Continuous Ambulatory Peritoneal Dialysis

WHAT YOU SHOULD KNOW:

• Continuous ambulatory peritoneal dialysis (CAPD) is done to remove wastes, chemicals, and extra fluid from your body. The peritoneum is a thin lining on the inside of your abdomen (stomach), and some other organs. During CAPD, a liquid called dialysate is put into your abdomen. It is put in through a CAPD catheter. The catheter is a tube that goes from the outside, to the inside of your abdomen. The dialysate pulls wastes and substances from your blood and lymph fluid through the peritoneum. The wastes mix with the dialysate. The peritoneum works like a filter as the wastes are pulled through it.
  
  
• The dialysate is left in your abdomen for 3 to 5 hours. This is called the dwell time. After the dwell time, the dialysate is drained out through the catheter. Filling and emptying your abdomen with dialysate is called an exchange. Exchanges may be done 3 to 5 times during the day, and once during the night. CAPD exchanges can decrease or take away problems such as swelling, itching, fatigue, and weakness. CAPD can help decrease high blood pressure, and make you feel more like doing the things you enjoy.

AFTER YOU LEAVE:

Medicines:

• Keep a written list of the medicines you take, the amounts, and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Ask your caregiver for information about your medicine. Do not use any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers.
  
  
• Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment.

• Antibiotics: This medicine is given to fight or prevent an infection caused by bacteria. Always take your antibiotics exactly as ordered by your caregiver. Keep taking this medicine until it is completely gone, even if you feel better. Stopping antibiotics without your caregiver's OK may make the medicine unable to kill all of the germs. Never "save" antibiotics or take leftover antibiotics that were given to you for another illness.
  
  
• Blood pressure medicine: This medicine may be given to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.
  
  
• Diabetes medicine: If you have diabetes, CAPD may cause your blood sugar levels to go higher than usual. Ask your caregiver for help keeping your blood sugar levels within the range they should be. You may need to check your blood sugar levels more often when you are having CAPD exchanges.
  
  
• Vitamins and minerals: Vitamins are removed from your body during CAPD exchanges. It may be hard to eat and drink enough to give your body all the vitamins that it needs. You may need to take iron and folic acid. These medicines help your body make more red blood cells, which can give you more energy.

Ask your caregiver when to return for a follow-up visit. Keep all appointments. Write down any questions you may have. This way you will remember to ask these questions during your next visit.

Doing CAPD exchanges: You may have to wait 14 days or longer after you have your CAPD catheter placed before you can use it. This should give your exit site time to heal. Your caregiver will tell you when it is okay to use your catheter. Do your CAPD exchanges in a well-lit room that has no pets, dander, strong breezes, or fans. Having pets or a breeze blowing in the room may increase your risk of getting an infection.

• Supply list: Collect the following supplies and place them on a clean table close to where you will be doing your CAPD exchange:
  
  
  • Clean water and soap.
    
    
  • Dialysate bag.
    
    
  • Waste product bag.
    
    
  • "Y"-shaped tubing.
    
    
  • IV stand. This is needed so that you can hang your dialysate bag on it. The stand should have a hook at the top to help hold the bag in place. The dialysate fluid drains into your abdomen by gravity. Because of this, the bag needs to be hung up higher than the level of your abdomen.
    
    
  • One pair of disposable (single use) medical gloves.
    
    
  • Medical mask to wear over your face while doing CAPD.
    
    
  • Tubing clamp, and a piece of soft cloth. Use the cloth as padding between the clamp and catheter when you are clamping the catheter tube. This will decrease the chance that the clamp will make a hole or crack in the catheter. Ask your caregiver about other clamps that are less likely to break the catheter or make holes in it.
    
    
  • New plastic syringe without a needle (if needed.)
  
  
• Wash your hands with soap and water: Rub your hands together with soap for at least 15 seconds before rinsing them. Dry your hands with a clean towel or paper towel. Do not touch the tubing or your catheter without washing your hands and wearing gloves.
  
  
• Put on your gloves and mask: Keep your fingernails short and clean. Do not use fake nails. Put on your mask so that it covers your mouth and nose.
  
  
• Flush the tubing: Flushing the tubing with dialysate liquid before doing CAPD may help prevent infections. Connect the lower end of the Y tubing to your catheter, and connect the two other ends of the tubing to the dialysate bag, and the waste bag. Clamp the tubing that is attached to the catheter that goes into your abdomen. This will close off the tubing so that the dialysate does not go into your abdomen yet. Allow 100 milliliters (ml) of fresh dialysate to flow out of the bag, and down the tubing into the waste bag. After this amount of dialysate has drained out, clamp the tubing that drains to the waste bag closed.
  
  
• Let the dialysate flow into your abdomen: Take the clamp off of the tubing that is attached to the catheter that goes into your abdomen. Let the rest of the dialysate flow into your abdomen. This should take no more than 10 minutes. You may lie down, sit, or stand up while the dialysate flows in. After all of the dialysate is in your abdomen, wash your hands and put on new gloves. Disconnect your catheter from the tubing. Clamp your catheter closed. Leave the dialysate in your abdomen for 3 to 5 hours of dwell time.
  
