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.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• During catheter insertion, you may bleed more than expected and lose a lot of blood. Your wound may not heal well and your catheter may not work as it should. You may need to have it removed or replaced. During CAPD, you may feel pain in your back and stomach. You may lose your appetite, lose weight, and feel weak. You may have high sugar and cholesterol levels in your blood. Having the CAPD catheter increases your risk of getting an infection on your skin or in your abdomen.
  
  
• If you do not have a CAPD catheter put in, you will not be able to do CAPD exchanges. If you do not have these exchanges, symptoms from kidney problems will get worse and stay longer. Wastes, chemicals, and extra water will build up in your body. You will feel very tired and weak. You may be confused, and lose your memory. Your arms, legs, and face will swell up. Your blood pressure may increase higher, and you may have trouble breathing. You may lose consciousness (go into a coma) and even die.

Getting Ready

The week before your procedure:

• Ask a family member or friend to drive you home after your procedure. Do not drive yourself home.
  
  
• A test called a nasal swab culture may be done to check for germs in your nose. Your caregiver will take a sample from your nose using a cotton swab and send it to a lab. The lab will test the sample for germs. Having certain germs in your nose increases your risk of getting infections when you have a CAPD catheter. Caregivers may give you antibiotic (germ-killing) medicine to decrease your risk for infection.
  
  
• Tests such as the peritoneal equilibration test (PET) may be done. This is a test done to check if your peritoneum can filter wastes, extra fluid, sugar and salt. Ask your caregiver for more information about this and other tests that you may need. Write down the date, time and location of each test.
  
  
• Caregivers may teach you and your family things you need to know about kidney failure, and the procedure to place the CAPD catheter. Your caregiver will teach you and your family how to do CAPD. You will learn how to prepare and use the supplies and equipment. You will also learn what to do if you have problems during the exchanges.

The night before your procedure:

• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.
  
  
• Bowel preparation: You may be given medicine to empty out your intestines (bowels) before your procedure.
  
  
• Ask caregivers about directions for eating and drinking.

The day of your procedure:

• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• You will be asked to bathe or have a shower. Any hair on your stomach will trimmed. Your caregiver will mark the best place on your abdomen to put in your catheter.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

Medicine will be given to make you relax and decrease your pain. Your caregiver will make a cut below or beside your belly button, or just below your ribs. He will cut through muscles and tissues to make a hole where the catheter will be placed. A catheter will be put into the cut and then pushed all the way inside your abdomen. In some cases, the end of the catheter may be placed and left just under your skin for 3 to 5 weeks. Your caregiver will put some liquid through the catheter to check if it works well. He may also put blood thinner medicine in it to help prevent your catheter from getting clogged. The catheter is held in place with stitches, and the area is covered with bandages.

After your procedure:

You may be taken to a room where caregivers will watch your for a time. Do not try to get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you may be taken to a hospital room, or be sent home. The bandages covering your abdomen will keep the area clean and dry. Caregivers will check the area and change your bandages.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You have a fever.
  
  
• You are quickly gaining weight.
  
  
• Your arms, legs, or face are swelling up.

Seek Care Immediately if

• You have new feelings of confusion and are unable to remember things.
  
  
• You lose consciousness.
  
  
• You suddenly have chest pain and trouble breathing.

Learn more about Continuous Ambulatory Peritoneal Dialysis (Precare)