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Peritoneal Dialysis at Home How to Contact Your Peritoneal Dialysis Team

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Peritoneal Dialysis at Home How to Contact Your Peritoneal Dialysis Team Peritoneal Dialysis at Home How to Contact Your Peritoneal Dialysis Team The PD Unit is on level 4 of the River zone, section B, at the main hospital campus. The PD Unit is open Monday through Friday from 8 a.m. to 8 p.m. We are closed on weekends, Thanksgiving, Christmas and New Year’s Day. Address 4800 Sand Point Way N.E. Seattle, WA 98105 Phone numbers Main hospital 206-987-2000 PD Unit 206-987-1310 PD Unit dietitian 206-987-6358 or 206-987-5538 PD Unit social worker 206-987-9584 or 206-987-9876 After hours, weekends, and holidays: If you have an urgent dialysis-related concern that cannot wait until the PD Unit is open, please call the main hospital at 206-987-2000. Calls will be forwarded to an operator who can help you to reach the on-call dialysis nurse. For all other medical problems, please contact your primary care provider, kidney doctor or family doctor. For any PD Cycler equipment related concern, please call Baxter Technical Support at 1-800-553-6898. For life threatening emergencies dial 911. 2 Peritoneal Dialysis at Home Table of Contents Starting Peritoneal Dialysis ........................................................ 5 Hand Hygiene ........................................................................... 17 Caring for Your Catheter .......................................................... 29 Safe Treatment ........................................................................ 53 PD Problem-Solving ................................................................. 69 Balancing Fluids ......................................................................101 Dialysis Medicines ....................................................................119 Caregivers ...............................................................................141 Automatic Dialysis with a Cycler Machine Versus Manual Dialysis ......................................................... 153 Seattle Children’s Hospital 3 4 Peritoneal Dialysis at Home Peritoneal Dialysis at Home – Lesson 1 Starting Peritoneal Dialysis In this lesson you will learn: • What healthy kidneys do for your child’s body • The condition of uremia and its symptoms • All about peritoneal dialysis (PD) and a process called Automated Peritoneal Dialysis (APD) • The steps of a peritoneal dialysis cycler or exchange • Lifestyle benefits of APD Seattle Children’s Hospital 5 Lesson 1: Starting Peritoneal Dialysis Words to know APD Automated Peritoneal Dialysis, sometimes called CCPD. CAPD Continuous Ambulatory Peritoneal Dialysis (also known as manual PD). This type of dialysis is done manually. Gravity is used to drain and fill your peritoneal cavity with dialysis solution. Catheter A tube that carries the dialysate into and out of your body. CCPD (APD) Continuous Cyclic Peritoneal Dialysis. This type of dialysis is done with a machine called a cycler. The cycler will automatically drain, fill and dwell the dialysis solution from your peritoneal cavity. Cycler Machine used to do peritoneal dialysis. Dialysate A liquid that has a sugar called dextrose in it to help pull waste and extra fluid into the peritoneal cavity. Dialysis The process of removing waste products and excess fluid from the body. Dwell time The time the dialysis solution sits in your peritoneal cavity. Exchange or cycle The process of draining, filling, and dwelling the dialysis solution from your peritoneal cavity. Peritoneum A layer of tissue covering the wall of the abdominal cavity. The peritoneum is a natural filter and lets waste product and fluid pass from your blood into the dialysis “sugar” solution. Transfer set A 4- or 6-inch length of tubing that attaches to the PD catheter. The transfer set lets the catheter open and close. Ultrafiltrate The fluid that is removed from the bloodstream during dialysis. Uremia Occurs when the kidneys don’t work like they should. The toxins or “waste” build up in the body. 6 Peritoneal Dialysis at Home Lesson 1: Starting Peritoneal Dialysis What do healthy kidneys do? Remove waste Waste products, such as blood urea nitrogen (BUN) and creatinine, are made by the body during normal daily functions. These products are removed from the blood by healthy kidneys. Balance fluid Healthy kidneys know when there is too much or too little fluid in the body. When kidneys are working, they make urine to remove extra fluid your child drinks. If your child has too little fluid in their body from sweating, throwing up, or having diarrhea, the kidneys keep fluid and make less urine. More on this in Lesson 6. Control blood pressure Healthy kidneys help keep the blood pressure in a safe range. They release a signal that tells the body when to raise or lower blood