ASSIGNMENT ON CONTINUOUS

AMBULATORY PERITONEAL
DIALYSIS & CONTINUOUS
ARTERIOVENOUS HEMODIALYSIS

SUBMITTED TO, SUBMITTED BY,

MS. Shuman Sanhati Banerjee
PG Tutor M.Sc Nursing Final Year
IQ City Institute Of Nursing Sciences IQ City Institute Of
Durgapur Nursing Sciences,
Durgapur
SUBMITTED ON, 21/12/12
 INTRODUCTION
The kidneys filter your blood by removing waste and excess fluid from your body.
This waste is sent to the bladder to be eliminated when you urinate.

Dialysis performs the function of the kidneys if they’ve failed. According to the
National Kidney Foundation, end-stage kidney failure occurs when the kidneys are

performing at only 10 to 15 percent of their normal function.

Dialysis is a treatment that filters and purifies the blood using a machine. This
helps keep your fluids and electrolytes in balance when the kidneys can’t do their
job.

Dialysis has been used since the 1940s to treat people with kidney problems.
 DEFINITION
Dialysis is the procedure used to correct fluid and electrolyte imbalances and to
remove waste products in renal failure.

TYPES OF DIALYSIS
There are two types of dialysis –
a) Hemodialysis
b) Peritoneal dialysis
1.Hemodialysis: In hemodialysis, an artificial kidney (hemodialyzer) is
used to remove waste and extra chemicals and fluid from your blood. To
get your blood into the artificial kidney, the doctor needs to make an
access (entrance) into your blood vessels. This is done by minor surgery
to your arm or leg .Sometimes, an access is made by joining an artery to
a vein under your skin to make a bigger blood vessel called a fistula
.However, if your blood vessels are not adequate for a fistula, the doctor
may use a soft plastic tube to join an artery and a vein under your skin.
This is called a graft. Occasionally, an access is made by means of a
narrow plastic tube, called a catheter, which is inserted into a large vein
in your neck. This type of access may be temporary, but is sometimes
used for long-term treatment.
2.Peritoneal dialysis: In this type of dialysis, your blood is cleaned
inside your body. The doctor will do surgery to place a plastic tube
called a catheter into your abdomen (belly) to make an access. During
the treatment, your abdominal area (called the peritoneal cavity) is
slowly filled with dialysate through the catheter. The blood stays in the
arteries and veins that line your peritoneal cavity. Extra fluid and waste
products are drawn out of your blood and into the dialysate. There are
several kinds of peritoneal dialysis but two major ones are:
 i. Continuous Ambulatory Peritoneal Dialysis (CAPD)
ii. Automated Peritoneal Dialysis (APD).
Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of
peritoneal dialysis that is done without machines. You do this yourself,
usually four or five times a day at home and/or at work. You put a bag of
dialysate (about two quarts) into your peritoneal cavity through the
catheter. The dialysate stays there for about four or five hours before it is
drained back into the bag and thrown away. This is called an exchange.
You use a new bag of dialysate each time you do an exchange. While the
dialysate is in your peritoneal cavity, you can go about your usual
activities at work, at school or at home.
Automated Peritoneal Dialysis (APD) usually is done at home using a
special machine called a cycler. This is similar to CAPD except that a
number of cycles (exchanges) occur. Each cycle usually lasts 1-1/2
hours and exchanges are done throughout the night while you sleep.

A)HEMODIALYSIS
With hemodialysis, a machine removes blood from your body, filters it through a
dialyzer (artificial kidney) and returns the cleaned blood to your body. This 3- to 5-
hour process may take place in a hospital or a dialysis center three times a week.

You can also do hemodialysis at home. You may need at-home treatments four to
seven times per week for fewer hours each session. You may choose to do home
hemodialysis at night while you sleep.
PRE-PROCEDURE

Before you start hemodialysis, you’ll undergo a minor surgical procedure to make
it easier to access the bloodstream. You may have:

Arteriovenous fistula (AV fistula): A surgeon connects an artery and vein in your
arm.
Arteriovenous graft (AV graft): If the artery and vein are too short to connect, your
surgeon will use a graft (soft, hollow tube) to connect the artery and vein.

AV fistulas and grafts enlarge the connected artery and vein, which makes dialysis
access easier. They also help blood flow in and out of your body faster.

If dialysis needs to happen quickly, your provider may place a catheter (thin tube)
into a vein in your neck, chest or leg for temporary access.

Your provider will teach you how to prevent infections in your fistula or graft. This
provider will also show you how to do hemodialysis at home if you choose to do
so.

DURING PROCEDURE

During hemodialysis, the dialysis machine:

Removes blood from a needle in your arm.

Circulates the blood through the dialyzer filter, which moves waste into a dialysis
solution. This cleansing liquid contains water, salt and other additives.

