In peritoneal dialysis, the dialyzer is the abdominal cavity. Blood transferred through its vessels is dialyzed by a catheter installed through a straight abdominal wall. The membrane of the procedure is the intestinal mucosa, which covers all organs and systems. As a result, peritoneal dialysis proceeds in much the same way as in an artificial dialyzer.
Features
The peritoneal type of purification has a low power. To achieve the necessary purification, the process must occur around the clock. For this, the presence of a special solution is necessary in the abdominal cavity. After a few hours, it is saturated with slag, after which it is changed to fresh.
Peritoneal dialysis works continuously, around the clock, like our kidneys. This option allows you to reduce the burden on the cardiovascular system, maintain kidney function. The solution is changed four times a day, but for the convenience of patients, time is divided unevenly. Daytime replacement solutions can be biased for a more comfortable life for the patient. Although for a greater effect, it is recommended to strive for uniform fill.
Typically, peritoneal dialysis is done at home or on an outpatient basis. You need to visit the clinic only in order to undergo follow-up examinations - usually a doctor is visited up to two times a month.
Equipment
To carry out blood purification, you must have certain equipment.
- Table. Its surface should be flat. It is best to put an oilcloth on, as you will constantly have to use alcohol solutions, antiseptics, from which the surface can deteriorate.
- Stand for hanging the drug. Wall mounted hooks can be used to suspend peritoneal dialysis 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, allowing to determine the weight of solution bags. It is better to use scales up to five kilograms, as they are more accurate.
- Device for measuring blood pressure.
- Thermometer for measuring body temperature.
- Towel.
Solutions
Different solutions are used for blood purification, mainly based on glucose and lactate, but there are other drugs.
- Extranil. A solution that helps maintain excellent filtration, protecting the peritoneum from concentrated solutions. Usually this substance is used once a day.
- Nutrinyl. Designed to provide amino acids for malnutrition, protein deficiency. The solution is applied once a day instead of one of the usual fillings.
- Bicarbonate-based solutions (instead of lactate). They are used as buffers. This tool 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 dialysis.
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 using a cuff. The tube is installed under local anesthesia, less often under general anesthesia.
After suturing the catheter, at least two weeks pass before the first procedure. During this period, the cuff grows in order to fix the tube more efficiently.
Manual dialysis
There are two types of dialysis: automatic and manual. For the latter, no additional equipment is needed. For this procedure, you need two containers and wire tubes.
As a solution for dialysis, glucose is used. In some cases, additional substances are introduced into it.
The process of blood purification occurs inside the abdominal cavity. About two liters of fluid is injected through the catheter. Then the tip of the catheter is closed with a cap. The injected fill remains in the body for several hours. Then it is removed, draining through a catheter, and a fresh solution is introduced into the cavity. This whole procedure takes about half an hour. Typically, a patient needs to have up to six treatments per day.
Atomics
The cleaning procedure can be performed 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 dialysis mode. So, its use allows you to free daytime for a normal life, and intensively carry out therapy at night and in the evening. The cycle carries out the exchange of solutions from bags through a line constantly connected to the catheter. Since the solution is constantly fresh, cleaning is more intense. In the morning, the device fills the last portion of the solution, and the patient disconnects from it. When connecting in the evening, the cycler immediately changes the fill and starts to execute the specified program.
Not all patients can use automatic transfusion. For some, it is not enough to replace the solution only at night. For such people, it is recommended to strive for a uniform replacement of the drug.
Indications
The peritoneal type of cleansing is used in patients suffering from chronic renal failure, at a time when the pathology passes into the terminal stage and it is no longer possible to restore kidney function. With this 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 the functioning of the kidneys.
There are a number of indications in which the doctor directs the patient to peritoneal dialysis:
- impaired blood supply to the kidneys;
- in the presence of severe SS diseases related to contraindications for hemodialysis;
- bleeding disorder;
- if the patient refuses hemodialysis.
In children, this type of procedure is prescribed for acute renal failure, with impaired urea metabolism.
Contraindications
Dialysis of the peritoneal type 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
During the procedure, complications may occur. They are infectious and non-infectious types.
The main complications of the infectious type include peritonitis and infection at the site of the tube. Both types of pathology arise due to violation of the rules of antiseptics during the replacement of the fill. If an infection occurs, standard treatment is performed with the use of antimicrobials, washing the abdominal cavity, and stopping dialysis. In some cases, a catheter is removed.
Non-infectious ailments include violations of the work of the highway. This type of complications arises due to a change in the position of the catheter, the appearance of bends. To fix this, the system is flushed, but sometimes surgical intervention may be required.
In rare cases, the solution may leak in or out. In this case, replace the tube with a new one. Right-sided pleurisy may occur even less frequently. This complication is observed when the solution flows into the pleural cavity. To eliminate the problem, reduce the dose of the solution.
Each patient undergoing dialysis should periodically visit a doctor to evaluate the results, and strictly follow all recommendations.