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Continuous Ambulatory Peritoneal Dialysis – CAPD

Continuous Ambulatory Peritoneal dialysis is a renal replacement therapy for chronic renal failure, as are hemodialysis and its variants, and kidney transplantation .

All the data presented in the following section are from the book “Diagnosis and treatment of kidney diseases – guidelines, recommendations, and standards of conduct”.

Continuous Ambulatory Peritoneal dialysis involves the penetration of small- and medium-molecular uremic toxins through several layers of the serous peritoneal membrane, which is the equivalent of a dialysis membrane in an artificial kidney and separating the abdominal organs from the free peritoneal cavity.

What means continuous ambulatory peritoneal dialysis?

If your kidneys have failed, continuous ambulatory peritoneal dialysis (CAPD) is a method of restoring your kidney function by using the membrane that covers your internal organs.

Continuous Ambulatory Peritoneal Dialysis – CAPD

An electrolyte dialysis (01 ) fluid is cyclically introduced into the abdominal cavity. There are many advantages of peritoneal dialysis that suggest choosing this method of treatment for the patient as well as contraindications as a result of which the patient will not be able to use.

Read more… How to care for a, Hemodialysis patients?

Continuous ambulatory peritoneal dialysis procedure:

You fill your abdomen with dialysate, leave it there for a set amount of time, and then drain it. The fluid is moved through the catheter and into and out of your abdomen by gravity.

  1. Three to five exchanges during the day and one with a prolonged dwell period while sleeping may be required.
  2. You can exchange at home, at work, or anywhere else that is clean.
    While the dialysate is in your abdomen, you can go about your daily activities.

Types of peritoneal dialysis:

There are two kinds of peritoneal dialysis:

  • Continuous Ambulatory Peritoneal Dialysis (CAPD)
  • Automated Peritoneal Dialysis (APD)

Continuous ambulatory peritoneal dialysis vs automated peritoneal dialysis:

Continuous ambulatory peritoneal dialysis (CAPD) entails manually completing PD exchanges, whereas automated peritoneal dialysis (APD) is a wide term that refers to all modalities of PD that use a mechanical device to aid with dialysate delivery and drainage.

Continuous cyclical PD (CCPD), intermittent PD (IPD), nocturnal intermittent PD (NIPD), and tidal PD are some of the different types of APD (TPD). Every day, the patient or caregiver must perform three to five exchanges in CAPD. Many of the issues associated with CAPD, such as a lack of long-term patient desire, technique failure, and recurrent peritonitis, prompted a renewed interest in APD and the creation of CCPD in 1981. ().

Peritoneal dialysis complications:

When your kidneys can no longer efficiently eliminate waste items from your blood, peritoneal dialysis is used. This method filters the blood in a different way than hemodialysis, which is a more prevalent blood-filtering procedure.

Complications of peritoneal dialysis can include:

  1. Infections: Peritoneal dialysis is associated with an infection of the abdomen lining (peritonitis). The location where the catheter is implanted to transfer the cleansing fluid (dialysate) into and out of your abdomen can also become infected. If the individual performing the dialysis isn’t properly trained, the danger of infection is higher.
  2. Gaining weight: Sugar is present in the dialysate (dextrose). If you absorb some of the dialysate, you may consume hundreds of extra calories per day , resulting in weight gain. The extra calories can also raise blood sugar levels, which can be dangerous if you have diabetes .
  3. Hernia: Long periods of holding fluid in your abdomen might put a strain on your muscles.
  4. Inadequate dialysis: After a few years, peritoneal dialysis may become ineffective. It’s possible that you’ll need to transition to hemodialysis.

If you have peritoneal dialysis, you must avoid the following foods:

  1. Certain prescription and over-the-counter medications, such as nonsteroidal anti-inflammatory drugs, might harm your kidneys.
  2. Swimming in a lake, pond, river, or non chlorinated pool, or soaking in a bath or hot tub – all of these activities raise the chance of infection. Showering and swimming in a chlorinated pool are both appropriate options.

Continuous cycling peritoneal dialysis (CCPD):

This approach, also known as automated peritoneal dialysis (APD), uses a machine (automatic cycler) to make numerous exchanges while you sleep at night. The cycler fills your abdomen with dialysate, lets it sit there for a while, then drains it into a sterile bag that you empty in the morning.

