A client is to receive peritoneal dialysis to prepare for the procedure, the nurse should

When you walk into a dialysis center you may see the staff wearing medical “scrubs” and “lab coats." You may wonder, since they're dressed alike, if everyone has the same job. While the health care professionals who take care of you are all specially trained, they all have different jobs. In this series of eight articles we will see how each member has a specific purpose to make up your health care team. Let's start with nurses.

What do nephrology nurses in a hemodialysis center do?

Nurses are caring individuals. After all, that's what they do: provide care. Registered nurses (RNs) who care for patients who have kidney disease are called nephrology nurses. The word nephrology means, “relating to the kidneys.” Nephrology nurses are specially trained and educated to care for patients with kidney disease.

RNs working in a hemodialysis center plan and manage the care patients receive. The nurses responsibilities include:

• checking the patients' vital signs and talking with them to assess their condition
• teaching patients about their disease and its treatment and answering any questions
• overseeing the dialysis treatment from start to finish
• making sure patients are given the correct medications ordered by their doctors
• evaluating patients' reaction to the dialysis treatment and medications
• reviewing the patients' lab work, home medications and activities and letting the doctors know about changes in their patients' conditions
• helping patients follow-up with their transplant center
• supporting the entire care team in delivering quality care in a considerate, respectful manner

What do PD nurses and home hemodialysis nurses do?

Some dialysis patients don't get hemodialysis in a center but perform peritoneal dialysis (PD) at home or hemodialysis at home. These patients also rely on nephrology nurses to plan, coordinate and oversee their care. While many of the responsibilities of the peritoneal dialysis (PD) and home hemodialysis nurse are the same as in-center hemodialysis nurses, there are some differences.

The main duties of the home hemodialysis and PD nurses are to:

• assess the patients' condition
• teach patients how to do peritoneal dialysis or hemodialysis in the home setting
• consider the patients' learning needs and provide education about their treatment
• make a training plan for each patient
• give the patients the medications ordered by their doctors
• evaluate the patients' ability to perform their dialysis treatments and take all doctor-prescribed medications
• help patients follow-up with their transplant center
• review the patients' lab work, home medications and activities and let the doctors know about changes in their patients' conditions

PD and home hemodialysis nurses have excellent teaching skills. They teach their patients how to perform their own treatments at home and give them the knowledge to know what to do if any complications occur during their treatment.

Talk to your nurse

Want to find out why you're feeling a certain way? Have questions about your health? Need an explanation about a doctor's order? Ask your nurse. Each time you go into the center for your dialysis treatment, a nurse will talk to you to find out how you're feeling. This is a good time to ask all of your questions so you can get the answers you need.

Are you interested in being a DaVita nurse?

Many dialysis nurses find their jobs very rewarding because they get to provide treatment for the same patients regularly and follow their care over time. Patients also report that they appreciate being treated by RNs who know their condition and with whom they have developed a bond.

Another perk for dialysis nurses may be that many hemodialysis centers are closed on Sunday because of the Monday-Wednesday-Friday and Tuesday-Thursday-Saturday dialysis schedule. Even though some patients dialyze in the wee hours of the morning and others go into the late evening, there isn't an over night shift that has to be covered, which allows for more reasonable work hours.

DaVita would like to talk to you if you:

• have an RN license from the state where you work
• have a CPR certification
• are a Certified Nephrology Nurse (CNN) or Certified Dialysis Nurse (CDN) (desired)
• have hemodialysis or peritoneal experience (preferred)
• are willing to be trained and educated in the care of patients with kidney disease (if you have a nursing background, DaVita offers training)
• have a strong work ethic, enjoy intellectual challenges and work well in a team-focused environment

Find out more about a nursing career with DaVita

Overview

Peritoneal dialysis (per-ih-toe-NEE-ul die-AL-uh-sis) is a way to remove waste products from your blood when your kidneys can't adequately do the job any longer. This procedure filters the blood in a different way than does the more common blood-filtering procedure called hemodialysis.

During peritoneal dialysis, a cleansing fluid flows through a tube (catheter) into part of your abdomen. The lining of your abdomen (peritoneum) acts as a filter and removes waste products from your blood. After a set period of time, the fluid with the filtered waste products flows out of your abdomen and is discarded.

These treatments can be done at home, at work or while traveling. But peritoneal dialysis isn't an option for everyone with kidney failure. You need manual dexterity and the ability to care for yourself at home, or you need a reliable caregiver.

Why it's done

You need dialysis if your kidneys no longer function well enough. Kidney damage generally progresses over a number of years as a result of long-term conditions, such as:

• Diabetes
• High blood pressure
• Kidney inflammation (glomerulonephritis)
• Multiple cysts in the kidneys (polycystic kidney disease)

In hemodialysis, blood is removed from the body, filtered through a machine and then the filtered blood is returned to the body. Hemodialysis is typically done in a health care setting, such as a dialysis center or hospital, though it can sometimes be done at home.

Although both types of dialysis can effectively filter your blood, the benefits of peritoneal dialysis compared with hemodialysis include:

• Greater lifestyle flexibility and independence. These can be especially important if you work, travel or live far from a hemodialysis center.
• A less restricted diet. Peritoneal dialysis is done more continuously than hemodialysis, resulting in less accumulation of potassium, sodium and fluid. This allows you to have a more flexible diet than you could have on hemodialysis.
• Longer lasting residual kidney function. People who use peritoneal dialysis might retain kidney function slightly longer than people who use hemodialysis.

