Wrexham Renal Unit -BCUHB
PD Training
Manual
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Wrexham Renal Unit -BCUHB
Contents.
PD TRAINING MANUAL .......................................................................................... 1
A GUIDE FOR PATIENTS ........................................................................................ 1
INTRODUCTION........................................................................................................ 4
PD--- WHAT IT DOES AND HOW IT DOES IT! ................................................... 5
PD HAS TWO EFFECTS ON THE BODY: ........................................................................... 5
DIFFUSION. .................................................................................................................. 6
ULTRAFILTRATION. ...................................................................................................... 6
YOUR FUTURE ON DIALYSIS. .............................................................................. 7
RISK OF INFECTION................................................................................................ 8
WARMING THE FLUID............................................................................................ 9
WAYS TO WARM THE FLUID: ........................................................................................ 9
"SOLO" EXCHANGE PROCEDURE................................................................... 10
FAULTY FLUID. ....................................................................................................... 12
EXIT SITE AND CATHETER CARE. ................................................................... 13
PROCEDURE FOR REDRESSING YOUR EXIT SITE ...................................... 14
CATHETER LEAKAGE OR DAMAGE. ............................................................... 15
POSSIBLE CAUSES FOR EXIT SITE LEAKS ..................................................................... 15
DRAINAGE PROBLEMS. ....................................................................................... 16
PROBLEMS WITH DRAINAGE OUT .............................................................................. 16
PROBLEMS WITH DRAINAGE IN .................................................................................. 17
FIBRIN........................................................................................................................ 18
ADMINISTRATION OF HEPARIN (SOLO). ....................................................... 19
PERITONITIS. .......................................................................................................... 20
SIGNS & SYMPTOMS OF PERITONITIS: ........................................................................ 20
WHAT TO DO IF YOU SUSPECT PERITONITIS. ............................................................... 21
If you can go home. ............................................................................................... 21
If you need to stay in Hospital. .............................................................................. 21
CAUSES OF PERITONITIS............................................................................................. 22
BLOOD STAINED FLUID. ...................................................................................... 23
FLUID BALANCE..................................................................................................... 24
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FLUID OVERLOAD. ................................................................................................ 25
SIGNS & SYMPTOMS. ................................................................................................. 25
CAUSES OF FLUID OVERLOAD.................................................................................... 25
ACTION. ..................................................................................................................... 25
GLUCOSE REMOVES EXCESS FLUID ............................................................... 26
DEHYDRATION. ...................................................................................................... 27
SIGNS & SYMPTOMS. ................................................................................................. 27
CAUSES OF DEHYDRATION. ....................................................................................... 27
ACTION. ..................................................................................................................... 27
For example: ......................................................................................................... 27
DRY / TARGET WEIGHT. ...................................................................................... 28
CONTAMINATION. ................................................................................................. 29
GOING ON HOLIDAY / TRAVELLING ON PD. ................................................ 30
ACTION ...................................................................................................................... 30
INFORM US:-............................................................................................................... 30
HOLIDAY CHECKLIST (ABROAD).................................................................... 32
SWIMMING ON PD. ................................................................................................ 33
GUIDE TO INSURANCE FOR DIALYSIS PATIENTS....................................... 34
TRAVEL INSURANCE .................................................................................................. 34
MOTOR INSURANCE. .................................................................................................. 34
ORDERING OF STORES OR PRESCRIPTIONS. ............................................... 35
COLLECTION OF RUBBISH. ................................................................................ 36
AFTERCARE. ............................................................................................................ 37
TESTS AND INVESTIGATIONS. .......................................................................... 38
BLOOD TESTS. ........................................................................................................... 38
SWABS. ...................................................................................................................... 38
U.K.M. ...................................................................................................................... 38
P.E.T. ........................................................................................................................ 38
LIFESTYLE, HOBBIES, SEX, FUTURE. .............................................................. 39
CONCLUSION. ......................................................................................................... 41
QUESTIONNAIRE. .................................................................................................. 42
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Wrexham Renal Unit -BCUHB
Introduction.
This training manual has been written to help you learn how to carry out and manage
your own PD treatment as well as discussing a few problems that you may come
across and how to deal with them.
It should be used to help you learn things during your training period and then it
can be taken home for you to use for reference purposes.
Here are some phone numbers that you may find useful:
WREXHAM MAELOR HOSPITAL
(01978) 291100 (ask to bleep on call
CAPD nurse) out of office hours.
PD OFFICE
CUNLIFFE WARD
(01978) 727101 between 9 am to 5 pm
(01978) 727103
(01978) 725402
DIETICIAN
(01978) 727159
SOCIAL WORKER
(01978) 727296
BAXTER HELPLINE NUMBER
(01635) 201902 (24 hours)
You can speak to someone at any time of the day or night so if you are worried ring us.
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Wrexham Renal Unit -BCUHB
PD--- What it does and how it does it!
