Objetive: DEAR STUDENTS THE OBJETIVE OF THIS TRAINING , IS GIVE YOU A BASIC UNDERSTANDIG OF PERITONEAL DIALYSIS PROCEDURE AND ALLOW TO PROVIDE TO LEARNING ABOUT THE CHRONIC RENAL FAILURE PATIENTS . WE ARE SURE THAT THE OBJECTIVES OF THIS TRAINING WILL BE ACHIEVED. PROFESSORS…… 1
Chronic Kidney Failure Chronic kidney failure, also called chronic kidney disease, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When chronic kidney failure reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can accumulate in your body. 7.2.1 The peritoneal membrane / P. Martin 2
Chronic Renal Failure Slow progressive renal disorder related to nephron loss, occurring over months to years. In the initial Stage, CKD non present symptoms . Culminates in End Stage Renal Disease 3
Causes of Chronic Renal Failure: HIV positive (Asocieted Nephrophaty ) HIVAN (Namibia) Diabetes Hypertension Renal vascular disease (also vascular disease) Nephritis Pyelonephritis & chronic UT I Polycystic kidney disease Renal Neoplasms Analgesic nephropathy Immunological disorders: Lupus, Goodpasture syndrome, Metabolic disorders: gout Nephrotic Syndrome ?primary or secondary 7.2.1 The peritoneal membrane / P. Martin 4
7.2.1 The peritoneal membrane / P. Martin 5
Treatment Options SubPeritoneal Dialysis Hemodialysis Kidney Transplant Conservative management 6
7.2.1 The peritoneal membrane / P. Martin 7 Sagittal view of the peritonealcavity during peritoneal dialysis
7.2.1 The peritoneal membrane / P. Martin 8
7.2.1 The peritoneal membrane / P. Martin 9
10 The peritoneal anatomy A sagittal section trough the peritoneal cavity General facts Living membrane Reusable Provides lubrication for internal organs Normally contains 10 – 100 cc's fluid Semipermeable Bi-directional
7.2.1 The peritoneal membrane / P. Martin 11 (Gp:) Transport across the peritoneum (Gp:) Osmosis Diffusion Convection Peritoneal physiology
7.2.1 The peritoneal membrane / P. Martin 12 Diffusion Peritoneal physiology
7.2.1 The peritoneal membrane / P. Martin 13 RANDOM movement of solutes across the peritoneal membrane from an area of high concentration to an area of low concentration (without assistance by any flow of fluid) Diffusion HIGH low Peritoneal physiology
7.2.1 The peritoneal membrane / P. Martin 14 Factors affecting diffusion solute size concentration gradient electrical charge blood flow rates Peritoneal physiology
7.2.1 The peritoneal membrane / P. Martin 15 Movement of water across the peritoneal membrane from an area of low concentration to an area of high concentration. (Gp:) Osmosis low HIGH Peritoneal physiology
7.2.1 The peritoneal membrane / P. Martin 16 Osmotic Ultrafiltration Peritoneal physiology Glucose generates a high osmotic pressure which induces ultrafiltration from the capilaries (blood) to the peritoneal cavity
7.2.1 The peritoneal membrane / P. Martin 17 Factors affecting osmosis dextrose concentration dwell time membrane permeability Peritoneal physiology
7.2.1 The peritoneal membrane / P. Martin 18 the dwell time the peritoneum characteristics rapid transperitoneal absorption with decline of the osmotic gradient in time: Dextrose 1.5%: maximum UF rate of 9.27 mL/min Dextrose 4.25%: maximum UF rate of 21.0 mL/min Dextrose 1.5% removes 100-300 cc of extra water Dextrose 2.3% removes 300-500 cc of extra water Dextrose 4.25% removes 600-800 cc of extra water Fluid removal is dependent on:
7.2.1 The peritoneal membrane / P. Martin 19 Convection Solutes move across the peritoneal membrane in an'orderly flow' from one area to another by being carried by a flowing fluid. Peritoneal physiology
7.2.1 The peritoneal membrane / P. Martin 20 Diffusion Convection Ultrafiltration (osmotic pressure gradient) solute removal fluid removal The composition of PD solution is the key factor that governs diffusion, convection as well as the removal of fluid excess from the body · Electrolytes correction · Body fluid balance · Acid-base control · Blood purification Peritoneal dialysis
7.2.1 The peritoneal membrane / P. Martin 21
