Page 395 - Critical Care Nursing Demystified

380 CRITICAL CARE NURSING DeMYSTIFIED

Closely watch dialysate infuse and drain. A kink or clotting of the catheter
from exudate can cause slower infusing and draining times. It can also stop
the drainage.
Record the output of the dialysis and relate it to the amount infused and the
total amount + or – the patient during the treatment period.
Observe the dialysate for bloody drainage. During the first several cycles, the
dialysate may have blood-tinged drainage that will clear with each passing
cycle. If bleeding persists, notify the surgeon who placed the PD catheter.
Reposition the patient frequently. Patients are usually more comfortable in
a high Fowler’s position during initiation and indwelling because it assists
with ease of breathing.

At the end of the PD treatment nursing care includes:
Capping the dialysis catheter using sterile technique
Repeat VS, abdominal, and neurological checks
Observing for signs of respiratory distress, which is associated with fluid
retention (crackles, decreased SaO , air hunger, tachypnea, hypertension)
2
Weigh the patient analyzing the weight with the amount of fluid taken from
the patient (dry weight: weight has been reduced with treatment) Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Recording the number of cycles and total amount of fluid removed
Capping the dialysis catheter and redressing the site
Administering any medications that were held due to dialysis
Asking the patient if he or she has any questions about the procedure and
how the patient tolerated it
Supporting the patient and listening to fears as this is a life-altering procedure

NURSING ALERT
Peritonitis is a serious complication of PD. Fever, abdominal cramping that increases,
pain or swelling at the catheter insertion site, and cloudy dialysate can indicate peri-
tonitis. Notify the physician, prepare to take a dialysate specimen, and anticipate that
the physician will start the patient on antibiotics.

Continuous Renal Replacement (CRRT)

The last type of dialysis that can be seen in the critical care environment is
continuous renal replacement therapy (CRRT). CRRT is similar to HD because
it is an extracorporeal procedure and requires a temporary external access site.