ASSISTING THE PATIENT UNDERGOING DIALYSIS

ASSESSMENT IMPLEMENTATION

1. Obtain patients weight, vital signs, abdominal girth. Insertion of Peritoneal Catheter
2. Inspect catheter size for erythema, tenderness, and 1. Wash hands, and close patient’s room door
drainage 2. Organize equipment at bedside
3. Review physicians’s order - 3. Administer analgesia or anti-anxiety medication if
a. PD - Usually include 24 exchanges with required by a patient and ordered by physician.
specific dialysate volume and composition, 4. If patient is producing urine and does not have any
as well as specific dwell time - commonly 20 foley catheter in place, catheterize with staight
minutes catheter.
b. CAPD - Usually include 3 to 5 exchanges 5. Place patient in supine position.
with specific dialysate volume and 6. Clear bedding from the umbilical region.
composition, as well as specific dwell time -
range from 4 to 8 hours.
Initiating Dialysis Exchange
4. Obtain laboratory data as ordered -
a. PD - Every 12 to 24 hours 1. Wash hands and place patient in semi-fowlers or high
fowlers position
b. CAPD - Can vary, depending on individual 2. Make sure all clamps of inflow and outflow tubings are
needs. in “OFF” position.
3. Add medication as listed in physician’s order -
a. Heparin
PLANNING b. Local Anesthetic
c. Prophylactic Antibiotic
1. Wash hands and if PD is started at bedside, obtain 4. Attach two warmed dialysate bags to inflow tubing
equipment and attach IV pole. Bags are punctured exactly as IV
a. Ordered dialysate at room temperature solution bags.
b. PD button to leave at bedside 5. Primes inflow tubing by removing protective cap and
c. Sterile gloves maintaining sterility. Hold tubing over basin or sink,
d. Occlusive dressing materials open inflow clamp and allow fluid to run through
e. Hydrogen peroxide tubing until air is removed.
f. Provide iodine ointment 6. Open the clamp on dialysate bag #1, infuse solution
g. Mask over prescribed time (usually 2L/15 to 20 mins)
h. IV pole 7. Clamp inflow tubing for prescribed dwell time.
i. Y connecting tubing ( for CAPD client) 8. Remove dialysate bag for IV pole. Place warmed bag
j. Sterile drainage bag #3 on pole.
k. Waxed pencil or non-water soluble marker 9. Unclamp outflow tubing and drain (usually for 20
l. Obtain PD set which should contain mins) Check outflow for cloudy appearance, blood
m. Connect tubing for installation of fluids and amount
n. Connector tubing for drainage 10. Clamp outflow tubing
o. Y connector 11. Empty and measure fluid in drainage bag.
p. Clams for connector tubing 12. Repeat steps 3 to 10 until all exchanges are
q. Drainage bag completed.
13. During first exchanges, monitor patient’s vital signs
2. Explain the procedure to the client. Prepare the every 15 minutes. Take BP, HR, and Temp.
patient emotionally and physically. 14. Promotes patient’s comfort during dialysis.
3. See that the consent form has been signed. a. Frequent back care and massage procedure
b. Turn from side to side
c. Elevate head of bed
d. Allow patient to sit on chair if condition
permits
15. When all exchanges are complete, cover catheter and
insert deanne button into insertion site. This can be
medical procedures or designated to nurses in special
units.
16. Inspect catheter dressing. If dressing is reapplied,
apply a clear transparent occlusive dressing.
17. Wash hands and dispose of contaminated supplies
according to agency policy.

EVALUATION

1. Note the patient’s -

a. Weight
b. Abdominal girth
c. Fluid balance before and after PD
d. Vital signs
e. Temperature
f. Status of catheter site
g. Color of drainage
h. Condition of catheter dressing

2. Record the following -

a. Exact time of beginning and end of each
exchange starting and finishing time of
drainage
b. Amount of solution infused and removed
c. Fluid balance
d. Number of exchanges
e. Medication added
f. Pre and Post dialysis weight plus daily
weight
g. Level of responsiveness
h. Assessment of vital signs and patient’s
condition