Peritoneal Dialysis: Working on the inside

Peritoneal Access example with catheter shown on a stomach

Peritoneal Dialysis (PD)

Peritoneal dialysis is another form of dialysis used to remove waste products, toxins and excess fluid from the body, using blood vessels in the lining of your abdomen - your peritoneum -  as a filter of waste from your blood. Each treatment is called an exchange.


2 Choices in Peritoneal Dialysis 

There are two choices in Peritoneal Dialysis:  Continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD)

Both choices have pros and cons. Some people like the flexibility of doing manual exchanges throughout the day and for ease when travelling. Others prefer their dialysis during their sleep.  

A Cavity in Your Abdomen

In peritoneal dialysis, the inside of your abdomen—your peritoneal cavity—is filled with a special dialysis fluid that looks like water called Dialysate.  The dialysis fluid exposes blood vessels in the peritoneum to the fluid.  


Dialysis fluid enters the peritoneal cavity through a tube called a catheter. The catheter is surgically inserted in your abdomen, usually below and to one side of your navel and stays there as long as you are using this form of dialysis.

How a Peritoneal Machine Works with You

1.  Control Panel

This is where the programming takes place for your treatment. You can start, pause and stop treatments as needed. There are step-by-step instructions that you follow through the whole treatment process.

2.  Solution support

This is where all your bags of dialysate that you will need for one treatment process.  You will have exactly which strength of solution you require.

3.  The Heater Tray

This is where your dialysate is warmed to the correct temperature to go into the body. There is also a scale that tells the cycler how much fluid is going in so it's sure to drain the right amount and prevents the machine from pumping where there is no solution left.

4.  The Heater Bag

The cycler pumps dialysate into the heater bag and keeps it there until the correct temperature is reached for your next fill.

5.  Pump and Tubes

The pumps and tubes connect to the machine, solution bags, your catheter and the drain line. The machine open and closes the tubes and pumps the correct fluids in the right direction with each exchanged.

6.  Used Dialysate

Used dialysate solution drains from your body through the catheter that is attached to the drain line which   The discarded solution discharges directly to a drain, toilet or drain bag.  

Common Questions

What is dwell time?

Dwell time is the time that dialysate stays in your abdomen during your dialysis session. There are several factors your Nephrologist takes into account in determining how many exchanges you are to do each day and for how long. Even shortening your dwell time by even a few minutes will make the dialysis less effective. 

What does peritoneal dialysis solution do?

Peritoneal dialysis solution called dialysate is the fluid used to absorb waste products, toxins and extra fluids from the body using the lining of the peritoneum.


The waste, toxins and fluid are then removed from your body during dialysis, leaving the right amounts of electrolytes and nutrients in your blood for your body to use. There are different strengths of dialysate depending on your body’s needs. Your nephrologist will prescribe the strength that is right for you.

What is peritoneal dialysis solution made of?

Peritoneal dialysis solution is called Dialysate and is made of water and electrolytes. The electrolytes are mostly salts and sugar that are naturally found in your body.  

Peritoneal Dialysis Machine

Access for Peritoneal Catheter

A flexible, plastic tube called a Peritoneal Dialysis (PD) catheter is surgically placed in your lower abdomen by a surgeon.


The bottom part of the catheter stays inside your body in the peritoneal cavity. The top portion of the catheter remains outside of your body, about two to four inches from the exit site.

Peritoneal dialysis catheter system for home dialysis

Continuous ambulatory peritoneal dialysis

Also called an exchange which takes place four times per day around the time of breakfast, lunch, dinner and bed time.  Each exchange takes about 40 minutes.

A typical process:

  1. 1
    Connect your PD access to a disposable exchange set
  2. 2
    Drain out used dialysis fluid (dialysate) into a bag
  3. 3
    Fill from the bag of fresh solution
  4. 4
    Disconnect, discard bags and tubing
  5. 5
    The dialysate stays in you until the next exchange

The two sides of Peritoneal Dialysis

Strengths

  • Relieves symptoms of uremia
  • Makes it easier to travel
  • Frees you from in hospital treatments
  • Allows you a bit more of liberal diet
  • Less stressful on your body because dialysis is done continuously (i.e. daily) versus intermittently (i.e. three times per week)
  • Gives you greater flexibility with your treatment

Keep in Mind

No matter the choice in your dialysis treatment, it is paramount that you keep the communications open with your medical support team and your family, as it is natural to feel overwhelmed and scared.


Stay calm, stay positive and keep the channels open in expressing your feelings and concerns.

Limitations

  • Permanent catheter in your abdomen
  • Possibility of peritonitis (infection of your peritoneal cavity) which can be life threatening
  • Dialysis must be a daily part of your life
  • You will have to take medications
  • You will need to learn new food choices
  • You will need to prevent the catheter from getting wet - no swimming or full body showering
  • You must meet the need of designated space in your home to allow for regular delivery of supplies - usually 49 boxes every two weeks
  • You must go through training to learn how to hook-up and discount yourself from the machine
  • No pets can be in the room while you are receiving your treatment i.e: no dog sleeping on bed

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