CONTINUOUS AMBULATORY PERITONEAL DIALYSIS

CONTINUOUS AMBULATORY PERITONEAL DIALYSIS – Patient with End-Stage Renal Disease, Equipment, Preparation of the Equipment, Major Steps of Continuous Peritoneal Dialysis, Role of Nurse in Infusing the Dialysate for CAPD, Steps to Clean the Peritoneal Catheter in Case of Patient with CAPD before Dialysis, Post-Procedure Care for CAPD (temporarily) and Complication (NURSING PROCEDURE)

Continuous ambulatory peritoneal dialysis (CAPD) is a procedure that requires insertion of permanent peritoneal catheter (Tenckhoff) which is sutured under local anesthetic and its distilled portion is tunneled subcutaneously to the skin surface to circulate dialysate in peritoneal cavity constantly the dialysate flows in and out of peritoneal cavity by gravity

PATIENT WITH END-STAGE RENAL DISEASE

Advantage of CAPD

• It is an alternative to hemodialysis and gives the patient more independence and it requires less travel for treatment
• Provide more stable fluid and electrolyte level
• Helps resume normal daily activities between solution changes
• Less expensive than hemodialysis

Disadvantages

• Condition that prohibit CAPD
• Recent abdominal surgery, abdominal adhesions
• Infected abdominal wall diaphragmatic, tears
• Respiratory insufficiency

EQUIPMENT

• Prescribed amount of dialysate (2 liter bags)
• Basin of hot water
• Three face masks
• The 42” connective tubing with drain clamp
• Six to eight package of sterile 4” multiply 4” gauge pads
• Labeled specimen container
• Povidone-iodine solution
• Sterile basin
• Container of alcohol
• Sterile gloves
• Belt or fabric pouch
• Two sterile water proof paper drapes
• Optional syringes

PREPARATION OF THE EQUIPMENT

• Check the concentration of the dialysate, expiry date and appearance of the solution
• Warm the solution to body temperature with heating pad
• Wash the hand and put surgical mask
• Remove the dialysate from; the warming setup and remove the protective wrapper. Squeeze the bag firmly and check for any leak
• Add any prescribed medication to the dialysate using sterile technique, if ordered
• Disinfect multiple dose vials for five minute with povidone-iodine soak
• Insert the connective tubing into the dialysate container
• Open the drain clamp to prime the tube, then close the clamp
• Place the povidone-iodine sponge on the dialysate container’s port
• Cover the port with dry gauze pad and secure it with tape
• Remove and discard the surgical mask
• Tear the tape to secure the new dressing

MAJOR STEPS OF CONTINUOUS PERITONEAL DIALYSIS

• The bag of dialysate is attached to the tube entering the patient’s abdominal area, so the fluid flows into the peritoneal cavity
• As the dialysate remain in the peritoneal cavity the patient can roll up the bag and place under his or her shirt and can perform the normal activities
• Unroll the bag and the suspending it below the pelvis allow the dialysate to drain from the peritoneal cavity back into the bag

ROLE OF NURSE IN INFUSING THE DIALYSATE FOR CAPD

• Check the patient’s weight
• Assemble all the equipment to patient’s bedside
• Explain the procedure in detail
• Do surgical hand washing
• Prepare a sterile field using a waterproof sterile paper as drape and place near the patient, maintain the drapes sterility
• Fill the snap-top container with povidone-iodine solution and place the snap top and the basin on the sterile field
• Take four pairs of sterile gauze pad soak it in povidone-iodine solution and place it in the sterile basin
• Place the remaining gauze pads on the sterile field
• Remove the alcohol containers cap and place it near the sterile field
• Put on a clean surgical mask and provide one for the patient
• Remove the dressing covers of the peritoneal catheter and discard it
• Be careful not to touch the catheter or skin
• Check the skin integrity at the catheter site, any signs of infection
• Put on sterile gloves and palpate the insertion site and subcutaneous tunnel route for tenderness or pain
• Record the type and amount of fluid instilled and returned for each exchange, time, duration, patient’s weight, blood pressure and pulse rate and any medications added
• Note the color of the returned fluid and check for any pus, mucus and blood

STEPS TO CLEAN THE PERITONEAL CATHETER IN CASE OF PATIENT WITH CAPD BEFORE DIALYSIS

• Wrap one gauze pad dipped in povidone-iodine solution at the distal end of the catheter and keep it for five minutes
• Clean the catheter, insertion site in concentric circles away from the insertion site
• Use straight strokers to clean the catheter beginning at insertion site and moving forward
• Use clean area of the pad for each stroke
• Clean the exposed area of the catheter cap by loosening it
• Place each used pad to the base of the catheter which acts as a support
• Place the fenestrated paper drape around the base of the catheter
• Remove the povidone-iodine sponge on the catheter cap, the cap clean the end of the catheter hub. Attach the connective tubing from dialysate container to the catheter
• Ensure that the luer-lock connector is tight
• Open the drain clamp of the dialysate container and allow the solution to enter the peritoneal cavity for 5-10 minutes
• Leave small amount of fluid in the bag to make the folding easier
• Close the drain clamp
• Fold the bag, secure it with belt or tuck it in the patient’s clothing
• After 4-6 hours unfold the bag, open the clamp and allow the peritoneal fluid to drain back into the bag
• Attach new bag of dialysate when the drainage is complete to repeat the infusion
• Discard the used bag appropriately

POST-PROCEDURE CARE FOR CAPD (Temporarily)

• Wash the hands. Put on the surgical mask and glove; give one mask to the patient
• Explain the procedure to the patient in detail
• Remove and discard the dressing from the peritoneal catheter
• Set-up a sterile field to patient by covering a clean dry surface with a water proof drape
• Place all the equipment on the sterile field
• Take 4” multiply 4” gauze pad, soak it and squeeze it with povidone-iodine solution and place it in the sterile field
• Tape the dialysate tubing to the side rail
• Now change to another pair of sterile gloves, place one fenestrated drape around the base of the catheter
• Clean the dialysis tubing using a povidone-iodine sponge for one-minute, moving in one direction away from the catheter, clean it moving from the insertion site to the junction of the catheter and the dialysis tubing
• Place the used sponge at the base of the catheter to prop it up
• Place the second fenestrated paper drape over the first at the base of the catheter
• Clean the junction of the catheter and the dialysate tubing for one minute
• Disconnect the dialysate tubing from the catheter
• Take the catheter tube and attach to the catheter
• Ensure that both the notches of the heart plastic catheter tip fix properly
• Clean the insertion site with povidone-iodine sponge from the insertion site to outward
• Allow the skin to air-dry before applying the dressing
• Discard the used one appropriately

COMPLICATIONS

• Peritonitis
• Septicemia