Page 1850 - Saunders Comprehensive Review For NCLEX-RN

using a special dialysate warmer pad, because the
cold temperature of the dialysate can cause
discomfort.

C. Abnormal outflow characteristics indicative of

complications
1. Bloody outflow after the first few exchanges indicates
vascular complications (the outflow should be clear
after the initial exchanges).
2. Brown outflow indicates bowel perforation.
3. Urine-colored outflow indicates bladder perforation.
4. Cloudy outflow indicates peritonitis.
D. Insufficient outflow
1. The main cause of insufficient outflow is a full colon;
encourage a high-fiber diet, because constipation can
cause inflow and outflow problems. Administer stool
softeners as prescribed.
2. Insufficient outflow may also be caused by catheter
migration out of the peritoneal area; if this occurs, an
x-ray will be prescribed to evaluate catheter position.
3. Maintain the drainage bag below the client’s abdomen.
4. Check for kinks in the tubing.

5. Change the client’s outflow position by

turning the client to a side-lying position or
ambulating the client.
6. Check for fibrin clots in the tubing and milk the tubing
to dislodge the clot as prescribed.
E. Leakage around the catheter site
1. Clear fluid that leaks from the catheter exit site will be
noted.
2. It takes 1 to 2 weeks following insertion of the catheter
before fibroblasts and blood vessels grow into the
catheter cuffs, which fix it in place and provide an
extra barrier against dialysate leakage and bacterial
invasion.
3. Smaller amounts of dialysate need to be used;

it may take up to 2 weeks for the client to tolerate a
full 2-L exchange without leaking around the catheter
site.
XI. Kidney Transplantation (Fig. 54-4)
A. Description
1. A human kidney from a compatible donor is
implanted into a recipient.
2. Kidney transplantation is performed for irreversible
kidney failure; specific criteria are established for

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