  
• Drain the dialysate out of your abdomen, and into the waste bag:
  
  
  • After the dwell time, follow the steps of washing your hands and putting on your mask. Be sure the supplies that you need are easy to reach and use. Connect the Y tubing to your catheter again. Do this in the same way as you did to put the dialysate into your abdomen. Clamp the tubing that goes to the dialysate bag so that it is closed. Remove the clamps from your catheter and the waste bag. Let the dialysate drain from your abdomen and into the waste bag.
    
    
  • If the dialysate is not flowing out well, change your body position. If this does not make the dialysate flow out better, disconnect the end of the tubing that is attached to your catheter. Use a syringe to gently suck the dialysate out of your abdomen. It should take less than 45 minutes to drain the dialysate out of your abdomen. The dialysate that drains out should be clear in color. After all the dialysate has drained out, close the waste bag and dispose of it as directed by your caregiver. Wash your hands.

Caring for your CAPD catheter and the skin around it: Your catheter must be cleaned after each use. Use soap and water to clean the catheter. Ask your caregiver to show you how to clean your catheter. Keep the catheter clean and dry between each CAPD exchange. The place where your catheter comes out from your abdomen is called the exit site. It should be pink, and have no pus coming out from it. It should be less than 13 mm in size (smaller than a dime.) Check the exit site each day for at least six months after the catheter is placed. Wash your skin using soap and water. Put an new bandage over the exit site every day after you clean the area. Ask your caregiver to show you how to take care of the skin around your exit site.

Diet:

• You may lose weight and become weak when you have CAPD exchanges. You may not feel like eating. Your body may lose protein and other nutrients that you need to be healthy. You may need to increase the fiber in your diet by eating more vegetables and fruits. Fiber helps you have regular soft bowel movements (stools) and helps prevent constipation. Decreasing the amount of salt in your diet may decrease your blood pressure. Ask your caregiver what diet is best for you, and for more information about it.
  
  
• Your caregiver will ask you to limit the amount of liquids you drink. Your caregiver will tell you how much to drink each day. Write down how much liquid you drink each day. Measure the amount of urine you pass each time you go to the bathroom. Show this information to your caregiver when you have follow up visits. He will tell you if you have too much or too little fluid in your body, and what to do to correct it.

Problem solving with a CAPD catheter: Tell your caregiver if you have any of the following problems:

• Hernias (lumps) at your catheter exit site, belly button area, or groin. A hernia is a fluid-filled sac. This sac may be caused by too much dialysate going into your abdomen. Tell your caregiver if you see or feel a new lump on your abdomen.
  
  
• Flow problem: The inflow or outflow of your dialysate may slow or stop completely. This may mean that your catheter is blocked, or is in the wrong place inside your abdomen. Change your body position when doing your dialysis. If this does not work, your catheter may have moved out of place. Tell your caregiver if the dialysate is draining out of your abdomen slower, or if it is not coming out at all.
  
  
• Infection: Yellowish discharge (pus) may come out from the exit site or out of your catheter. The exit site may look red and be painful to touch. You may have a fever and chills, or feel very weak. You may feel sick, or start throwing up. You may be constipated. Tell your caregiver if you get any of these problems.
  
  
• Leaking dialysate from the exit site: You may see dialysate leaking from the exit site for up to a month after you have your catheter put in. You may notice that the dialysate drains out more slowly during exchanges, or there is less of it.
  
  
• Pain: The skin around your exit site may be painful. You may feel pain in your pelvis, low back, and shoulder while doing CAPD exchanges. Change your body position when you are doing your exchanges. Try lying down, sitting, or standing up. Ask your caregiver for exercises that you may be able to do to help decrease back pain.
  
  
• Stomach swelling: You may feel full during and after CAPD exchanges. This feeling may go away over time. If it does not go away, talk to your caregiver.

Removing your CAPD catheter: Your catheter may be used for up to two years if it is not damaged or blocked. Your caregiver may need to remove it if you have an infection or if the catheter has a crack or hole in it. You may also choose to have hemodialysis instead of peritoneal dialysis. Hemodialysis uses your blood vessels in place of a catheter. Your caregiver will remove your catheter if you do not need dialysis exchanges anymore.

CONTACT A CAREGIVER IF:

• Pus or fluid is draining out of the exit site.
  
  
• The dialysate that drains out of your abdomen looks cloudy.
  
  
• The exit site is bigger than it used to be.
  
  
• There is no dialysate flowing out of your abdomen during an exchange, even after changing positions and using a syringe.
  
  
• You have a fever (high body temperature) or chills.
  
  
• You have dull pain in your abdomen while doing a dialysis exchange.
  
  
• There is a new bump that has grown in your abdomen since you have started doing CAPD exchanges.
  
  
• Your catheter exit site is red, tender or painful.
  
  
• You have questions about kidney failure, CAPD, or APD.

SEEK CARE IMMEDIATELY IF:

• You have hard, painful bowel movements and the stool is hard to pass.
  
  
• You have stomach pain, and you are vomiting (throwing up).
  
  
• You have trouble breathing while doing your exchanges.
  
  
• Your catheter has a crack or hole in it, or it has come part or all of the way out of your abdomen.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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