Peritoneal dialysis - Causes, Symptoms and Treatment .MF .
Peritoneal dialysis - an artificial method of cleansing the blood of toxins, based on the filtration properties of the peritoneum of the patient.
peritoneum - a thin shell, fully or partially covers the internal organs of the abdominal cavity.Physically peritoneum is a membrane with selective permeability to various substances.The peritoneum has been three types: small, water permeable, medium passage for water-soluble compounds and compounds with a low molecular weight, and large - for substances with high molecular weight.Due to the high penetrating ability of the peritoneum is capable of passing different kinds of toxins.This differs from the method of peritoneal dialysis of hemodialysis, in which only pass through the membrane material and partly with a low average molecular weight.
In peritoneal dialysis, a dialysis solution (dialysate) is situated in the abdominal cavity and it is filtered continuously toxins from blood vessels in the wall of the peritoneum.Within hours, the dialysate is contami
speed and volume of filtration is constant, the cleaning process is slow and prolonged, that allows the use of peritoneal dialysis in patients with low or unstable blood pressure in children.In addition to filtering occurs in peritoneal dialysis solution penetration into the excess fluid.This process is called ultrafiltration.The dialysate contained an osmotic active substance, for example, a concentrated glucose solution which concentration gradient for attracting fluid.As a result of excess fluid from the blood through the vessels in the peritoneal dialysate misses.Besides glucose as an osmotic agent in a dialysis solution contains some amino acids, dextrose, glycerol, starch.In addition, the complex comprises a dialysate chemicals, selected according to the patient needs.
Indications peritoneal dialysis
Peritoneal dialysis is recommended for patients with end-stage chronic renal failure.
Peritoneal dialysis is preferable to hemodialysis in the following cases:
• for patients who did not seem possible to establish an adequate vascular access (people with low blood pressure, severe diabetic angiopathy, young children).
• For patients with severe diseases of the cardiovascular system, in which the holding of sessions of hemodialysis can lead to complications.
• For patients with bleeding disorders who are contraindicated the use of means preventing thrombosis.
• For patients intolerant of synthetic membrane filters for hemodialysis.
• For patients who do not want to depend on the apparatus for hemodialysis.
Contraindications peritoneal dialysis
Peritoneal dialysis is contraindicated in:
• The presence of adhesions in the abdominal cavity, as well as the increase of the internal organs, which limits the surface of the peritoneum.
• When installed low filtration characteristics of the peritoneum.
• Have drains in the abdominal cavity adjacent organs (colostomy, cystostomy).
• Purulent diseases of the skin in the abdominal wall.
• Mental illness, when the patient is not able to conduct proper session peritoneal dialysis.
• Obesity is when blood purification efficiency in peritoneal dialysis is being questioned.
peritoneal dialysis procedure
Set for peritoneal dialysis includes containers (empty and with the solution) and the conductive line.
kit for peritoneal dialysis.
Also during the procedure used Zickler.Zickler is a device which provides a programmable and discharge cycles Bay solution, and also capable solution heated to the desired temperature and weighed to assess fusion dialysate fluid volume removed.
cycler peritoneal dialysis.
to access the abdominal cavity used peritoneal catheters.
Catheters should ensure good drainage of the abdominal cavity, tightly fixed, and be protected from infection.Adequate irrigation of the abdominal cavity is carried out thanks to the high-rate discharge Gulf solution.The catheter is firmly fixed in the subcutaneous fat due to germination of the aortic cuff of connective tissue.It also creates a barrier to infection.Catheters made of silicone or polyurethane.Setting catheter surgically performed in the pelvic cavity.The outer part of the catheter is displayed under the skin on the front or side surface of the abdominal cavity.
Exterior patients with peritoneal catheters.
After catheter placement for adequate fixing it should pass 2-3 weeks, and then embarking on dialysis sessions.
for peritoneal dialysis must attach the filled dialysate container to the catheter.
Schematic representation of peritoneal dialysis session.
This process takes place in compliance with hygiene and antiseptic rules, including treatment of hands, work surfaces, the skin around the catheter, as well as places of connection lines and a catheter (adapter), donning the mask on the face.The front surface of the stomach is freed from clothes, pure cotton towel tied to the belt.From the sterile package take out the empty package and drain container with fresh dialysate.When the container with fresh solution is hung up on a tripod at a height of 1.5 m, and the drain bag is placed on the floor.Turnpike after treatment interconnected antiseptic solution.
