peritoneal dialysis

The peritoneum is a good biological semi-permeable membrane with good dispersion, penetration, secretion and absorption. When the condition requires, the peritoneum can be used as a dialysis membrane. By dialysis against blood in the surface blood vessels of the peritoneum, the accumulated metabolites and excessive electrolyte in the body can be excreted with the dialysate, thereby eliminating toxic substances in the body, regulating water and electrolytes. And the purpose of acid-base balance. Treating diseases: kidney failure Indication 1. Acute renal failure can be used after the diagnosis is clear. Early can be used as preventive dialysis, the effect is better; when the condition is heavier, the disease can be stabilized at a certain level; when the condition is very serious, it needs to be combined with hemodialysis for acute renal function with shock and cardiac insufficiency. Peritoneal dialysis is preferred for patients with depletion and a tendency to have severe bleeding. 2. Chronic renal failure. 3. Acute drug poisoning and severe edema, water intoxication and heart failure caused by any cause. 4. Other patients can also treat some patients with acute liver failure, acute pancreatitis and multiple myeloma. Contraindications 1. Localized peritonitis should be contraindicated; diffuse peritonitis should only be considered when it is unavoidable. 2. Recently, there are abdominal abdominal surgery with abdominal drainage, extensive peritoneal adhesions and pregnancy. 3. Severe chronic respiratory failure. 4. If the patient is in a critical state, patients with low blood pressure or poor cardiovascular function should be treated first, and peritoneal dialysis can only be used after the condition is improved. Preoperative preparation 1. Check liver and kidney function. Patients with bladder irritation should be treated with cystoscopy to understand whether the bladder or ureter has tumor invasion. 2. Improve the general condition of the patient and give a high protein, high calorie and low slag diet. Surgical procedure The placement of the peritoneal dialysis tube is closely related to the peritoneal dialysis effect. The operation requires the peritoneal dialysis tube to be placed in the bladder rectal fossa (uteral rectal fossa) to ensure smooth drainage. 1. Position, incision: The patient is lying on his back. In the right side of the pubic symphysis and umbilical cord, the skin was cut 0.5 to 1 cm, the abdominal wall was separated, the peritoneum was cut, and the dialysis tube was sent to the bladder rectal fossa. The dialysis tube was rinsed with heparin saline to prove patency and suture the peritoneum [ Figure 1 (2)]; Under the skin, outside the muscle layer, 2 to 3 cm from the incision, make a subcutaneous tunnel, and pass the dialysis tube out of the abdominal wall, respectively fix two polyester fleece loops and close the abdominal wall. 2. Dialysis method (1) Intermittent peritoneal dialysis (ipd): standard ipd program, manual operation, dialysate 2l / time, continuous exchange 8 ~ 10 times per dialysis day, 1 hour each time, 4 ~ 5 dialysis days per week, total dialysis time The number is 36 to 42 hours. (2) Continuous ambulatory peritoneal dialysis (capd): standard capd protocol, daily exchange of dialysate 4 times, 2l each time. Exchange time, 8 am, 12 noon, 5 pm, 10 pm; dialysate selection, use 1.5% dialysate for sugar three times during the day and 4.25% dialysate with sugar at night. (3) Continuous circulation peritoneal dialysis (ccpd): ccpd standard protocol, exchange dialysate 5 times a day, 2l each time. Exchange time, starting at 10 o'clock in the evening, shutting down at 8 o'clock in the morning, and switching once every 2.5 hours at night for 4 times; infusion for 10 minutes, indwelling for 2 hours, discharging for 10 minutes, and keeping 11 hours during the day; dialysate selection, nighttime Each time, 1.5% dialysate containing sugar was used, and 4.25% dialysate containing sugar was used during the day. Different dialysis methods and dialysis rates of different sugar concentrations are selected for different patients. Blood biochemical data changes should be monitored daily during dialysis to avoid excessive water and electrolyte discharge. complication The effect of peritoneal dialysis is good, but there are also some complications that should be taken seriously and prevented. 1. Peritonitis: The incidence rate is high in the past, but it is not common after intermittent dialysis and certain preventive measures. The precaution is to improve the aseptic technique and add the appropriate amount of antibiotics to the dialysate. 2. Injury to internal organs: Injury and intestinal tube are serious and rare complications; attention should be paid to the operation when intubating. 3. Bleeding: a large number of progressive hemorrhage caused by multiple visceral injuries, should stop dialysis and appropriate treatment in a timely manner; a small amount of bleeding should be closely observed, can continue to dialysis. 4. Dialysis fluid leakage: It can leak from the periphery of the dialysis tube during operation, or it may leak out from the incision after surgery; it is common in the peritoneal purse-string suture is not tight, the dialysis tube is placed too shallow or outward, if it is found to leak from the incision, Should be sutured immediately, bandage; if the leakage is serious, the tube should be re-surgery. 5. Drainage is not smooth: mostly due to adhesion or intestinal tube, omentum obstruction of dialysis tube hole, should be replaced with a fine-dialysis dialysis tube or repeated washing with heparin saline; if it is still invalid, stop dialysis.