CAPD stands for Continuous Ambulatory Peritoneal Dialysis
APD stands for Automated Peritoneal Dialysis
PD has two effects on the body:
1. It lowers the high levels of waste products that are in the bloodstream caused by
chronic renal failure.
2. It can remove excess fluid from the body.
This works by the following two processes:
 Diffusion.
 Ultrafiltration.
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Wrexham Renal Unit -BCUHB
Diffusion.
This is the process whereby the PD fluid in your abdomen draws waste products from
the blood stream, through tiny holes or 'pores' in the peritoneum therefore lowering
the waste product levels in the blood.
Peritoneum.
Dialysis
fluid.
Blood
containing
waste
products.
Blood.
Dialysis fluid.
Ultrafiltration.
This process allows fluid to be drawn from the blood, across the peritoneum and into
the PD fluid. The higher the concentration of glucose in the fluid, the more fluid will
be drawn across the membrane from the body.
Blood Side.
Dialysis
Fluid.
Blood Side.
Dialysis
Fluid.
Water.
Water.
3.86 %
Glucose
To allow these processes to go on in your body continuously, the PD fluid in your
abdomen needs to be replaced with fresh fluid on a regular basis. How often it is
changed is an individual requirement. For CAPD, on average it is four times daily.
On APD this takes place overnight between 8 – 12 hours. The process where the fluid
is changed is called an “exchange”, and takes around 30 minutes.
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3.86%
Glucose
Wrexham Renal Unit -BCUHB
Your Future on Dialysis.
At the present time PD is playing a huge part in your life and is probably in your
thoughts almost constantly. This is because it is new to you and you are in the process
of learning about it.
You will always have to pay attention to your PD and take care when doing your
treatment, but in a few weeks you will have settled down into a routine and will find
that you can resume your usual daily activities, hobbies and employment with minimal
disruption.
The length of the training period varies from one person to the next – there is no set
time limit. It will continue until you feel confident to manage your own treatment at
home and when the PD staff and medical team are happy that you can cope.
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Wrexham Renal Unit -BCUHB
Risk of Infection.
The biggest risk of PD is infection which can occur around the exit site or within the
abdomen (called peritonitis) or both.
Infection is caused by bacteria which are everywhere in the atmosphere, on objects
around you as well as on your skin. Normally they don’t cause any problems but if
they enter your abdomen, this will lead to infection.
There are many ways in which the risk of infection can be reduced and these
will be taught to you during your training period. The following are some general
points to reduce the risk of infection.
It is important to maintain a high level of personal cleanliness. Showering is
recommended either daily or alternate days.
It is also important to keep your `PD area’ clean and tidy. Regular tidying,
vacuuming and dusting of that area is recommended.
Hand washing is very important also. During your training you will be taught a
particular hand wash which you should perform as taught. Nails should be kept
short and clean (to prevent build up of bacteria under nails) and skin should be clean
and intact. You will probably find that the soaps and handrubs that are used will
dry out the skin on your hands. To prevent your skin chapping and becoming
sore, handcream is recommended after each exchange.
The bowl used for hand washing should be used only for PD and should be washed
and dried thoroughly after each exchange, then stored upside down (to prevent dust
settling in it.) Alternatively you can wash your hands in the bathroom if nearby.
If you have a sink in the room to use for your PD it should be washed daily to
prevent the build up of bacteria. When washing your hands take care to avoid
touching the sink or taps (otherwise bacteria would be transferred on to your hands).
Animals should not be allowed into the room where PD takes place.
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Warming the Fluid.
The fluid needs to be warmed before use for comfort purposes. It doesn’t need to be
warmed to a certain temperature, but around body temperature. You may experience
abdominal pain if it is too cold and if it is too hot it may permanently damage your
peritoneum.
Ways to warm the fluid:
Do
Do Not
Heating plate or APD machine.
Microwave oven (this causes “hotspots"
and can melt the plastic. It is banned by the
Dept of Health).
Between two hot water bottles.
Immersing bag in warm water.
Water could leak through any tiny holes
in the plastic which would cause
contamination.
Warm airing cupboard.
Left on a clean, dry window sill in the sun.
On a shelf above a warm radiator.
The hospital can lend you a heating plate to use for holidays or if you are unable to
warm bags in an airing cupboard.
Heating plates should be wiped down once or twice a week, depending on how dusty
they get, with a damp paper towel and then dried - Remember to unplug from mains
before doing so.
APD Machines should be wiped down daily in the same manner.
NB. It is your responsibility to check when the plate needs servicing and inform PD
staff. The sticker on the side of the plate will indicate when the service is due.
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"SOLO" Exchange Procedure.
1.
Close doors and windows and switch off fans to prevent dust being blown
around. Allow one hour to pass after vacuuming, dusting and bedmaking for
dust to settle.
2.
Fill bowl with water and gather equipment i.e. warmed bag, hand rub, blue
clamps, Minicap packet and Alcowipe.
