Download - Acute peritoneal dialysis prescription
Acute peritoneal dialysis PrescriptionYousaf khanLecturer Renal diaysisIPMS-KMU
Introduction Provide nephrologist with non vascular alternative dialysis Use intensive care setting, actually less efficient that conventional
dialysis Its continuous nature comparable with dx Management of actual renal failure with toxic or metabolic, electrolyte,
volume problem in critical ill patient Use in children it low cost make attractive
Advantage: simple than other mode of dx Does not require highly trained person or expensive complex equipment Perform usually manually but can be done by cycle Avoid vascular problem like hemorrhage, air embolism and thrombosis
ets Does not require anticoagulation Hemodynamicaly instability, lacked blood hemodialyzer reaction
Disadvantage: PD is less efficient than hemodialysis in the treatment of
acute problem like pulomary edema, poisonings or drug overdose, acidosis and hyperkalemia ets
Protein losses can be substantial in PD and could complicate the care of already malnourished, critically ill patients.
Morbidity 30% and mortality 5%
Indication: Acute renal failure Hemodynamically unstable patients Patient in whom vascular access is problematic
Contraindication: Recent surgery requiring abdominal drains Fungal peritonitis Severe hypercatabolic states and abdominal wall
cellulitis Peritoneal fibrosis hernia Big poly cystic kidney
Peritoneal catheter: Initial insertion of a Tenckhoff catheter
Use of Automated cyclers: Traditionally been done using manual exchanges APD with considerable saving time
Prescribing acute peritoneal dialysis:A: Session length: In the setting of acute renal failure, continous removal of fluids and
solutes is required in a patient who often is catabolic, oliguric and in need of ongoing nutritional and therapeutic support.
24 hr at a time, reassessing and altering the prescription as indicated.
B: Exchange volume: Depend size of peritoneal cavity Average size adult can usually tolerate 2L exchange Some nephrologist prefer to start with smaller volume 1-1.5L for the
first few exchange.
C: Exchange time: Combine time required for inflow, dwell and drain Most commonly use 1hr, although 2hr exchange time also are
commonly. Inflow 10 mint, dwell time 30 mint and outflow 20 -30 mint
Acute peritoneal dialysis order
Prescribing acute peritoneal dialysis:D: Choosing the dialysis solution dextrose concentration:
E: Dialysis solution additives: Potassium, Heparin (1000 units/2L) and Insulin
(administration may be required for diabetic patient)
Prescribing acute peritoneal dialysis:F: Monitoring fluid balance
G: Monitoring Clearance:
Complication A number of problems may arise during the course of acute
peritoneal dialysisAbdominal distention: Incomplete drainage may lead to progressive intraperitoneal
accumulation of dialysate with attendant discomfort, distention, and even respiratory compromise.
Peritonitis: Peritonitis may complicate acute peritoneal dialysis in up to
12% of cases. This is occurs most often within the first 48hr Infection from gram positive dominant
Hypotension: Rapid removal of large amounts of fluid can lead to
hypovolemia with consequent hypotension, arrhythmia and even death.
ComplicationHyperglycemia: In the daibetic or prediabetic patient, the high dextrose
solutions used for peritoneal dialysis can result I hyperglycemia.
Hypernatremia
Hypoalbuminemia: With the frequent exchanges utilized in acute peritoneal
dialysis, protein loss via the dialysate can be as high as 10 – 20g per day and up to twice this amount if peritonitis.
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