Peritoneal dialysis (PD) is an alternative procedure to chemodialysis for patients withsevere chronic kidney disease. The patient's peritoneum is used as a film across which fluids andsubstances that are dissolved in it (electrolytes, urea, glucose, albumin and other smallmolecules) are rotated through the blood. Permanent tube in theabdomen is used to inject liquid that is used to purify the bloodand also when the process is complete to pour liquid out. This methodof dialysis has its advantages as well as its disadvantages. There is apossibility of performing dialysis without going to medicalinstitutions but there is also a high risk of infection inthe place where permanent tube is inserted in the abdomen. Catheter is surgicallyplaced in the abdomen with one end attached to the skin surface. It isused to influence substantial amounts of liquid, about 2.5 liters,and before each infusion, area around the catheter must bedisinfected. Dialysate remains in the abdomen and waste productsdiffuse across the peritoneum from the underlying blood vessels.Every four to six hours the liquid is poured out and in its place the fresh dose is poured in. This process is repeated six times within 24hours. Sodium, chloride, lactate orbicarbonate and a glucose, used to providehyperosmolarity, are the main ingredients of dialysate. The amountof liquid depends on frequency of dialysis and manufacturer of liquid.
There are several types of liquids andthe way they affect the patient's blood. The exchange of fluid fromthe blood with glucose from the peritoneum is increased by the highconcentration of glucose. Solution circulates from peritoneal cavityto the organs in order to enter the lymphatic system. It is not knownwhy the amount of fluid that lymphatic vessels can absorb isdifferent for every individual, and is referred to as high, low orintermediate level. If it is a high exchange level,substances need to be well soluble. In that way small molecules between theblood and dialysis fluids are quickly and easily exchanged and the results are improved. Low level carriers arebetter fluid filters (fluid transport through the membrane into theblood faster with somewhat better results with long-term,high-volume treatment), but in practice any type of conveyor isgenerally managed through appropriate use of either APD or CAPD.
Regular monitoring of quantities ofliquids to be poured from the patient is needed. If the amount greater than 500 ml or even liter is lost during three processes ofdialysis it can cause hypovolemic shock or hypotension, and in the opposite case, it may cause hypertension and edema. It is also important to monitor the color of fluid, which can be pink in the first couple of treatments and later should be clear or pale yellow. If the color ispurple or there are traces of blood in the fluid, there is a possibility of internalbleeding. If the liquid is pale it can be a sign of infection.
If the fluid is too acidic, when the liquidis too cold or if it is injected too fast, it may cause discomfort or even pain.
Fluid can also increase pressure on thediaphragm causing difficulty with breathing. Constipation mayinterfere with the ability of fluid flow through the catheter.