3.
Remove watch, bracelets and stoned rings. Roll up sleeves. Take out miniset
from clothing.
4.
Clean the work surface with an Alcowipe.
5.
Wash hands as taught and dry thoroughly. Apply alcohol handrub.
6.
Remove new bag from outer wrapper and place on surface, lines uppermost.
7.
Pick up lines, holding the end with the coloured ring and pull gently - using the
other hand to straighten and unravel tubing.
8.
Keeping the lines straight with one hand, use the other hand to peel off drainage
bag and place on left hand side of surface, then turn over bag of fluid.
9.
Then check the following points:
10.
Coil up tubing and lay under bag with the end of the tubing overhanging
the edge by 1 - 2 inches.
11.
Rub hands with alcohol rub until dry. Remove coloured ring with little
finger.
CLARITY
STRENGTH
EXPIRY DATE
VOLUME
NO LEAKS
DO NOT TOUCH THE EXPOSED TIP WITH CLOTHING OR HANDS.
12.
Remove Minicap from miniset.
13.
Connect lines to miniset without contamination.
14.
Hang full bag on hook, place drainage bag on floor with clear window
uppermost.
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Wrexham Renal Unit -BCUHB
15.
Open twist clamp and drain out fully.
16.
Close twist clamp and apply blue clamp to drainage line.
17.
Break seal from full bag. Open blue clamp for 16 - 17 seconds to flush into
drainage bag. Close blue clamp.
18.
Open twist clamp and drain in, then close twist clamp. Apply blue clamp to
line.
19.
Remove bag from hook and place on floor.
20.
Open Minicap packet and visually check for iodine and sponge.
21.
Rub hands with alcohol until dry.
22.
Disconnect tubing from miniset and drop onto floor (keeping hold of miniset).
Pick up Minicap and twist on to miniset.
23.
Empty fluid into toilet and dispose of rubbish in yellow plastic bags. Wash
and dry bowl and leave upside down.
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Faulty Fluid.
Occasionally there are faults in the bags such as:
 Holes or tears in the outer wrapper
 Missing injection ports
 Leaks
 Particles or debris in the fluid.
If any of these things occur - discard the fluid.
Remember - If in doubt, throw it out!!
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Wrexham Renal Unit -BCUHB
Exit Site and Catheter Care.
Your skin is the body's natural protection against bacteria entering the body.
Any break in the skin is an area prone to infection. Your exit site is one such area.
It is very important that you make sure your exit site stays infection free otherwise
bacteria may track down your catheter and cause infection within your abdomen
called Peritonitis. The following points will reduce the risk of exit site infection:
 Keep exit site dry. Redress it immediately after a shower or if it becomes wet any
other way e.g. swimming, heavy rain etc.
 Keep your catheter in a secured position at all times to allow skin to heal around
the catheter. If the catheter is constantly moving around it will damage the exit site.
 Avoid pulling or twisting your catheter which will damage the exit site and let
bacteria enter.
Pay particular attention to securing your catheter when
contemplating physical activities such as sport, sex etc.
 Redress exit site on alternate days if it is infection free. Examine it for signs of
infection e.g.
REDNESS
PUS OR DISCHARGE
SORENESS.
 Act promptly if you suspect infection. Phone the PD nurses who will arrange
for a swab of your exit site which will show if there is infection present.
 If infection is present the doctor will prescribe a course of antibiotics for you to
take as well as some ointment to put on your exit site.
Remember - If you think it’s infected then get
it inspected!!
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Wrexham Renal Unit -BCUHB
Procedure for Redressing your Exit Site
1. Close doors, windows and switch off fans. Allow dust to settle for
one hour after vacuuming, bedmaking or dusting. Wash hands.
2. Gather equipment…..




ALCOWIPE/TRIGENE WIPES
ALCOHOL HAND RUB
MEPORE DRESSING
ROLL OF TAPE
3. Clean your surface with an Alcowipe.
4. Open Mepore Dressing and place on surface and prepare tape.
5. If able to shower, leave dressing intact and place Miniset into a new
plastic bag, taping it upside down to abdomen.
6. After showering, dry body as usual and remove plastic bag.
7. If not showering, arrange clothing to allow you to see exit site.
8. Wash hands as taught and dry thoroughly.
9. Rub hands with handrub until dry.
10.Remove dressing, ensuring catheter doesn't pull on exit site and
inspect site.
11.Wash hands and apply hand rub.
12.Clean exit site with trigene wipe.
13.Apply Mepore to exit site. Secure with tape.
14.Discard rubbish into yellow plastic bag.
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Wrexham Renal Unit -BCUHB
Catheter Leakage or Damage.
It is advisable to regularly check that the catheter itself is intact and not damaged as
bacteria will enter your abdomen leading to peritonitis if there are any holes or splits
in the catheter.