Several conditions are required to start

Continuous Ambulatory Peritoneal Dialysis condition

The patient’s body weight should be normalized. Both obesity and underweight are contraindications. The patient’s visual and manual skills are also necessary.

To perform peritoneal dialysis procedures, it is necessary in this regard to be independent or fully burdened by a guardian or family member who has received training at home.

Despite these requirements, peritoneal dialysis has many advantages that should encourage patients to choose this method of treatment for chronic renal failure.

Dialysis takes place at home, which is important for many patients, especially if the distance to the dialysis center is very large. No travel necessary to continue working and learning. The patient does not feel addicted to the dialysis machine.

It may also use a less restrictive diet than when using hemodialysis. To peritoneal dialysis, residual kidney function can be maintained longer, the anemia is better controlled and there is no need for hemodialysis fistula. An advantage over hemodialysis is also a lower risk of infection with blood-borne viruses.

Already before the introduction of dialysis, the patient should undergo brief training explaining the possible methods of renal replacement therapy.

The patient can thus learn about the pros and cons of peritoneal dialysis, hemodialysis, and transplantation.

The peritoneal dialysis catheter is inserted in the surgery department and can be used for dialysis after 2 weeks.

There are two basic types of peritoneal dialysis

CADO, i.e. continuous outpatient peritoneal dialysis and ADO automatic peritoneal dialysis. ADO is performed using a cycler, usually at night (NDO). It is more often chosen by professionally active people because patients during the day are free from replacing dialysis fluid.

It is also more often recommended for people without residual renal function, patients with concomitant chronic obstructive pulmonary disease (COPD), and clinical contraindications for high intraperitoneal pressure.

CADO is done manually by 3 to 5 changes per day or by the cycler as a continuous cyclic peritoneal dialysis (CCDO) during the night with leaving fluid in the peritoneum for the day. CADO is a method recommended for patients who are candidates for kidney transplantation and for those with residual kidney function.

Peritoneal dialysis depends

Continuous Ambulatory Peritoneal Dialysis

The success of peritoneal dialysis depends largely on the patient and/or their caregivers. That is why proper patient education is so important.

Their skills and knowledge lead to improved treatment, reduce or even eliminate possible complications as well as improve the patient’s quality of life. Peritoneal dialysis complications are divided into non-infectious and infectious.

Unfortunately, these non-infectious ones are difficult to prevent and are often the cause of the patient starting hemodialysis instead of dialysis.

Providing the patient with adequate knowledge on how to care for chronic peritoneal dialysis catheters is the key to success in the prevention of dialysis peritonitis. In the recommendations contained in the chapter “Standards of conduct related to the peritoneal catheter in the paper, it is recommended to protect the catheter mouth with a dressing, which is mainly aimed at its mechanical protection.

Dressing Instructions

The dressing should be changed every day or every other day. Also, before each bath, the patient should remove the dressing and then put it on clean again after disinfection and drying of the skin.

Drying the skin under a dressing protects the skin against maceration and damage Patients are also advised to take a shower and not to bathe in open water because of the risk of infection of the catheter mouth.

For the prevention of Staphylococcus aureus infections, control and eradication are used in carriers of this bacterium. This is done by taking nasal swabs in the patient and his helpers.

If carriage is detected, mupirocin is administered intranasal 2 times a day for 5 days every 4 weeks in 3 series. Staphylococcus aureus carrier testing should also be performed on personnel in contact.

Peritoneal Dialysis catheter infection

A patient undergoing dialysis may develop a number of complications not related to dialysis catheter infection. They were listed in the chapter “Standards for peritoneal dialysis” at work.

Non-infectious complications include those dependent on increased intra-abdominal pressure, such as abdominal hernia, dialysis fluid streaks, musculoskeletal, gastrointestinal, and reproductive disorders.

At first, the intermittent ADO method is used in a supine position. Dialysis fluid infiltration may affect the abdominal cavity, pleural cavity, or genitals.

The procedure in their case depends on the moment of its detection. In early infiltrations, a 1-3 week break in dialysis is sufficient, and sometimes even just a reduction in the volume of exchanges and a change in the manner of conducting dialysis to discontinued ADO.