Talk with your doctor about which type of dialysis might be best for you. Factors to consider include:

• Your kidney function
• Your overall health
• Your personal preferences
• Your home situation
• Your lifestyle

Peritoneal dialysis may be the better option if you:

• Can't tolerate the rapid changes of fluid balance associated with hemodialysis
• Want to minimize the disruption of your daily activities
• Want to work or travel more easily
• Have some residual kidney function

Peritoneal dialysis might not work if you have:

• Extensive surgical scars in your abdomen
• A large area of weakened abdominal muscle (hernia)
• Limited ability to care for yourself, or a lack of caregiving support
• Inflammatory bowel disease or frequent bouts of diverticulitis

It's also likely that people using peritoneal dialysis will eventually have a decline in kidney function that requires hemodialysis or a kidney transplant.

Risks

Complications of peritoneal dialysis can include:

• Infections. An infection of the abdominal lining (peritonitis) is a common complication of peritoneal dialysis. An infection can also develop at the site where the catheter is inserted to carry the cleansing fluid (dialysate) into and out of your abdomen. The risk of infection is greater if the person doing the dialysis isn't adequately trained.
• Weight gain. The dialysate contains sugar (dextrose). Absorbing some of the dialysate might cause you to take in hundreds of extra calories daily, leading to weight gain. The extra calories can also cause high blood sugar, especially if you have diabetes.
• Hernia. Holding fluid in your abdomen for long periods may strain your muscles.
• Inadequate dialysis. Peritoneal dialysis can become ineffective after several years. You might need to switch to hemodialysis.

If you have peritoneal dialysis, you'll need to avoid:

• Certain prescription and over-the-counter medications that can damage your kidneys, including nonsteroidal anti-inflammatory drugs.
• Soaking in a bath or hot tub, or swimming in a lake, pond, river or nonchlorinated pool — which increases the risk of infection. Showers and swimming in a chlorinated pool are generally acceptable.

How you prepare

You'll need an operation to insert the catheter that carries the dialysate in and out of your abdomen. The insertion might be done under local or general anesthesia. The tube is usually inserted near your bellybutton.

After the tube is inserted, your doctor will probably recommend waiting up to a month before starting peritoneal dialysis treatments to give the catheter site time to heal.

You'll also receive training on how to use the peritoneal dialysis equipment.

What you can expect

During peritoneal dialysis:

• The dialysate flows into your abdomen and stays there for a prescribed period of time (dwell time) — usually four to six hours
• Dextrose in the dialysate helps filter waste, chemicals and extra fluid in your blood from tiny blood vessels in the lining of your abdominal cavity
• When the dwell time is over, the solution — along with waste products drawn from your blood — drains into a sterile collection bag

The process of filling and then draining your abdomen is called an exchange. Different methods of peritoneal dialysis have different schedules of exchange. The two main schedules are:

• Continuous ambulatory peritoneal dialysis (CAPD)
• Continuous cycling peritoneal dialysis (CCPD)

Continuous ambulatory peritoneal dialysis (CAPD)

You fill your abdomen with dialysate, let it remain there for a prescribed dwell time, then drain the fluid. Gravity moves the fluid through the catheter and into and out of your abdomen.

With CAPD:

• You may need three to five exchanges during the day and one with a longer dwell time while you sleep
• You can do the exchanges at home, work or any clean place
• You're free to go about your normal activities while the dialysate dwells in your abdomen

Continuous cycling peritoneal dialysis (CCPD)

Also known as automated peritoneal dialysis (APD), this method uses a machine (automated cycler) that performs multiple exchanges at night while you sleep. The cycler automatically fills your abdomen with dialysate, allows it to dwell there and then drains it to a sterile bag that you empty in the morning.

With CCPD:

• You must remain attached to the machine for about 10 to 12 hours at night.
• You aren't connected to the machine during the day. But in the morning you begin one exchange with a dwell time that lasts the entire day.
• You might have a lower risk of peritonitis because you connect and disconnect to the dialysis equipment less frequently than you do with CAPD.

To determine the method of exchange that's best for you, your doctor will consider your medical condition, lifestyle and personal preferences. Your doctor might suggest certain modifications to individualize your program.

Results

Many factors affect how well peritoneal dialysis works in removing wastes and extra fluid from your blood. These factors include:

• Your size
• How quickly your peritoneum filters waste
• How much dialysis solution you use
• The number of daily exchanges
• Length of dwell times
• The concentration of sugar in the dialysis solution

To check if your dialysis is removing enough waste products, your doctor is likely to recommend tests, such as:

• Peritoneal equilibration test (PET). This test compares samples of your blood and your dialysis solution during an exchange. The results indicate whether waste toxins pass quickly or slowly from your blood into the dialysate. That information helps determine whether your dialysis would be improved if the solution stayed in your abdomen for a shorter or longer time.
• Clearance test. A blood sample and a sample of used dialysis solution are analyzed to determine how much of a certain waste product (urea) is being removed from your blood during dialysis. If you still produce urine, your doctor may also take a urine sample to measure its urea concentration.

If the test results show that your dialysis schedule is not removing enough wastes, your doctor might change your dialysis routine to:

• Increase the number of exchanges
• Increase the amount of dialysate you use for each exchange
• Use a dialysate with a higher concentration of dextrose

You can improve your dialysis results and your overall health by eating the right foods, including foods low in sodium and phosphorus. A dietitian can help you develop an individualized meal plan. Your diet will be based on your weight, your personal preferences, and your remaining kidney function and other medical conditions, such as diabetes or high blood pressure.

Taking your medications as prescribed also is important for getting the best possible results. While receiving peritoneal dialysis, you'll likely need various medications to control your blood pressure, stimulate production of red blood cells, control the levels of certain nutrients in your blood and prevent the buildup of phosphorus in your blood.

What are the steps for peritoneal dialysis?

What is a patient receiving peritoneal dialysis at risk for?

Why does peritoneal dialysis need to be done 4 times a day?

Which criteria is required before a patient can be considered for continuous peritoneal dialysis?