You will be given a small clamp to keep with you to put on your catheter if it
should develop a split or a hole. Put the clamp above the split and close to the exit site
to prevent bacteria entering your abdomen and then phone the PD nurses who will
ask you to visit the ward.
If your clothing or dressing is very wet but you cannot see any holes or splits in your
catheter, the fluid may be leaking out from around your catheter. If this happens ring
the unit or on call nurse as soon as possible.
Possible causes for exit site leaks

Using 3.86% bags

Exit site Infection

Lifting heavy objects too soon

Resuming sexual intercourse too soon
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Wrexham Renal Unit -BCUHB
Drainage Problems.
Occasionally you may experience drainage problems.
Problems with drainage OUT
If the fluid will not drain out of your abdomen then check the
following………
 Check that the tubing is not twisted or kinked which will obstruct the flow.
 Check that appropriate seals are broken and clamps off.
 If machine alarms, check display and refer to Homechoice pro “mini guide”.
 Ensure that you are not constipated as this can cause drainage problems.
If there is still no flow…..
 Clamp off tubing and go for a walk around the room for a few minutes (take care
not to pull on catheter) then try again. If drainage now occurs, carry on with therapy
as normal.
If still no drainage……

Inform the PD or Ward nurses
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Wrexham Renal Unit -BCUHB
Problems with drainage IN
If the fluid will not drain into your abdomen then check the
following points…….
 Check the tubing for kinks or twists which are obstructing the flow.
 Check that appropriate seals are broken and clamps open.
CAPD
 Make sure the bag is above head height.
 Squeeze the bag firmly a few times (with the clamps open) which may dislodge any
obstruction.
 Phone the PD nurses if there is still no drainage.
APD
.
Check Display and refer to Homechoice pro “miniguide”
.
Phone PD Nurses if there is still no drainage
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Wrexham Renal Unit -BCUHB
Fibrin.
Fibrin is a protein substance which sometimes occurs in your drainage. It looks
like egg white or cotton wool floating in the fluid and can be seen in the tubing as
white lumps or strands of cotton.
It is a harmless substance, but it can sometimes block your catheter and cause
drainage problems because of its jelly like consistency.
If you see fibrin in your fluid / tubing and you have experienced drainage problems,
you may be taught how to add Heparin to your fluid. Heparin dissolves fibrin and
therefore prevents drainage problems.
NB. Only in the event of your drainage being slow do you add Heparin.
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Wrexham Renal Unit -BCUHB
Administration of Heparin (SOLO).
You will need to have the following equipment handy when doing an exchange in
case you need to add heparin:




Syringe
Heparin ampoule 1,000 iu per ml
Needle
Swabs x 2.
Then follow these steps:
1.
Collect the equipment together. Check that the packets are intact and not torn and
check that the heparin is clear and not out of date.
2.
Open syringe packet and lay on the surface. Open needle and connect to
syringe without contamination.
3.
Fill syringe with 0.5mls of air by withdrawing plunger.
4.
Swab the rubber bung on the heparin ampoule with medical swab.
5.
Remove guard from needle and insert the needle through the rubber bung into the
ampoule.
6.
Push air into ampoule then withdraw 0.5mls of heparin per litre.
7.
Withdraw needle and syringe from ampoule and cover needle with guard.
8.
Perform 16 - 17 second flush as normal. Remove bag from hook and lay on
surface. Clean injection port with second swab. Hibisol hands.
9.
Remove guard from needle and insert into injection port carefully without
piercing the sides. Inject heparin into bag. Pull back plunger to refill syringe
with fluid then gently re-inject into bag, then remove syringe and needle.
10. Shake bag well to evenly distribute the heparin, then drain in.
11. Discard needle and syringe into sharps box, not yellow bags.
12. When the sharps boxes are full, seal them and then the council will collect
them.
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Wrexham Renal Unit -BCUHB
Peritonitis.
If you have an infection within your abdomen it is called Peritonitis. It is caused by
bacteria entering your abdomen which normally would be prevented by your skin.
Having a catheter entering your abdomen and using it to drain fluid in and out of your
abdomen is a perfect way for bacteria to enter.
There are several ways which you can prevent peritonitis and it cannot be stressed
enough how important it is to maintain high levels of hygiene and to follow the
procedure that you are taught.
Peritonitis can cause scar tissue to form on your peritoneal membrane which doesn't
allow the processes of Diffusion and Ultrafiltration to occur. If there is a lot of scar
tissue (built up from several peritonitis episodes or after one very severe episode) it
may mean that PD doesn't work effectively therefore you would need to be dialysed
using a machine called haemodialysis.
Signs & Symptoms of Peritonitis:
 Cloudy or hazy fluid when draining out.
 Abdominal pain.
 Flu like symptoms.
 Red, sore exit site.
 Diarrhoea and/or vomiting .
Not everyone gets all of the above symptoms. Some people get cloudy fluid but feel
perfectly well while others have cloudy fluid and feel ill.