Returns filtered blood to your body through a different needle in your arm.

Monitors your blood pressure to adjust how fast blood flows in and out of your
body.
POST PROCEDURE

Some people experience low blood pressure during or immediately after

hemodialysis. You may feel nauseous, dizzy or faint.

Other side effects of hemodialysis include:

Chest pain or back pain.

Headaches.

Itchy skin.

Muscle cramps.

Restless legs syndrome.

B)PERITONEAL DIALYSIS
With peritoneal dialysis, tiny blood vessels inside the abdominal lining
(peritoneum) filter blood through the aid of a dialysis solution. This solution is a
type of cleansing liquid that contains water, salt and other additives.Peritoneal
dialysis takes place at home. There are two ways to do this treatment:

a)Automated peritoneal dialysis uses a machine called a cycler.

b)Continuous ambulatory peritoneal dialysis (CAPD) takes place manually.

PRE PROCEDURE
About three weeks before you start peritoneal dialysis, you’ll have a minor surgical
procedure. A surgeon inserts a soft, thin tube (catheter) through your belly and into
the peritoneum. This catheter stays in place permanently.

A healthcare provider will teach you how to perform peritoneal dialysis at home
and prevent infections at the catheter site.

DURING PROCEDURE

During peritoneal dialysis, you:

Connect the catheter to one branch of a Y-shaped tube. This tube connects to a bag
that has dialysis solution. The solution flows through the tube and catheter into the
peritoneal cavity.

Disconnect the tube and catheter after about 10 minutes, when the bag is empty.

Cap off the catheter.

Go about your usual activities while the dialysis solution inside the peritoneal
cavity absorbs waste and extra fluids from the body. This process can take 60 to 90
minutes.

Remove the cap from the catheter and use the other branch of the Y-shaped tube to
drain the fluid into a clean, empty bag.

Repeat these steps up to four times a day. You sleep with the solution in your
stomach all night.

Some people prefer to do peritoneal dialysis at night. With automated peritoneal

dialysis, a machine called a cycler pumps the fluid in and out of the body while
you sleep.
POST PROCEDURE

The liquid in your belly can make you feel bloated or full. It might feel
uncomfortable, but the treatment isn’t painful. Your stomach may stick out more
than usual when it’s filled with fluid.

COMPLICATIONS
COMPLICATIONS OF HEMODIALYSIS

Some people have problems with the AV fistula or graft. You may develop an
infection, poor blood flow or a blockage from scar tissue or a blood clot.

Rarely, the dialysis needle comes out of your arm, or a tube comes out of the
machine, during dialysis. A blood leak detection system alerts you or the medical
staff to this problem. The machine temporarily shuts off until someone fixes the
problem. This system protects you from blood loss.

COMPLICATIONS OF PERITONEAL DIALYSIS

Some people develop skin infections around the catheter. You’re also at risk for
peritonitis, an infection that occurs when bacteria get inside the abdomen through
the catheter. You may experience fever, abdominal pain, nausea and vomiting.

Using the abdominal catheter and pumping your belly full of fluid can weaken
abdominal muscles over time. You may develop a hernia. This condition occurs
when an organ like the small intestine pokes through the abdominal muscles. You
may feel a bulge near the belly button or in the groin area between the abdomen
and upper thigh. Your doctor can repair a hernia with surgery.

During peritoneal dialysis, your body absorbs dextrose, a sugar, from the dialysis
solution. Over time, this extra sugar can lead to weight gain.
 SUMMARY
If your kidney disease becomes very severe and crosses a point where there’s not
enough function to maintain the body, then you need either a transplant or
dialysis.You typically start dialysis when you have symptoms or your lab tests
show toxic levels of waste in your blood. Symptoms of kidney failure include
nausea, fatigue, swelling, and throwing up. When you should start dialysis depends
on your age, energy level, overall health, lab test results and how willing you are to
commit to a treatment plan. Although it can make you feel better and live longer, it
involves a lot of your time.Your doctor will let you know when you should start
treatment. They’ll also explain which type might work best for you.

CONCLUSION
Here I conclude the topic dialysis. In this topic I have discussed about definition
and different types of dialysis, procedure of hemodialysis and peritoneal dialysis ,
complications of dialysis. Dialysis is the filtration of the blood while the kidneys
are not able to function properly. Sometimes by renal rehabilitation only the
patient can recover from chronic kidney disease but sometimes they requires
dialysis.

BIBLIOGRAPHY
a) https://medlineplus.gov/dialysis.html
b) https://www.healthline.com/health/dialysis
c) https://www.kidney.org/atoz/content/dialysisinfo
d) https://my.clevelandclinic.org/health/treatments/14618-dialysis