Peritoneal Dialysis

What is Peritoneal Dialysis

Peritoneal is a process to remove waste when your kidneys are no longer working. This procedure helps in filtering the blood in different ways in comparison to the common blood filtering process mostly known as hemodialysis.

What is dialysate?

Dialysate is a fluid composed of water, electrolytes, and salts. Dialysate is used during dialysis to clean your blood inside the dialyzer by eliminating waste products and balancing electrolytes. Dialysate contains sugar that attracts fluid and waste from your blood. Peritoneal dialysis uses your peritoneum as a filter. When you exchange, the dialysate holds to the waste and fluid and eliminates them from your body.

What happens during peritoneal dialysis?

During PD, a cleaning solution known as dialysate is injected into a specific part of your stomach. Dialysis utilizes the peritoneum, the membrane that surrounds most of the organs in your stomach, as a filter for the dialysis procedure.
You must let the dialysate rest in your stomach for a duration of time while it filters your blood. This is referred to as dwell time. The spent dialysate will then be drained from your stomach and replaced with fresh dialysate.
Exchange is the process of emptying used dialysate and replenishing it with fresh dialysate. Typically, each changeover (drain and refill) takes 30–40 minutes. You can perform these swaps manually or with the assistance of a machine.

What risks can occur during peritoneal dialysis?

The most common peritoneal dialysis problems are infection around the catheter site and infection of the abdominal wall lining (peritonitis). Problems with the catheter may occur less frequently. However, the majority of issues can be controlled or avoided. When any of the following problems exist, peritoneal dialysis is not recommended:

• Scarring of the abdominal wall lining  which is the peritoneal membrane

• Leaks in the abdominal wall lining

• Crohn’s disease and ulcerative colitis are examples of active inflammatory bowel disease.

Types Of Peritoneal Disease

There are two types of Peritoneal Disease mostly one of them is Continous Cycler assisted PD and secondly, is Continuous ambulatory PD.For choosing which will be perfect PD according to your life & Schedule your doctor will suggest you.

Questions	Continuous cycler assisted PD(CCPD)	Continuous ambulatory PD(CAPD)
How does it work?	To complete your exchange, CCPD uses a machine known as a cycler. When you connect your catheter to the cycler’s tubes, it will: Dialysate should be consumed. Wait for the appropriate dwell time. Empty the used dialysate from your stomach into a bag. Refill your stomach with clean dialysate and repeat the process for 3–5 exchanges overnight.	CAPD uses gravity to assist you in doing manual exchanges. Gravity aids in the filling and draining of your stomach with dialysate. To get dialysate into your system, do the following: You will be seated on a chair, with a tube attached to a bag of dialysate suspended above you. Gravity will pull the dialysate from the bag and into your stomach via the tube. To drain the used dialysate, connect a tube to your catheter and let gravity take the dialysate out of your abdomen, through the tube, and into a bag beneath you. You will refill your stomach with clean dialysate and repeat the procedure.
How often it should be done?	CCPD is typically performed at night while you sleep. It must be completed every night. Every morning, the machine will empty your stomach of dialysate for the final time. This time, the dialysate will remain in your stomach for the entire day, until you go to bed and resume your nightly CCPD treatment. If your body is retaining too much dialysate during the long daytime dwell time, your doctor may advise you to do exchanges during the day. You weigh more than 175 pounds. You require more waste removal from your blood than can be accomplished during your CCPD overnight sessions.	CAPD should be done in the daytime because you are only to do every exchange yourself. The common individual has four exchanges every day. During the dwell time, you will allow the dialysate to sit in your stomach between exchanges. At the conclusion of each day, you will fill your stomach once more, and the dialysate will remain in your stomach all night. You will resume your exchanges in the morning. Your doctor may advise you to utilise a mini-cycle (a smaller version of the cycler machine used in CCPD) to perform some exchanges while you sleep if you: During the long night dwell time, your body retains an excessive amount of dialysate. You weigh more than 175 pounds. You require more waste removal from your blood than can be accomplished during your CAPD daytime doses.
How much time does it take?	Generally, the cycler does 3–5 rotations nightly, which takes around 9 hours. Your doctor will advise you on how many exchanges you should perform and how long you should stay in each position. Your dialysis nurse or technician will explain to you how to use the cycler machine to ensure that you receive the proper therapy.	Each exchange normally takes between –30–40 minutes to drain and fill your abdomen with dialysate. Your doctor will advise you on the number of exchanges you should perform each day as well as the duration of your dwell periods.
Where it should be done?	You are supposed to do it in your bedroom. Most people do PD in their home, But you can do it anywhere the place is clean.	You are supposed to do it anywhere wherever you like whether home, workplace, other space, or where you spend most of the time but the condition is that the place should be clean and dry.

When we can be back to normal activities?

PD can provide a great deal of freedom. If you do PD at night, you will have more time during the day for other things, but you will be limited in what you can accomplish. You should avoid swimming and enjoying hot tubs because your catheter region should not become wet. If your doctor is aware of the things you enjoy, he or she may be able to suggest a treatment plan that allows you to continue doing them.

How does dialysate enter and exit the stomach?

Before you can start PD, you will require minor surgery to insert a soft, flexible tube known as a catheter into your abdomen or chest. The catheter’s tip will exit through your skin. This tube will be used for your exchanges.
You can obtain your catheter either under general anaesthesia or with a local anaesthetic. General anaesthesia is a medication that puts you to sleep and prevents you from feeling pain. While you are awake, a local anaesthetic prevents you from feeling discomfort in the area where the surgery is taking place.
Wait 2–3 weeks following surgery for your incision site to heal before utilising the new catheter. This is why doctors advise having your catheter placed three weeks before your first peritoneal dialysis session. In some circumstances, you can use your catheter immediately away after surgery.

How should I care to prevent my belly from infection?

Peritonitis is a kind of infection that occurs in your belly, it’s a too common problem that happens in people. If the area is not cleaned by you from where the catheter enters into the body then bacteria may enter into your body and bacteria can also enter into your body while you connect and disconnect your dialysate bag.
You will need to take care of your catheter properly while doing it exchange. To prevent peritonitis you will need to look after these points:-    

• Wash your hands well before handling your catheter
• clean the region where your catheter enters your body daily
• use an antibiotic spray on the area where your catheter enters your body
• keep your catheter dry at all times
• keep your PD supplies in a clean, dry location.
• When performing exchanges, wear a mask.
• Only conduct exchanges in clean, dry areas.
• Keep an eye out for indicators of infection, such as:
• Fever
• Pain or redness surrounding the catheter
• Dialysate that appears hazy or off-color when drained from your stomach