If you have cloudy fluid, ring the PD nurses even if
you feel well.
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Wrexham Renal Unit -BCUHB
What to do if you suspect Peritonitis.
1.
Carry on with your exchange as normal.
2.
Ring the PD nurses who will ask you to visit the unit. Do this as soon as you
notice cloudy fluid. Don’t wait to see if it will have cleared by next exchange, it
won’t have, it will only be worse!!
3.
Bring the cloudy bag into hospital with you. This will be sent to the laboratory.
4.
Bring with you some belongings and your regular medications should you need to
stay in hospital.
5.
When you arrive on the ward, you will be examined by the doctor. You will also
have your temperature, blood pressure and pulse taken as well as some blood
samples. Depending on how you are and the results of the tests done, you will be
allowed to go home or asked to stay in hospital.
If you can go home.
The PD nurses will perform an exchange and add antibiotics, to the fluid, these
antibiotics may need to be injected once daily for the next few days. You may be
taught how to inject your own bags. If this is not possible, you will need to come in
daily for your antibiotics.
If you need to stay in Hospital.
You will be an inpatient on the ward until you are feeling better and the doctors are
happy that you have responded to treatment. You may need to have antibiotics
through a drip in your arm, but this will all be explained to you as the situation arises.
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Wrexham Renal Unit -BCUHB
Causes of Peritonitis.
 Unsuitable environment / surface when carrying out your exchange.
 Poor surface preparation.
 Poor hand wash technique.
 Poor exchange technique.
 Contamination of miniset or fluid.
 A hole in your catheter or lines.
 Exit site infection.
 Constipation
NB. Sometimes peritonitis does not respond to the antibiotics and in these cases it will
be necessary to have the catheter removed.
The abdomen will then be rested for 4 to 6 weeks and during this time you will require
haemodialysis on a temporary basis.
Following this another PD catheter will be inserted.
Remember: If you are unsure about your fluid
ring the PD nurses!
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Wrexham Renal Unit -BCUHB
Blood Stained Fluid.
Sometimes you may notice that the fluid is clear, but has a pink/red colour to it. This
indicates that a small amount of blood has leaked into the fluid. It is not anything to
worry about and will clear up. It may have been caused by any of the following things:
 Lifting heavy objects.
 Pulling the catheter.
 After sports activities (such as aerobics).
 After sexual intercourse.
 During menstruation in women.
If you notice a blood stained bag of fluid carry on with your exchange as normal. It
will usually clear within a day.
Remember: Avoid using Heparin when fluid is blood
stained!
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Wrexham Renal Unit -BCUHB
Fluid Balance.
One of the functions of the kidneys is to help the body maintain fluid balance. This is
a state where the body has just the right amount of fluid in it. When you have chronic
renal failure, your body loses the ability to maintain fluid balance therefore you can
run into problems where you have too much or too little fluid in your body.
Too little fluid
Dehydration
Too much fluid
Fluid overload
Fluid balance
Dry / Target weight
To maintain your fluid balance when you are on PD you will have to assess yourself
daily and decide whether you are fluid overloaded, dehydrated or at your dry/target
weight(fluid balanced).
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Wrexham Renal Unit -BCUHB
Fluid Overload.
This means that there is too much fluid in your body. If not resolved it raises your
blood pressure, putting a strain on your heart and therefore increasing the risk of
strokes and heart attacks.
Signs & Symptoms.






Weight increase of at least 0.5 kilogram (or 1lb).
Swollen ankles.
Swollen fingers / tight rings.
Puffy, swollen eyes (especially in the mornings).
Breathlessness.
Headache.
Not everyone will get all of the above symptoms so don't wait until you have every
symptom before you take any action, but act on any of the above.
Causes of Fluid Overload.
 Drinking too much fluid.
 Eating salty foods (which cause the body to retain fluid)
 Not draining out properly and therefore absorbing PD fluid into your system
 Not using enough strong 3.86% exchanges
 Not weighing or not altering your regime when necessary
Action.
If you are fluid overloaded you will need to take action to remove the excess fluid
from your system and return to your dry weight. This is done in the following ways:




Using stronger fluid for your exchanges.
Drinking less volume of fluid.
Avoiding salty foods.
Ensuring complete drainage of fluid during exchanges.
For example:
If your weight has increased by 0.5 kg from one day to the next (but you feel fine and
have none of the other symptoms) and your usual regime is 2 x 2.27% and 2 x 1.36%
exchanges, on the day that your weight is elevated you would use 1 x 3.86% 2 x
2.27% 1 x 1.36% exchanges.
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Wrexham Renal Unit -BCUHB
Glucose Removes Excess Fluid
YE
1.36%
Glucose
Removes a little
fluid
Yellow
or
‘Weak’
bag
2.27%
Glucose
Green or
‘medium’
bag
3.86%
Glucose
Orange
or
‘strong’
bag
Removes slightly
more fluid than
1.36%
Removes a lot
more fluid
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Wrexham Renal Unit -BCUHB
Dehydration.