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Peritoneal Dialysis Catheter Two double-cuff Tenckhoff peritoneal catheters: standard (A), curled (B). 7.2.1 The peritoneal membrane / P. Martin 23
Dialysis SubDialysis is the diffusion of solute molecules through a semipermiable membrane, passing from higher concentration to that of lower concentration. It is the process of separating colloids and crystalline substances in solution by the difference in their rate of diffusion through a semi permeable membrane. The purpose of dialysis is to remove endogenous and exogenous toxins and to maintain fluid electrolyte and acid- base balance till the renal function recovers. It is a substitute for some excretory functions of kidneys but does not replace the endocrine and metabolic functions. 7.2.1 The peritoneal membrane / P. Martin 24
INDICATIONS Uremic symptoms with neurologic abnormalities Persistent hyperkalemia, above 6.5 mEq/L Blood urea level more than 50 mmol/l Serum Creatinine more than 900 µmol/l Severe acidosis, pH less than 7.2, TCO2 less than 10-12 mEq/L Hyperphosphatemia Pulmonary edema and CCF 7.2.1 The peritoneal membrane / P. Martin 25
Peritoneal dialysis SubPeritoneal dialysis is a technique that employs the patient’s peritoneal membrane as a dialyzer. Excess body water is removed by an osmotic gradient created by the high dextrose concentration in the dialysate; wastes are removed by diffusion from the peritoneal capillaries into the dialysate. Because peritoneal dialysis is not as efficient as hemodialysis, it must be performed daily rather than 3 times weekly as in hemodialysis. 7.2.1 The peritoneal membrane / P. Martin 26
7.2.1 The peritoneal membrane / P. Martin 27
7.2.1 The peritoneal membrane / P. Martin 28
Phases of A Peritoneal Dialysis Exchange Fill: fluid infused into peritoneal cavity Dwell: time fluid remains in peritoneal cavity Drain: time fluid drains from peritoneal cavity 7.2.1 The peritoneal membrane / P. Martin 29
7.2.1 The peritoneal membrane / P. Martin 30
INTERMITTEN PERITONEAL DIALYSISIPD (WILL DO IN IHO) 7.2.1 The peritoneal membrane / P. Martin 31 WARD 7 NEW BUILDING
1.Continuous Ambulatory PD SubIt is the most commonly used method of peritoneal dialysis. The filtration process occurs most hours of the day. The exchange usually take about 3 minutes , 3-4 times a day and only require a solution bag with tubing attached to it that connects to the child’s blood stream. It gives freedom. 7.2.1 The peritoneal membrane / P. Martin 32
2.Automated Peritoneal Dialysis Suba)Continuous Cyclic Peritoneal Dialysis Continuous regimen means that the dialysis solution is present in the peritoneal cavity continuously, with the exception of short significant periods between exchange. It uses duel lumen catheterization, i.e., 2 catheters, one for inflow and other for outflow. 7.2.1 The peritoneal membrane / P. Martin 33
Intermittent Peritoneal Dialysis Sub-USUALLY DONE IN HOSPITAL It means the dialysis sessions are performed several times a week. This technique uses one catheter for inflow and outflow. Flow is interrupted after both inflow and outflow during exchange. 7.2.1 The peritoneal membrane / P. Martin 34
PROCEDURE The abdomen is cleaned in preparation for surgery, and a catheter is surgically inserted with one end in the abdomen and the other protruding from the skin. Before each infusion the catheter must be cleaned, and flow into and out of the abdomen tested. The warmed solution is allowed to enter the peritoneal cavity by gravity and remains a variable length of time (usually 10-15 minutes) according to the rate of solute removal and glucose absorption in individual patients. The total volume is referred to as dwell while the fluid itself is referred to as dialysate. 7.2.1 The peritoneal membrane / P. Martin 35
SubThe dwell can be as much as 2.5 litres, and medication can also be added to the fluid immediately before infusion. The dwell remains in the abdomen and waste products diffuse across the peritoneum from the underlying blood vessels. After a variable period of time depending on the treatment (usually 4–6 hours), the fluid is removed and replaced with fresh fluid. 7.2.1 The peritoneal membrane / P. Martin 36