Peritoneal dialysis: indications, procedure( solutions, apparatus), contraindications
Peritoneal dialysis is one of the methods of blood purification( along with hemodialysis), which is used for impaired renal function.Experts consider this procedure in two ways.On the one hand, peritoneal dialysis is only the first stage of substitution treatment for kidney diseases, hemodialysis and even transplantation are used.On the other hand, such blood purification is indispensable when hemodialysis to a patient is strictly contraindicated.
What is peritoneal dialysis?
Peritoneal dialysis refers to this method of purifying blood, when the role of the dialyzer( membrane filter) is the peritoneum.That is dialysis solution, or dialysate, is in the abdominal cavity, there are also procedures for infusion( its infusion) and purification itself.Unlike hemodialysis, this procedure is also recommended for young children.
The sheath has a very intense circulation, three types of substances can pass through it:
- water-soluble compounds and substances with a low molecular weight;
- substance with a large molecular weight.
The peculiarity and advantage of peritoneal dialysis over other similar procedures is the convenience for the patient.There are 2 types of such blood purification, and with any person gets a chance to lead a practically full-fledged way of life: work, study, travel.
It is important only to follow a strict diet and visit the dialysis center on a regular basis to take tests and perform the procedure.And if necessary peritoneal purification of blood can be done even at home.
The video is the essence of hemodialysis and peritoneal dialysis:
Peritoneal dialysis is prescribed for patients with chronic renal failure.When the disease passes into a severe terminal stage and the kidney function can not be restored, dialysis remains the only way to prolong a person's life.In some cases, the situation is still reversible, and several dialysis sessions are sufficient.
There are special indications in which the doctor sends the patient for peritoneal dialysis:
- it is impossible to provide full-blown vascular access( in persons with hypotension, small children, etc.);
- presence of severe cardiovascular diseases, in which hemodialysis can cause dangerous complications;
- impaired coagulation, in which anticoagulants can not be administered - substances that prevent the formation of thrombi;
- individual intolerance of synthetic membrane filters for hemodialysis;
- personal disagreement of the patient on hemodialysis( a person does not want to depend on the apparatus of an "artificial kidney" all his life).
Today in medical practice, two types of peritoneal dialysis are equally often used: manual and automated.The choice of technique depends on several factors: the patient's lifestyle, medical indications and the patient's personal request.
Manual( in a different way - continuous ambulatory peritoneal dialysis, or NAPD).
In this case, the "exchange" - the discharge of a dirty, toxin-filled solution and the infusion of a new portion - occurs during the day, in the hospital( in some cases, at home).Usually this is 4-5 procedures, the exact number is determined by the doctor.Dialysis time can be adjusted depending on the patient's individual schedule: work, occupations, etc.
Automated( automatic peritoneal dialysis, or ADF).
Blood purification occurs at night, the whole procedure takes 8-12 hours.In the ADF, a special "cycler" device is used, which completely regulates the process.In the morning you just need to turn off the device and start your normal day.
Carrying out the procedure
The technology for conducting NADP and ADA is different in many respects, but they have one preparatory stage - the installation of a catheter.
Catheter for both types of dialysis is used quite the same: silicone or porous polyurethane, 30 cm in length, with a diameter - with an ordinary pencil.It is fixed in subcutaneous fat, the denture cuff serves as a fixer( the best option is a catheter with two cuffs).Place the tube under local or general anesthesia.
From the moment of suturing the catheter to the first dialysis procedure, 2-3 weeks should pass.During this time, the cuff will germinate with a connective tissue - this is an additional insurance for the secure attachment of the tube.
No special equipment required for manual dialysis.Only two containers are needed( one with saline solution, the other - empty, the waste liquid drains into it) and wired lines.
As a dialysis solution glucose is used, additional components can be included in the dialysis fluid: amino acids, calcium, etc. The main producers are: German( Fresenius Medical Kea), Irish( Baxter Helskea), etc.
AllThe process of purification of blood occurs directly in the abdominal cavity.First, about 2 liters of dialysate are poured through the catheter for 10-15 minutes, then the end of the catheter is closed with a cap.The liquid remains in the patient's stomach for 4-6 hours.
Then the person comes back to the procedure, and there is an "exchange" - the dirty saline is drained and a fresh portion is injected.It lasts for 30-40 minutes.Usually a patient needs 3-5 procedures a day, all the rest of the time he is free to do his own business.
