Page 394 - Critical Care Nursing Demystified

Chapter 8 CARE OF THE PATIENT WITH CRITICAL RENAL NEEDS 379

The warmed dialysate is infused through the PD catheter into the perito-
neum dwelling in this space according to physician preference. The longer the
fluid is intact with peritoneum in the abdomen, the more fluid and electrolytes
it will remove. Next, the IV tubing is clamped and the dialysate is allowed to
flow by gravity into a drainage bag, which, except for its size, looks like an
indwelling urinary catheter drainage bag. The dialysate is ordered to be drained
at a specific amount of time. Once measured and determined to be more than
what was infused, the process begins again. An infusion, dwell time, and drain
time is considered one cycle and time limits are placed by the nephrologist.
A cumulative tally of fluid removed is kept.
Before starting PD, the nurse should perform the following:

Explain the procedure to the patient.
Perform baseline VS measurements.
Perform an abdominal assessment to check for peritonitis.
Take the patient’s predialysis weight (wet weight; the patient has retained
fluid).
Monitor electrolytes, BUN, creatinine, and WBC levels to observe for renal
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Instruct the patient to void to prevent inadvertent perforation.
Check the PD catheter dressing observing for infection, bleeding, and for the
catheter to be intact without kinking.
Gather all equipment, which includes dialysate, IV pole, tubing to and from
the catheter, and medications that can be added to the dialysate like antibiot-
ics to protect from peritonitis and heparin to prevent clotting of the catheter.
Bring appropriate personal protective equipment, which includes mask,
gloves, eye shields, and gown.
Prep the peritoneal catheter according to protocol; this may include cleans-
ing the catheter exit port with a disinfectant.
During the procedure, the patient will require close observation to prevent
complications associated with PD. The nursing care of this patient requires the
nurse to:
Monitor for respiratory distress, which could happen from increased in-
trathoracic pressure from increased intraabdominal pressure as fluid enters
the peritoneal space.
Monitor the patient for changes in temperature, which can indicate peritonitis.