pressure. They also help control blood pressure by balancing the fluid in the body. More on this in Lessons 6 and 7. Make red blood cells Healthy kidneys release a signal that tells the body when to make more red blood cells. More on this in Lesson 7. Balance electrolytes Kidneys play an important role in the regulation (balance) of fluids and electrolytes. When they malfunction it often leads to an electrolyte imbalance. Electrolytes are charged particles involved in sending impulses to nerves and muscles. Excessive amounts of electrolytes are removed from the blood by healthy kidneys. Maintain healthy bones Healthy kidneys remove extra phosphorus (foss-for-us) from the blood and take it out of the body in the urine. Too much phosphorus causes low calcium. Low calcium leads to weak, brittle bones. Keeping phosphorus levels normal keeps calcium levels normal, so bones stay strong and healthy. Kidneys also make vitamin D, which helps your body to absorb calcium from food. Growth and development Many things in the body affect your child’s growth and development. These include acids, bases, minerals, hormones and proteins. Healthy kidneys make sure these stay balanced so that children can grow and develop normally. Seattle Children’s Hospital 7 Lesson 1: Starting Peritoneal Dialysis What is uremia? The kidneys filter waste from the blood. When the kidneys are not working well, they do not filter the blood and wastes build up in the blood causing a condition called uremia. Symptoms of uremia are: Tiredness/ Loss of appetite weakness Difficulty Bad taste in mouth concentrating in school Nausea/vomiting (throwing up) Dialysis will help relieve the symptoms of urea. What is peritoneal dialysis? During peritoneal dialysis (PD) your child’s blood is filtered and extra fluid is removed. During PD, a cleansing fluid called dialysate is circulated through a tube (catheter) inside part of your abdominal cavity (peritoneal cavity). The dialysate absorbs waste products from the blood vessels in your abdominal lining (peritoneum) and then is drawn back out of your body and discarded. Imagine watching a teabag as the tea particles spread out through the water. A teabag steeping in water is like what happens during PD. The tea bag is the peritoneal membrane, the tea leaves are the blood vessels, the tea color that makes the tea is the waste in the blood vessels, and the water is the dialysate solution. This process is called diffusion. 8 Peritoneal Dialysis at Home Lesson 1: Starting Peritoneal Dialysis Tea leaves inside the tea bag (blood vessels) Tea bag steeping in water (peritoneal membrane) Water (dialysate Tea color (waste in solution) the blood vessels) You will hear some medical terms used when learning how dialysis works. These are some of the medical terms the team may use: Peritoneal membrane • The lining on the inside of your child’s abdomen between the abdominal wall and internal organs. It contains a lot of blood vessels. • Acts as a natural filter. • Allows waste products and excess fluid to pass into the dialysate solution. Osmosis • The movement of extra fluid from the bloodstream, across the peritoneal membrane, and into the dialysate solution to be drained. • The fluid that is removed is called ultrafiltrate (UF). • The amount of ultrafiltrate (UF) is determined by the concentration of the dialysate solution used. • PD does not remove a set amount of fluid each treatment. Diffusion • The movement of waste products from the bloodstream, across the peritoneal membrane, and into the dialysate fluid to be removed. • The waste moves from the bloodstream where there is a high concentration of particles to the dialysate solution where there is a low concentration of particles. It is through osmosis and diffusion using the peritoneal membrane and dialysate solution that dialysis removes wastes and fluids. Osmosis and diffusion are slow, gentle processes that your child will not feel. The processes stop on their own when each side of the peritoneal membrane is balanced. Seattle Children’s Hospital 9 Lesson 1: Starting Peritoneal Dialysis What is a peritoneal dialysis catheter? • The catheter is a small, flexible tube. It is surgically placed through the wall of the belly area (abdomen) into a space called the peritoneal cavity. The peritoneal cavity holds the abdominal organs. • The lining of the peritoneal cavity is called the peritoneal membrane. • Many blood vessels run throughout this peritoneal membrane. • PD uses the peritoneal membrane, along with dialysate fluid, to filter and clean waste products and extra fluid from the blood. The blood is from the blood vessels along the peritoneal membrane wall. • The catheter allows dialysate fluid to go in and out of the peritoneal cavity during a PD exchange. • A peritoneal dialysis catheter is your child’s permanent access for PD treatments. Internal organs Peritoneal
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