This means that there is too little fluid in your body which will lead to low blood
pressure which may cause you to feel dizzy, faint etc.
Signs & Symptoms.






Weight loss of 0.5Kg (1lb) or more.
Trim ankles.
Cramps.
Thirst.
Dizziness or feeling faint.
Nausea.
Causes of Dehydration.





Not drinking enough fluid.
Using too many strong bags.
Diarrhoea and/or vomiting.
Sweating more than normal (hot weather/ sports / high temperature)
Not weighing or not altering your regime when necessary
Action.
You need to replace the fluid in your body and resume your dry weight. This is done
by:
 Drinking an extra couple of drinks that day.
 Reducing the strength of your fluid.
For example:
If your weight was down by 0.5kg from the day before and you felt dizzy, you would
reduce the strength of your exchanges for that day. If your usual regime was 2 x
2.27% and 2 x 1.36% exchanges, that day you would use 4 x 1.36% exchanges and
drink an extra couple of drinks. If weight was back to normal the following day,
resume your usual regime, but try to identify why your weight dropped.
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A
n
k
l
e
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Wrexham Renal Unit -BCUHB
Dry / Target Weight.
As already mentioned, this is the weight at which you are fluid balanced i.e. not too
much and not too little fluid in your body.
This weight however does not always stay the same as it will change depending on
whether you gain or lose flesh weight. This weight change is a gradual one, for
example 0.5kg over several days rather than overnight. As well as this gradual flesh
weight change, you will notice your clothes becoming tighter/looser depending on
whether you gain or lose weight.
Weighing yourself in the morning halfway through your first exchange is advised or if
on APD, before your last bag fill. This will help you plan your regime for the day.
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Contamination.
If, by accident you touch the uncapped end of your catheter or lines with your hands or
clothing, the lines are then contaminated and should not be used. If it is the lines on
your new bag which become contaminated before you connect them to your miniset,
then just discard that bag and use a clean one.
If however, it is your miniset / extension set that is contaminated ensure that no fluid
passes through it into your abdomen as it will carry bacteria with it. This is done by
putting a new cap on the end, clipping your white clamp between the contamination
and your abdomen to prevent any bacteria "drifting" along your catheter.
Remember: Do not touch dark area
with hands or clothing
If there is a hole or tear in your catheter then follow the same steps: prevent further
contamination and put your white clip between the contamination and your abdomen.
Then phone the PD nurses. You will need to have a new miniset / extension set fitted
and a single dose of antibiotics into your fluid in case any bacteria have entered your
abdomen.
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Going on holiday / travelling on PD.
We can arrange to have your supplies delivered to your destination either in this
country or certain foreign countries.
Action
Discuss with PD staff the country you are considering visiting. They can then inform
you of the length of notice required for delivery of supplies as this differs from
country to country. Some destinations require extra costs for delivery and for the more
expensive areas the Renal Unit will not be able to pay these extra costs.
Inform us:A) Where you are going - resort hotel: name, address and tel. no.
B) When you are going and for how long.
C) What is your present regime.
You will have confirmation direct from the Company informing you when your
supplies are due to be delivered. It will then be your responsibility to:A) Check supplies to be correct
B) Inform the hotel manager when to expect your delivery and how much to expect!
C) If you are taking your holiday in the UK either inform the District Council that you
will need to have your waste collected or bring your yellow bag home with you.
When travelling, we would prefer that you do not do your bag exchange anywhere
which is not as clean as your room at home eg. not in a toilet or on a bus. Wait until
you arrive at your destination, it will not matter that for one day you miss a bag
exchange. It is much better that you do not put yourself at risk of peritonitis. If you
are flying, the airport will usually let you use a clean room there, if arranged in
advance. If you are taking a long flight it may be better to drain out. If you are going
somewhere for the day where the Red Cross or St John’s are in attendance, they will
only be too willing to help you.
Keeping your fluid warm may be a problem in winter, so it may be an idea to put it in
a picnic cool box with a hot water bottle, but check the fluid is not too hot before
using it. In the summer, you may want to put the fluid on the back ledge of the car to
keep it warm. Always leave the bag in the outer wrapper.
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If you are on the Transplant Waiting List please inform the Transplant Co-ordinator
of your holiday as you are suspended from the list for the duration of your holiday.
This is because you will be unable to fly home quickly enough if called for
transplant.
Always make sure you know the name of the nearest Renal Unit to your resort. (A
list will be sent with your confirmation).
Ensure you have your letter of dialysis details with you. This will be given to you by
the PD staff.
Remember to check that the Hotel/place you are staying in, has a suitable room with
the things needed for an exchange i.e. somewhere to wash your hands and a toilet to
empty the effluent away.
