potential for hemoperitoneum
  • Observe dialysis exchanges; drain fluid for decreasing color and resolution
  • Teach patient to:
    • Avoid heavy lifting/trauma
    • Document frequency, duration and treatment of bloody effluent
    • Bleeding, typically minimal to moderate, may resolve spontaneously

Download a copy of “Access Care and Complications Management.”

Download “Going Home with Confidence” patient brochure for PD.


1  Bernardini, J, et.al. ISPD Guidelines/Recommendations for Patient Training. Perit Dial Int. 26:625-632.
2  Medicare Benefit Policy Manual, Home Dialysis Support Services, Rev 61, 11-24-06,Chapter 11, 50.6

Medicare expects periodic monitoring of patient technique and adaptation to home dialysis.2