Peritoneal Dialysis Catheter Care

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. 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. 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.

INSTRUCTIONS:

Take your medicine as directed:

Call your primary healthcare provider if you think your medicine is not working as expected. Tell him if you are allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs you take. Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

When to do CAPD exchanges:

You and your caregiver will decide how many exchanges you need to do each day. Your caregiver will also discuss which type of PD may be best for you. During continuous ambulatory peritoneal dialysis (CAPD), you may need to do 3 to 5 exchanges during the day, and one exchange during the night. Automated peritoneal dialysis (APD) uses a cycler (special machine) to do your exchanges. One exchange is done during the day, and 3 to 5 exchanges are done during the night while you are asleep.

How to do CAPD exchanges:

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.
    
    
  • 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: Put on your mask so that it covers your mouth and nose. Keep your fingernails short and clean. Do not use fake nails. Put on your gloves, being careful not to touch anything except your supplies while they are on.
  
  
• 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. 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 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 goes 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. 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 and gloves. 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. Throw away the waste bag as directed by your caregiver.

Managing problems with the peritoneal dialysis 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.
  
  
• 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.

Managing dialysate flow problems during peritoneal dialysis exchanges:

When the dialysate is flowing into your abdomen during an exchange (inflow), the flow may slow down or even stop. When the dialysis is draining out of your abdomen during an exchange (outflow) this may also be a problem. The dialysate should take about ten minutes to flow into your abdomen. The dialysate should take less than 45 minutes to drain out of your abdomen. Inflow or outflow problems may mean that your catheter is blocked, or that the tube has moved out of the right place.

• If the inflow or outflow of the dialysate is slow, you may try the following:
  
  
  • Put in 10 to 20 ml of dialysate or saline solution into the catheter using a syringe. Hold the catheter and syringe in one hand. Use your other hand to firmly push the dialysate out of the syringe, through the catheter, and into your abdomen. This may push out the blood clot or move whatever is blocking your catheter. After doing this process a few times, use the syringe to try and pull fluid out gently. If fluid comes out, the catheter is no longer blocked. If this does not help, your caregiver may need to put medicine through the catheter that breaks down blood clots.
    
    
  
  
• If the inflow of the dialysate is fast but there is no outflow, you may try the following:
  
  
  • Change your position while doing your exchanges. You may sit up, lie down, or lie on your side. You may even lie with your head down and your feet up. Changing your position may make the dialysate flow out more easily. If this does not help, disconnect the end of the tubing that is attached to your catheter. Use a syringe to gently suck the dialysate out of your abdomen. Do not pull on your catheter. It may move your catheter out of place even more. You may also start bleeding if you pull on it. If the flow does not get faster, call your caregiver.
    
    

Diet changes that may be needed while doing peritoneal dialysis:

• You may lose weight and become weak when you are doing 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.

Cleaning and changing the bandages over the exit site:

Your caregiver will change your bandages every week for the first two weeks. On the third week, your bandages may need to be changed more often. When your exit site is healed up, you may need to change your bandages every day. A healed exit site is pink in color, and at least 13 millimeters in size (smaller than a dime). The area should not be painful. Change your bandages as follows:

• Collect your supplies:
  
  
  • Sterile (clean and new) medical gloves.
    
    
  • Medical mask.
    
    
  • New bandages.
    
    
  • Soap and fresh water.
    
    
  • Solution for removing old bandages and cleaning your skin. Ask your caregiver what solution is best to use.
    
    
  • Medical tape.
  
  
• Wash your hands: Use soap and water to wash your hands. Scrub them for at least 15 seconds. Dry your hands well with a clean towel or new paper towel.
  
  
• Put on your mask and gloves: Put on your mask, making sure that it covers both your nose and your mouth. This will help prevent germs from your nose or mouth going on your exit site. Put on your gloves. Do not touch anything other than the bandage and your supplies when your gloves are on.
  
  
• Avoid moving your catheter: Do not pull or twist your catheter when changing your bandages. Make sure that your catheter stays in its place.
  
  
• Remove old bandages: Use a sterile solution to carefully remove old bandages from the exit site. Pour the solution over bandages that are stuck on your exit site to loosen them. If there is a scab (dried up skin or blood), do not pull on it. Take off the bandage very slowly. Look for pus, fluid, or blood coming from the exit site. If you see these things, call your caregiver. If the area is painful, call your caregiver.
  
  
• Clean your wound, catheter, and skin: Wipe the exit wound, catheter, and skin around the catheter with a sterile solution. Pat the area dry with a clean bandage.
  
  
• Cover your catheter and the exit site with bandages: Covering your catheter when you are not using it may help it stay in place. This may help stop the catheter from bending and kinking, or being pulled out. Use several layers of bandages to cover the exit site and the skin around your catheter. Hold the bandages in place with tape.

Bathing and showering with a peritoneal dialysis catheter:

You cannot take a bath or shower until two weeks after your catheter was placed. Getting your exit site wet may delay healing. Use a washcloth, soap, and water to wash your skin. When the exit site heals, your caregiver may let you take a shower. If you take baths, do not let the exit site go under the water. Leave the bandages on until after your bath, and then put on new bandages. After your exit site has fully healed, you may swim in the ocean or chlorinated swimming pools. Dry the exit site right after swimming. Avoid using hot tubs, and swimming in rivers or ponds.

Things to do to help prevent infection at the catheter exit site:

• Keep your catheter held in the right place: Ask your caregiver how to tape your catheter to your body. This may help prevent the catheter from twisting and being moved or pulled out.
  
  
• Change your bandages as ordered by your caregiver: Germs may grow on the exit site and on old bandages. Change your bandages every day, or as often as your caregiver has told you to. You may need to keep your exit site covered with bandages for six months to a year.
  
  
• Take antibiotic (germ-killing) medicine as ordered: This medicine helps prevent or treat infection.

Removing the peritoneal dialysis catheter:

Your catheter can be used for up to two years if it is not blocked or damaged. Your caregiver may need to remove it if you get an infection. He may replace it when it is cut, clogged, or damaged. It will be removed if you need to have hemodialysis instead of PD. Your caregiver will remove it if you do not need to have dialysis 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 CAPD or your catheter.

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.

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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.

Learn more about Peritoneal Dialysis Catheter Care (Aftercare Instructions)