See checklist over page……….
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HOLIDAY CHECKLIST (Abroad)
1. Customs letter (if carrying needles or EPO pen)
2. Dialysis details letter
3. Homechoice machine letter
4. Spare miniset
5. Exit site infection antibiotics
6. Emergency pack
7. Current medication
8. TAKE:
SOLO:
Trigene wipes
Minicaps
Alcohol handrub
Blue clamps
Paper towels
Heating plate
APD:
Cassettes
Drain lines
Clam shells/Opticaps
Minicaps
Alcohol handrub
Paper towels
Peritonitis sample bag
Adapter plug
Homechoice Machine
DRESSING:
Mepore
Trigene
Tape
Plastic bags
Tegaderm if swimming
If you have any queries the PD nurses will go through this Checklist with you.
It is your responsibility to ensure you have everything you need. It is advisable to
check prior to leaving the UK that your dialysis supplies have arrived.
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Swimming on PD.
It is advisable for everyone to maintain a regime of regular exercise and swimming is
a gentle form of exercise suitable for all.
We advise you to swim in chlorinated pools. Do not swim in the sea or use Jacuzzi’s.
Tegaderm, a transparent and waterproof dressing 6ins x 8ins is given to you by the PD
nurses to apply to your abdomen to cover exit site dressing and your miniset. After
swimming, remove Tegaderm, carry out exit site care and also change your Minicap.
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Guide to Insurance for dialysis patients
Travel insurance
Due to constantly changing circumstances with travel insurers, it is best to enquire
with your travel agent or browse the internet. However……
1. Always check that any insurance policy covers pre-existing illness.
2. Always tell the insurance company that you are on dialysis. If you do not, your
insurance will be invalid.
Motor Insurance.
Dialysis patients must inform the Drivers Vehicle Licensing Centre (DVLC) and their
insurance company that they are on dialysis.
To inform the DVLC, send your license with a note to say that you are on dialysis.
They will send you a form to complete. This is a routine procedure and does not
normally pose a problem.
Insurance companies sometimes raise premiums or refuse to insure dialysis patients.
If you have any problems, it is best to ask your present insurer or alternatively, browse
the internet for alternative insurance companies.
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Ordering of Stores.
Your delivery arrives from the company once a month on dates that the company will
arrange for you. You will have this list of delivery dates and telephone call dates
which precede each delivery in the back of the folder supplied by the company. The
telephone call precedes the delivery by about a week.
Before this phone call you will need to count the stock items that you have left and tell
the company when they phone. The company will then deliver enough items for you
to use throughout the next month.
When the delivery arrives, you will need to check that the items issued are correct
then sign the invoice. The delivery man will carry your supplies to wherever you keep
them and will place the new items to the back so that you use up your oldest supplies
first, unless of course they have the same expiry date.
If you are going to be out on your delivery day, please tell the company where to leave
your supplies and they will advise the driver. Alternatively, you may find it more
convenient to provide the company with a key which will be labelled with a code
number and kept locked away between deliveries.
Please note if you are not in for your delivery and have not made alternative
arrangments, the company will have to re-schedule your delivery at extra charge to the
Renal Unit. The Renal Unit cannot sustain these additional costs.
NB. If you are running short of supplies please let us know. You can have whatever
you need from the hospital but it is your responsibility to collect it.
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Collection of Rubbish.
This is arranged through your district council by the PD nurses. The council will then
inform you of the day of the week which they will collect your clinical waste as well
as supplying you with your new yellow bags.
You should not need to inform the council about your medical condition or that you
are on dialysis.
NB. Sharps should never be put into yellow bags. Sharps must be disposed of in the
special containers supplied.
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Aftercare.
When you finish your PD training and go home, the nurses and doctors will need to
monitor your progress and ensure that you are as well as possible as well as trying to
prevent any complications and problems.
You will be asked to attend outpatients clinic on a regular two to three monthly basis
which allows the doctors to examine you and make sure everything is running
smoothly. In between clinic appointments the PD nurses will visit you at home.
During these visits the nurse will observe you carrying out your treatment to assess
whether you are putting yourself at risk of peritonitis in which case these risks will be
pointed out to you along with ways to reduce the risks.
You will also have an opportunity to discuss your progress in general and any
problems or worries that you may be having. In between these visits you are able to
contact the staff at any time of the day or night should you have an immediate
problem.
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Tests and Investigations.
Blood Tests.
These will be done regularly at clinics and sometimes at home visits. They are done
for several reasons. e.g. To check waste product levels, tissue typing and to check for
anaemia. The nurses or doctors will explain why they are being done on an individual
basis, so just ask if you are unsure.
Swabs.
Swabs are taken generally to detect infection and which bacteria is causing it. This
allows the doctors to prescribe the correct antibiotics.
ADEQUACY.