First performed drain solution into an empty bag.Then this part of the line is clamped, open the clamp on the bringing in line the branches.New dialysate is poured into the abdominal cavity.Thereafter, the clamps on the highways are pressed, the empty container and with the fusion solution bag removed.The outer catheter port closed protective cap is fixed to the skin and hides under clothes.Every month in patients taking blood and fluid from the abdominal cavity to the study.Based on the results conclude on the extent of blood purification, as well as the presence or absence of anemia, disorders of calcium-phosphorus metabolism, and, based on these indicators, there is a correction of treatment.On average, the exchange sessions are conducted three times a day, the volume of 2-2.5 liters of the dialysate solution.
When poor tolerability, non-compliance, lack of blood purification, as well as in the event of severe or recurring complications, recommended the patient's transfer to hemodialysis.
Complications of Peritoneal Dialysis
The most dangerous complication of peritoneal dialysis is peritonitis (inflammation of the peritoneum).The most common cause of inflammation is a failure to comply with the rules of antiseptics patients when sharing sessions.Peritonitis is diagnosed by the presence of two of the three attributes:
• External symptoms of inflammation of the peritoneum: abdominal pain, fever, chills, weakness, nausea, vomiting, a violation of the chair.
• turbid peritoneal fluid.
• Detection of bacteria in the peritoneal fluid.
Treatment: broad-spectrum antibiotics before the test results, then the antibacterial drug, taking into account sensitivity to the identified microorganisms.In addition to specific therapy recommended suspension of peritoneal dialysis, abdominal lavage standard dialysate or Ringer's lactate.The washing solutions were added with heparin, which prevents adhesions in the abdominal cavity.In severe cases, it may be necessary to remove the peritoneal catheter.
By noninfectious complications include the following:
• disruption of abdominal catheter with difficulty Bay / drain solution.This complication can be associated with a change in the location of the catheter, the catheter intestinal loop closure, such as constipation, bending of the catheter or to the closure of the lumen of the catheter or fibrin clots, which often occurs during peritonitis.At the close of the catheter lumen clots can try to rinse it with sterile isotonic solution.In case of failure shows replacement of the catheter.Complications associated with the change of position of the catheter, require surgery.
• In the Gulf, and finding the dialysate in the abdomen increases intra-abdominal pressure, which contributes to the formation of hernias.The most common hernia the white line, rarely umbilical and inguinal hernia.Depending on the size and vpravlyaemosti herniation addressed the issue of further treatment: surgery or watchful waiting.
• Expiration peritoneal solution out or into the subcutaneous adipose tissue is found, as a rule, immediately after the statement of intra-abdominal catheter, or a bad fixation of the catheter in elderly and debilitated patients.This complication is diagnosed when getting wet bandage standing in the catheter, or the formation of edema of the subcutaneous fat of the abdomen wall and genitals.Treatment consists of cessation of peritoneal dialysis for 1-2 weeks for optimal catheter fixation with carrying out patient hemodialysis sessions.Under unfavorable conditions show replacement of the catheter.
• Right-sided pleural effusion occurs in debilitated patients, and some patients at the beginning of treatment.This complication is associated with the penetration of the dialysate through the diaphragm into the pleural cavity.Treatment - reducing the volume of the filling solution.For the prevention of this condition it is recommended to carry out the exchange sessions in the vertical state.With an increase in respiratory failure shows the patient transfer to hemodialysis program.
• Abdominal pain that is not related to inflammation of the peritoneum, often at the beginning of treatment and after a couple of months passed.The pain usually associated with stimulation of peritoneal dialysate reactive or abdominal distension due to a large quantity of the solution.In the first case, the treatment consists in the selection of optimal chemical composition of the dialysate in the second - the Gulf of smaller volumes of solutions with increasing multiplicity of exchanges.
many experts peritoneal dialysis is seen as the first stage of substitution therapy for patients in end-stage renal failure.In some patients, a number of reasons peritoneal dialysis is the only possible method of treatment.
Compared with hemodialysis, peritoneal dialysis allows patients to lead an active lifestyle, engage in employment.Unfortunately, the duration of peritoneal dialysis depends on the filtering properties of the peritoneum, which, over time, gradually, and quickly enough for frequent reduced peritonitis.In this case, there is a need for alternative methods: hemodialysis or kidney transplantation.
physician therapist, nephrologist Sirotkin EV