In peritoneal dialysis, the dialyzer is the abdominal cavity. The blood carried through its vessels is dialyzed by a catheter inserted through the straight abdominal wall. The membrane of the procedure is the intestinal mucosa, which covers all organs and systems. As a result, peritoneal dialysis proceeds much like an artificial dialyzer.
Features
The peritoneal type of cleansing has a low power. To achieve the desired cleansing, the process must occur around the clock. This requires the presence of a special solution in the abdominal cavity. After a few hours, it is saturated with slags, after which it is changed to fresh.
Peritoneal dialysis runs continuously, around the clock, just like our kidneys. This option allows you to reduce the load on the cardiovascular system, preserve kidney function. The replacement of the solution is carried out four times a day, but for the convenience of patients, the time is divided unevenly. Day Replacementssolutions can be shifted for a more comfortable life of the patient. Although for greater effect it is recommended to strive for uniformity of fills.
Peritoneal dialysis is usually done at home or on an outpatient basis. You only need to visit the clinic in order to undergo follow-up examinations - usually a doctor is visited up to two times a month.
Equipment
To perform blood purification, you need to have certain equipment.
- Table. Its surface must be even. It is best to put an oilcloth, as you will constantly have to use alcohol solutions, antiseptics, from which the surface can deteriorate.
- Rack for hanging the drug. Wall-mounted hooks can be used to hang PD solutions.
- Chair. It should be comfortable so that you can sit on it for at least half an hour.
- Floor scales for measuring body weight.
- Kitchen scales to determine the weight of packages with a solution. It is better to use scales up to five kilograms, as they are more accurate.
- Device for measuring blood pressure.
- Thermometer to measure body temperature.
- Towel.
Solutions
Different solutions are used to purify the blood, mainly based on glucose and lactate, but there are other drugs.
- Extranil. A solution that helps maintain excellent filtration by protecting the peritoneum from concentrated solutions. This substance is usually used once a day.
- "Nutrinil". Created to ensure the supply of amino acids in case of malnutrition, protein deficiency. The solution is applied once a day instead of one of the usual fills.
- Bicarbonate based solutions (instead of lactate). They are used as buffers. This agent can replace all solutions based on lactate. In some cases, drugs are used in the treatment of peritonitis.
There are other solutions used for peritoneal kidney dialysis.
Carrying out the procedure
Used for peritoneal dialysis system or catheter, thirty centimeters long. It can be made of silicone or polyurethane. The catheter is fixed in the pancreas with a cuff. The tube is placed under local anesthesia, rarely under general anesthesia.
After the catheter is inserted, at least two weeks pass before the first procedure. During this period, the cuff grows in to more effectively fix the tube.
Manual dialysis
There are two types of dialysis: automatic and manual. The latter does not require any additional equipment. This procedure requires two containers and wire tubing.
Glucose is used as a dialysis solution. In some cases, additional substances are introduced into it.
The process of blood purification takes place inside the abdominal cavity. About two liters of fluid are injected through the catheter. Then the tip of the catheter is closed with a cap. The injected filling remains in the body for several hours. Thenit is removed by draining through the catheter, and a fresh solution is injected into the cavity. This whole procedure takes about half an hour. Typically, a patient needs up to six treatments per day.
Atomatics
You can carry out the cleaning procedure not only manually, but also in automatic mode. For this, a special device is used - a cycler for peritoneal dialysis. It allows you to change the mode of dialysis. So, its use allows you to free up daytime for normal life, and intensively carry out therapy at night and in the evening. The cycler carries out the exchange of solutions from bags through a line permanently connected to the catheter. Since the solution is constantly fresh, cleaning is more intensive. In the morning, the apparatus fills in the last portion of the solution, and the patient is disconnected from it. When connected in the evening, the cycler immediately changes its fill and starts executing the specified program.
Not all patients can use automatic transfusion. For some, it is not enough to change the solution only at night. For such people, it is recommended to aim for a uniform replacement of the drug.
Indications
Peritoneal type of cleansing is used in patients suffering from chronic renal failure, at a time when the pathology enters the terminal stage and it is no longer possible to restore kidney function. With such a course of the disease, dialysis becomes the only way to save a person's life. In some cases, the disease is reversible, and several procedures are enough to normalize kidney function.
There is a rowindications for which a doctor refers a patient to peritoneal dialysis:
- impaired blood supply to the kidneys;
- in the presence of severe CV diseases related to contraindications for hemodialysis;
- bleeding disorder;
- when the patient refuses hemodialysis.
In children, this type of procedure is prescribed for acute renal failure, in violation of urea metabolism.
Contraindications
Peritoneal dialysis is considered safer than hemodialysis, but even this method has contraindications. Most of them are associated with pathologies of the abdominal cavity.
The procedure is not prescribed for adhesions, injuries of internal organs. It is forbidden to install the system in the presence of purulent infections of the abdominal cavity, with obesity, mental illness, heart failure.
Complications
Complications may occur during the procedure. They come in infectious and non-infectious types.
The main complications of the infectious type are peritonitis and infection at the site of the tube. Both types of pathology arise due to a violation of the rules of antiseptics during the replacement of the fill. If an infection occurs, standard treatment is carried out with the use of antimicrobials, washing the abdominal cavity, and stopping dialysis. In some cases, the catheter is removed.
Non-infectious diseases include violations of the highway. This type of complication occursdue to a change in the position of the catheter, the appearance of bends. To fix this, they flush the system, but sometimes surgery may be required.
In rare cases, the solution may leak in or out. In this case, the tube is replaced with a new one. Rarely, right-sided pleurisy may occur. This complication is observed when the solution flows into the pleural cavity. To fix the problem, reduce the dose of the solution.
Every dialysis patient should visit a doctor periodically to evaluate the results, and strictly follow all recommendations.