Adequacy is a series of tests done over a 24 hour period which tells us whether or not
you are having enough dialysis or not. It involves you collecting samples of urine and
dialysis fluid and we will also take a blood sample. As a result of the Adequacy
testing, your PD regime may need to be changed.
This is done approximately six weeks after starting PD and every six months
thereafter.
P.E.T.
This is a Peritoneal Equilibration Test and allows us to assess the nature of your
particular peritoneal membrane. It involves you visiting the ward for 4-5 hours while
we perform 2 exchanges and take a blood sample. We generally do this about 6 weeks
after starting PD and it is repeated annually.
If Adequacy and PET indicate that you are not receiving enough dialysis, your regime
will need to be altered. In some cases it may be necessary to transfer onto
haemodialysis.
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Lifestyle, Hobbies, Sex, Future.
As you are completing your training your thoughts will probably be turning to the
future, can I go back to work? what about hobbies? sport? sex? etc. PD is something
that you need to do to remain healthy and allow you to continue your life in your
normal pattern but it shouldn't be allowed to take over your whole life. Remember that
your exchange times are flexible - fit them in with your usual daily routine rather than
sticking rigidly to times.
Returning to work is usually possible within a couple of months. If you need to
perform exchanges at work the PD staff will assist you in setting this up. If you are
working full time and CAPD is difficult, we can offer APD in order for you to
continue in your employment. Occasionally your work may need to be changed (if, for
example it is particularly heavy or "dirty" work) and if this is the case the social
worker will put you in contact with the resettlement officer who will be able to help.
It is advisable for everyone to maintain a regime of regular activity or exercise and as
you begin to feel the benefit of PD hopefully you will be able to once again
incorporate regular exercise in to your daily routine. As well as improving your
general health, exercise will help to prevent constipation which may cause drainage
problems.
The only activities to avoid are the ones which may pull or damage your catheter e.g.,
contact sports such as rugby or activities which put excess strain on your abdominal
muscles e.g. weight lifting, otherwise most other activities are fine.
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Initially you will probably be very aware of your catheter and line even though no-one
else can see it under your clothing, but hopefully you will become accustomed to it
and will be able to wear clothing such as shorts, T-shirts etc. without it being obvious.
Kidney failure can sometimes have an effect on sexual activity and often reduces
fertility. Often tiredness and lethargy caused by high levels of waste products in your
bloodstream and/or anaemia can reduce sexual drive. This, together with the presence
of the catheter and the side effects of certain drugs can disrupt your sex life. e.g.
Certain anti-hypertensive (blood pressure drugs) can make men impotent.
Communication between yourself and your partner is essential as they will also feel
affected by the presence of the catheter and may be wary of hurting you, pulling the
catheter etc. As long as the catheter is firmly taped down and cannot "pull" on the exit
site it can be secured to your side, out of the way. Although fertility is usually
reduced, contraception should still be used. You may notice some slight bloodstaining
of your fluid after sexual intercourse, this is nothing to worry about and will resolve.
If you are experiencing problems in this, or any other area of your life don't bottle it up
- discuss it with one of the nurses or doctors who may be able to help you or may
suggest someone else who can help you. People sometimes find that there may be
difficulties for themselves and their families to adjust to a life on PD and by
discussing things with staff in confidence often helps.
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Conclusion.
Now that you are able to manage PD and all it entails you will hopefully feel a lot less
worried about the future and will even feel confident about returning to your usual
lifestyle within the next few months.
There are several organisations you can contact for information and support.
The CAPD patient support group is the local support group run by people who are, or
have been, on dialysis or have had a transplant. Regular meetings provide opportunity
for contact with local people.
The National Kidney Federation are an organisation providing support and
information to people with kidney failure. Their contact details are….
The National Kidney Federation
6 Stanley Street
Worksop
Notts S81 7HX
Tel :
01909 487 795
Helpline :
0845 6010 209
Website :
www.kidney.org.uk
Email :
nkf@kidney.org.uk
There is a national group, the British Kidney Patients Association who on receipt of a
£1.00 joining fee will send an information pack. Their contact details are….
British Kidney Patients Association
Bordon
Hants GU35 9JZ
Tel:
Fax:
Web:
01420 472 021/2
01420 475 831
www.britishkidney-pa.co.uk
There are also various websites on the internet to gain information…….
www.nephroline.org
www.kidneywise.com
www.kidneyalliance.org.uk
www.cardiffandvale.wales.nhs.uk/main/kidneypatients/frameset/frameset.htm
It would be appreciated if you would take a few minutes to look back over your
training time and answer the few questions that follow. This allows us a chance to
evaluate the training programme and improve it for future PD patients.
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Questionnaire.
1. How did you feel about the pace of the training programme?
2. How did you feel about the information that was taught to you?
3. Was the information understandable ? too complicated? Necessary ? interesting ?
4. Were you given enough practical help?
5. How might the training programme be improved in your opinion?
Thank you for your response to these questions, please feel free to write overleaf
should you have any other comments.
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