Continuous Ambulatory Peritoneal Dialysis

What is continuous ambulatory peritoneal dialysis?

• 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.

Why do I need CAPD?

• CAPD may be needed if your kidneys are not working well, or if they have stopped working. Your kidneys may have been hurt by chemicals, medicines, diabetes, heart problems, infection, or smoking. The work of the kidneys includes removing wastes and extra fluid from your blood. These harmful substances leave your body in your urine. When your kidneys are damaged they cannot do this work. Toxic body wastes, substances, and fluids will build up, causing serious problems in your body.
  
  
• You may need CAPD when you have acute (short-term) or chronic (long-term) kidney failure. During acute kidney failure, you may only need CAPD until your kidneys get better. If you have chronic kidney failure, you will need to have dialysis exchanges for the rest of your life.

How is a CAPD catheter put in?

Medicine will be given to make you relax and decrease 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 in and pushed all the way inside your abdomen. In certain cases, the end of the catheter may be put in just under your skin for 3 to 5 weeks. Your caregiver will put 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.

How are CAPD exchanges done?

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.

How do I clean my 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.

What is automated peritoneal dialysis?

Automated peritoneal dialysis (APD) is a type of dialysis which uses a machine called a cycler. It helps put the dialysate in your abdomen, and helps drain it out after. With APD, you may do one exchange where you let the dialysate dwell in your abdomen during the day. At night, you can connect your catheter to the cycler. Peritoneal dialysis exchanges will be done while you are asleep. If you sleep for 8 to 9 hours, the machine may do 3 to 5 exchanges during that time. With APD, you do not need to stop what you are doing during the day to do an exchange. Ask your caregiver for more information about APD.

Should I change my diet when I need to have CAPD exchanges?

• 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.

What are the risks of having a peritoneal dialysis catheter, and CAPD exchanges?

• 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.

When should I call my caregiver?

Call your 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.

When should I seek immediate help?

Seek care immediately or call 911 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.

Where can I find support and more information?

Accepting that you need CAPD exchanges may be hard. Doing CAPD every day may be hard for you and your family. You and those close to you may feel angry, sad, or scared. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Ask caregivers to help your family learn how to support a person who needs CAPD. Contact any of the following:

• American Association of Kidney Patients
  3505 E. Frontage Rd, Suite 315
  Tampa , FL 33607-1796
  Phone: 1- 800 - 749-2257
  Web Address: http://aakp.org
  

• National Kidney Foundation
  30 East 33rd Street
  New York , NY 10016
  Phone: 1- 212 - 889-2210
  Phone: 1- 800 - 622-9010
  Web Address: http://www.kidney.org
  

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.