For the purpose of the ADF, a "cycler" device is required that provides blood purification at night.The device itself is about the size - roughly like a standard case on wheels, it does not take up much space and it can even be taken with you on a trip.
It is not difficult to manage with it: training in the hospital takes about 10 days.The patient simply connects the catheter to the device in the evening, the "cycler" itself calculates the necessary portion of the solution, makes the exchange of liquids and switches off in the morning.
Before disconnecting, pour the daily portion of dialysate into the abdominal cavity.In some cases, you need to connect the "cycle" during the day to produce a drain of the "spent" saline solution.
Peritoneal dialysis in young children
In young children - their calculations of the volume of dialysate and the duration of the cycle of blood purification.
The standard volume of dialysis fluid for babies is from 10-40 ml / kg.The time of pouring and draining( exchange) of the solution is only 5 minutes, at most 10 minutes.The cycle itself should last 1-3 hours( unlike adults 4-6).
The best exchange is fixed when the procedure lasts 1-2 hours.Also it is necessary to conduct 1-2 times a day weight control, measure the fluid balance at each cycle and measure the parameters of respiration, pulse, and pressure every hour.
Although peritoneal dialysis is considered a safer and more gentle procedure than hemodialysis, there are also serious contraindications for it.
Most of them are associated with diseases of the abdominal organs, although there are general prohibitions on dialysis:
- adhesions in the abdominal cavity;
- injury and an increase in internal organs in the area of the procedure( the surface of the peritoneum decreases, the filtration properties fall);
- if this patient has a reduced peritoneal filtration capacity;
- drainage is already installed in the abdominal cavity;
- has purulent skin diseases in the abdominal region;
- obesity( the effectiveness of the procedure decreases);
- mental illness of the patient( in which it is impossible to fully organize dialysis);
- severe heart failure.
Complications of peritoneal dialysis can be divided into 2 groups: infectious and non-infectious.
The main complications of an infectious nature are peritonitis( inflammation of the peritoneum) and infection of the place of insertion of the catheter.The cause of both diseases is non-observance of the rules of antiseptic during the exchange of fluids.Treatment is standard: antibiotics, rinsing of the abdominal cavity, discontinuation of dialysis sessions for a certain period.Sometimes a catheter removal is required.
Non-infectious complications can be as follows:
- Catheter failure when it is impossible to properly drain or pour the solution.The reasons are different: the catheter changes location, curves, it is closed by the intestinal loop, etc. Treatment: washing the tube, replacing, sometimes - surgery.
- Hernia( white abdominal line inguinal and umbilical).Appear because of increased intra-abdominal pressure.
- Leaving the solution outward or inward, into the subcutaneous fatty tissue.Requires replacement of silicone tube.
- Right-sided pleurisy.Occurs when the solution flows into the pleural cavity through the diaphragm.To eliminate the problem, you need to reduce the volume of dialysate.
Diet and hygiene
Today, there are different approaches to nutrition of people with chronic renal failure living on peritoneal dialysis.Therefore, an individual diet should be discussed with the attending physician and dietician.
The general recommendation on nutrition is to reduce the amount of fat, at the beginning of treatment - to adhere to a low-protein diet.Subsequently, the volume of proteins can be increased.It is important to reduce sugar in the diet.
The volume of the daily liquid will have to be reduced: how much - depends on how much fluid needs to be filtered daily.The easiest step to reducing the fluid being drunk is a diet low in salt.
In general, the diet for peritoneal purification of blood is slightly less severe than with hemodialysis: more salt and liquid are allowed, the control of proteins is not so strict.
Another important item is the care of the catheter.Here there are a few simple rules:
- Every day, flush the insertion point of the catheter with antibacterial soap.
- After showering, do not rub the area around the catheter, but only gently to soak.
- If irritation or redness occurs, use antiseptics on the advice of a doctor.
- Always fix the catheter on the skin with a belt - elastic or cotton.
- Discard tight trousers, skirts, waist belts at the point of exit of the catheter.
Peritoneal dialysis has many advantages.The procedure can be carried out by children, it is easy to organize at home, it allows you to maintain the usual rhythm of life.But doctors warn: in due course filtration ability of a peritoneum decreases, therefore in many cases transition to a hemodialysis is inevitable.