Saturday, April 21, 2012

How Peritoneal Dialysis Works

This is me at my 'station' in my room doing a manual exchange
I just wanted to try and give a more detailed explanation of how the dialysis process works.

There are two common types of dialysis. The one most people seem familiar with is hemodialysis. If you know someone who has dialysis three times a week in center, this is hemodialysis.  Hemodialysis can also be done at home, but more often it is done in center. This type of dialysis involves creating a fistula in the forearm (a surgeon takes a vein and an artery and sews them together to create a large access vein for the dialysis needles).

The peritoneal dialysis process uses the peritoneum in the abdomen as a membrane across which fluids and dissolved substances (such as electrolytes, urea, glucose, albumin and other small molecules) are exchanged from the blood. Fluid is introduced through a permanent tube in the abdomen and flushed out either every night while the patient sleeps (CCPD - Continuous Cycling Peritoneal Dialysis) or via regular exchanges throughout the day (CAPD - continuous ambulatory peritoneal dialysis). The primary complication of PD is infection due to the presence of a permanent tube in the abdomen.

The training process for peritoneal dialysis was stressful as there is high risk of infection if you don't use a proper sterile process. In order to do an exchange a patient needs to wash their hands for 30 seconds, put on a mask before removing the cap from the catheter, and use hand sanitizer. You also have to remove any pets from the area and close any windows (and turn off any air vents if the air is blowing).

Then you connect the the catheter to a manual exchange bag, drain the fluid that is currently inside, refill with new fluid and then disconnect the catheter. The whole process takes about 45-60 minutes.

After a week of training on the manual exchanges (CAPD) I was trained on how to use the cycler. I now hook up to this machine every night before bed time, usually about 10pm. It does an initial fluid drain, and fill, then it does three more exchanges while I sleep. The machine stops at about 7:30 am the next morning. During the day I do one manual exchange, usually sometime between 4pm-6pm.

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