In latex stains, surgery is necessary, and in pleural cavities, a pleural puncture may be required to drain fluid. Gastrointestinal disorders include constipation, diarrhea, vomiting, and nausea. Their cause is high intraperitoneal pressure. In the event of gastroesophageal reflux disease, a change in the dialysis method from CADO to ADO is indicated.

Read more… Care of a Mechanically Ventilated Unconscious Patient

Adverse Gastrointestinal effects

The persistence of adverse gastrointestinal effects may result in the patient being transfer to a hemodialysis program. On the part of the musculoskeletal system, patients may experience symptoms of sciatica or lumbago.

As in many cases, it is recommended to change the way of dialysis from CADO and ADO. In women, prolapse of the reproductive organ may also occur and in this case, it is recommended to change from CADO to ADO using a reduced daily exchange volume.

Hemoperitoneum and Encapsulating

Non-infectious complications also include those independent of increased intra-abdominal pressure. These include hemoperitoneum and encapsulating peritoneal sclerosis. Hemoperitoneum, or bleeding we divide into 3 degrees of severity.

Management varies in every degree, only hemoperitoneum grade 3 requires surgical intervention. In other cases, there is usually no contraindication to continuing peritoneal dialysis.

Encapsulating peritoneal sclerosis (EPS) leads to peritoneal loss as a dialysis membrane. Risk factors include long-term dialysis therapy, lasting over 5 years, frequent cases of dialysis peritonitis, use of dialysis fluids with high glucose concentration.

Symptoms are: blood dialysate, abdominal pain of unknown cause, and repeated episodes of intestinal obstruction. There is a decrease in peritoneal ultrafiltration, ascites, and intra-abdominal resistance accompanied by reduced intestinal peristalsis.

Infectious complications of Peritoneal Dialysis

Infectious complications of peritoneal dialysis include dialysis peritonitis. Its symptoms include the presence of turbid dialysis, fever, nausea, vomiting, peritoneal symptoms, abdominal pain, and ultrafiltration impairment.

The cause of peritoneal dialysis is most often errors made by the patient during independent dialysis replacement.

However, dialysis peritonitis may also have iatrogenic background such as:

  • Endoscopic examinations
  • Enema
  • Prolonged antibiotic therapy
  • Gynecological and dental procedures.

The most common pathogens responsible for peritoneal dialysis include Staphylococcus epidermidis and Staphylococcus aureus. Most often, effective antibiotic therapy cures the patient, and no need to give up.

Advantages of Peritoneal Dialysis

Despite the many advantages of peritoneal dialysis, there may be a point in the treatment program at which point the patient must or is advised to give up DO for hemodialysis.

The patient is no longer able to perform dialysis on his own at home. Sometimes, despite the willingness to continue this method of treatment on the part of the treatment, he is forced to start hemodialysis.

This may occur as a result of peritoneal insufficiency due to its fibrosis, intraperitoneal adhesions, the inefficiency of peritoneal dialysis manifested by abnormal creatinine clearance and ultrafiltration results.

Also in the case of recurrent diverticulitis, peritoneal cancer , and severe ischemic bowel disease, the patient is forced to give up the continuation of the DO program.

The indication for peritoneal catheter removal is persistent dialysis peritonitis despite treatment or an acute process requiring operative abdominal opening. The same indication is a catheter tunnel infection that caused or threatens peritonitis.

How long does continuous ambulatory peritoneal dialysis?

You maintain the CAPD solution in your stomach for 4 to 6 hours or more. The dwell time refers to how long the dialysis solution stays in your stomach. Normally, you change the solution four times a day and sleep with it in your stomach at night.

What is the difference between CAPD and APD?

Continuous ambulatory peritoneal dialysis (CAPD) entails manually completing PD exchanges, whereas automated peritoneal dialysis (APD) is a wide term that refers to all modalities of PD that use a mechanical device to aid with dialysate delivery and drainage.

What are the 3 types of dialysis?

Dialysis is divided into three categories: in-center hemodialysis, home hemodialysis, and peritoneal dialysis. Each form has advantages and disadvantages. It’s crucial to remember that you can change your dialysis type at any time, so you don’t have to feel “locked in” to one.

Written by Dr. Ozair (CEO of SignSymptom.com) as physician writers are physicians who write creatively in fields outside their practice of medicine.

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