Page 1846 - Saunders Comprehensive Review For NCLEX-RN

of lower concentration in the dialyzing fluid.
4. The peritoneal cavity is rich in capillaries; therefore, it
provides a ready access to the blood supply.
B. Contraindications to PD
1. Peritonitis
2. Recent abdominal surgery
3. Abdominal adhesions
4. Other GI problems such as diverticulosis
C. Access for PD (Fig. 54-3)
1. A siliconized rubber catheter such as a Tenckhoff
catheter is surgically inserted into the client’s
peritoneal cavity to allow infusion of dialysis fluid;
the catheter site is covered by a sterile dressing that is
changed daily and when soiled or wet.
2. The preferred insertion site is 3 to 5 cm below the
umbilicus; this area is relatively avascular and has
less fascial resistance.
3. The catheter is tunneled under the skin, through the
fat and muscle tissue to the peritoneum; it is
stabilized with inflatable Dacron cuffs in the muscle
and under the skin.
4. Over a period of 1 to 2 weeks following insertion,
fibroblasts and blood vessels grow around the cuffs,
fixing the catheter in place and providing an extra
barrier against dialysate leakage and bacterial
invasion.
5. If the client is scheduled for transplant surgery, the PD
catheter may be either removed or left in place if the
need for dialysis is suspected post-transplantation.
D. Dialysate solution
1. The solution is sterile.

2. All dialysis solutions are prescribed by the

PHCP; the solution contains electrolytes and minerals
and has a specific osmolarity, specific glucose
concentration, and other medication additives as
prescribed.

3. The higher the glucose concentration, the

greater the hypertonicity and the amount of fluid
removed during a PD exchange.
4. Increasing the glucose concentration increases the
concentration of active particles that cause osmosis,
increases the rate of ultrafiltration, and increases the
amount of fluid removed.
5. If hyperkalemia is not a problem, potassium may be
added to each bag of dialysate solution.

1846