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Fluids & Electrolytes
PERITONEAL DIALYSIS removes fluid and metabolic waste products from the blood and reestablishes normal fluid and electrolyte balance when the kidneys can no longer perform these functions. Sterile electrolyte-based fluid, called dialysate, is instilled into the peritoneal cavity through an abdominal catheter. This fluid removes electrolytes and waste products through diffusion; altering the concentration of glucose in the dialysis solution removes excess fluid through osmosis.
The major advantage to peritoneal dialysis is that it can be performed almost anywhere, and one common form, continuous ambulatory peritoneal dialysis, requires no machine or electricity. A dialysis nurse teaches patients who go home on peritoneal dialysis how to manage and document their care.
While the patient is hospitalized, you'll need to know how to document dialysis on the peritoneal dialysis flow sheet. For each exchange (infusion, dwell, and drainage of the dialysate), record the following information:
* date and time of exchange
* patient's vital signs
* dialysate dextrose concentration (for example, 1.5%, 2.5%, or 4.25%)
* dialysate volume (usually 1,000 to 3,000 mL)
* medications added to the dialysate, if any
* fill, dwell, and drain times
* amount of effluent (fluid allowed to drain after exchange) obtained and hourly and cumulative output totals
* effluent characteristics, including color and clarity.
Obtain and document daily patient weights before the first exchange in the morning and blood glucose level if the patient has diabetes. Document the appearance of the catheter exit site, site care, and the patient's response to treatment.
Monitor the patient for signs and symptoms of complications, such as peritonitis, which is characterized by cloudy dialysate drainage, abdominal pain, and fever. On the flow sheet, document who you notified, your interventions, and the patient's response.
With proper documentation, you can help your patient stay safe during peritoneal dialysis.
Molzahn A. Management of clients with renal failure. In Black J, et al., Medical-Surgical Nursing: Clinical Management for Positive Outcomes, 6th edition. W.B. Saunders Co., 2001.
Saxena R, West C. Peritoneal dialysis: A primary care perspective. Journal of American Board of Family Medicine. 19(4):380-389, July-August 2006.
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