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Continuous Ambulatory Peritoneal Dialysis
WHAT YOU NEED TO KNOW:
Continuous ambulatory peritoneal dialysis (CAPD) is done to remove wastes, chemicals, and extra fluid from your body. During CAPD, a liquid called dialysate is put into your abdomen through a catheter (thin tube). A procedure will be done to place this catheter. The dialysate pulls wastes, chemicals, and extra fluid from your blood through the peritoneum. The peritoneum is a thin lining on the inside of your abdomen. The peritoneum works like a filter as the wastes are pulled through it. The process of filling and emptying your abdomen with dialysate is called an exchange.
- You may be given medicine to lower your blood pressure or antibiotics for an infection caused by bacteria. Your healthcare provider or nephrologist may also recommend that you take vitamins and minerals. Vitamins are removed from your body during CAPD exchanges. It may be hard to eat and drink enough to get all the vitamins your body 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.
- Take your medicine as directed. Contact your healthcare provider or nephrologist if you think your medicine is not helping or you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.
Follow up with your healthcare provider or nephrologist as directed:
Write down your questions so you remember to ask them during your visits.
How to do a CAPD exchange:
You may need to wait 14 days or longer after your CAPD catheter has been placed before you can use it. This should give your exit site time to heal. Your healthcare provider will tell you when it is okay to use your catheter. CAPD exchanges may be done 3 to 5 times during the day, and once during the night. CAPD exchanges should be done in a well-lit room. There should be no pets, dander, strong breezes, or fans in the room. They can increase your risk of an infection.
- Gather your supplies. Place the following supplies on a clean table close to where you will be doing your CAPD exchange:
- Dialysate bag and waste product bag
- Y-shaped tubing
- IV stand (used to hang your dialysate bag)
- Disposable medical gloves
- Medical mask to wear over your face during CAPD
- Tubing clamps
- 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 catheter without washing your hands and wearing gloves. Keep your fingernails short and clean.
- Put on your gloves and mask. Put on your mask so that it covers your mouth and nose. Do not touch anything but the catheter and your supplies after you put the gloves on.
- Flush the tubing. Flush the tubing with dialysate liquid before your exchange to help prevent infections. Connect the lower end of the Y tubing to your catheter, and connect the 2 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 100 mL of dialysate has drained, clamp the tubing that goes to the waste bag.
- Let the dialysate flow into your abdomen. Hang the bag at a higher level than 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. Hang the bag at a lower level than your abdomen. Remove the clamps from the tubing that leads to the waste bag. Let the dialysate drain from your abdomen 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. After all the dialysate has drained out, close the waste bag and dispose of it as directed. Wash your hands.
- You will have to limit phosphorus and sodium (salt). You may need to decrease or increase potassium, depending on your blood levels. You will also need extra protein, because protein is lost through your exchanges. The dialysate contains sugar, which may cause you to gain weight. Your dietitian may want you to decrease the amount of calories you have each day if you gain weight.
- You may also need to limit liquid if your body is retaining (holding in) fluid. Your healthcare provider 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. Your healthcare provider may ask you to weigh yourself each day. Show this information to your healthcare provider 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.
Contact your healthcare provider or nephrologist 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.
- Dialysate is not flowing out of your abdomen during an exchange, even after you change position and use a syringe.
- You have a fever or chills.
- You have dull pain in your abdomen while you do a dialysis exchange.
- A new bump has grown in your abdomen since you started doing CAPD exchanges.
- Your catheter exit site is red, tender, or painful.
- You have questions or concerns about your condition or care.
Return to the emergency department if:
- You have constipation.
- You have stomach pain and are vomiting.
- You have trouble breathing while you do 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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