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Peritoneal dialysis training (Presentación PowerPoint)




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    Objetive: DEAR STUDENTS THE OBJETIVE OF THIS TRAINING , IS GIVE
    YOU A BASIC UNDERSTANDIG OF PERITONEAL DIALYSIS PROCEDURE AND
    ALLOW TO PROVIDE TO LEARNING ABOUT THE CHRONIC RENAL FAILURE
    PATIENTS . WE ARE SURE THAT THE OBJECTIVES OF THIS TRAINING WILL
    BE ACHIEVED. PROFESSORS…… 1

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    Chronic Kidney Failure Chronic kidney failure, also called
    chronic kidney disease, describes the gradual loss of kidney
    function. Your kidneys filter wastes and excess fluids from your
    blood, which are then excreted in your urine. When chronic kidney
    failure reaches an advanced stage, dangerous levels of fluid,
    electrolytes and wastes can accumulate in your body. 7.2.1 The
    peritoneal membrane / P. Martin 2

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    Chronic Renal Failure Slow progressive renal disorder related to
    nephron loss, occurring over months to years. In the initial
    Stage, CKD non present symptoms . Culminates in End Stage Renal
    Disease 3

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    Causes of Chronic Renal Failure: HIV positive (Asocieted
    Nephrophaty ) HIVAN (Namibia) Diabetes Hypertension Renal
    vascular disease (also vascular disease) Nephritis Pyelonephritis
    & chronic UT I Polycystic kidney disease Renal Neoplasms
    Analgesic nephropathy Immunological disorders: Lupus, Goodpasture
    syndrome, Metabolic disorders: gout Nephrotic Syndrome ?primary
    or secondary 7.2.1 The peritoneal membrane / P. Martin 4

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    7.2.1 The peritoneal membrane / P. Martin 5

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    Treatment Options SubPeritoneal Dialysis Hemodialysis Kidney
    Transplant Conservative management 6

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    7.2.1 The peritoneal membrane / P. Martin 7 Sagittal view of the
    peritonealcavity during peritoneal dialysis

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    7.2.1 The peritoneal membrane / P. Martin 8

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    7.2.1 The peritoneal membrane / P. Martin 9

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    10 The peritoneal anatomy A sagittal section trough the
    peritoneal cavity General facts Living membrane Reusable Provides
    lubrication for internal organs Normally contains 10 – 100 cc's
    fluid Semipermeable Bi-directional

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    7.2.1 The peritoneal membrane / P. Martin 11 (Gp:) Transport
    across the peritoneum (Gp:) Osmosis Diffusion Convection
    Peritoneal physiology

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    7.2.1 The peritoneal membrane / P. Martin 12 Diffusion Peritoneal
    physiology

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    7.2.1 The peritoneal membrane / P. Martin 13 RANDOM movement of
    solutes across the peritoneal membrane from an area of high
    concentration to an area of low concentration (without assistance
    by any flow of fluid) Diffusion HIGH low Peritoneal
    physiology

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    7.2.1 The peritoneal membrane / P. Martin 14 Factors affecting
    diffusion solute size concentration gradient electrical charge
    blood flow rates Peritoneal physiology

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    7.2.1 The peritoneal membrane / P. Martin 15 Movement of water
    across the peritoneal membrane from an area of low concentration
    to an area of high concentration. (Gp:) Osmosis low HIGH
    Peritoneal physiology

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    7.2.1 The peritoneal membrane / P. Martin 16 Osmotic
    Ultrafiltration Peritoneal physiology Glucose generates a high
    osmotic pressure which induces ultrafiltration from the
    capilaries (blood) to the peritoneal cavity

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    7.2.1 The peritoneal membrane / P. Martin 17 Factors affecting
    osmosis dextrose concentration dwell time membrane permeability
    Peritoneal physiology

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    7.2.1 The peritoneal membrane / P. Martin 18 the dwell time the
    peritoneum characteristics rapid transperitoneal absorption with
    decline of the osmotic gradient in time: Dextrose 1.5%: maximum
    UF rate of 9.27 mL/min Dextrose 4.25%: maximum UF rate of 21.0
    mL/min Dextrose 1.5% removes 100-300 cc of extra water Dextrose
    2.3% removes 300-500 cc of extra water Dextrose 4.25% removes
    600-800 cc of extra water Fluid removal is dependent on:

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    7.2.1 The peritoneal membrane / P. Martin 19 Convection Solutes
    move across the peritoneal membrane in an'orderly flow' from one
    area to another by being carried by a flowing fluid. Peritoneal
    physiology

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    7.2.1 The peritoneal membrane / P. Martin 20 Diffusion Convection
    Ultrafiltration (osmotic pressure gradient) solute removal fluid
    removal The composition of PD solution is the key factor that
    governs diffusion, convection as well as the removal of fluid
    excess from the body · Electrolytes correction ·
    Body fluid balance · Acid-base control · Blood
    purification Peritoneal dialysis

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    7.2.1 The peritoneal membrane / P. Martin 21

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    22

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    Peritoneal Dialysis Catheter Two double-cuff Tenckhoff peritoneal
    catheters: standard (A), curled (B). 7.2.1 The peritoneal
    membrane / P. Martin 23

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    Dialysis SubDialysis is the diffusion of solute molecules through
    a semipermiable membrane, passing from higher concentration to
    that of lower concentration. It is the process of separating
    colloids and crystalline substances in solution by the difference
    in their rate of diffusion through a semi permeable membrane. The
    purpose of dialysis is to remove endogenous and exogenous toxins
    and to maintain fluid electrolyte and acid- base balance till the
    renal function recovers. It is a substitute for some excretory
    functions of kidneys but does not replace the endocrine and
    metabolic functions. 7.2.1 The peritoneal membrane / P. Martin
    24

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    INDICATIONS Uremic symptoms with neurologic abnormalities
    Persistent hyperkalemia, above 6.5 mEq/L Blood urea level more
    than 50 mmol/l Serum Creatinine more than 900 µmol/l Severe
    acidosis, pH less than 7.2, TCO2 less than 10-12 mEq/L
    Hyperphosphatemia Pulmonary edema and CCF 7.2.1 The peritoneal
    membrane / P. Martin 25

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    Peritoneal dialysis SubPeritoneal dialysis is a technique that
    employs the patient’s peritoneal membrane as a dialyzer.
    Excess body water is removed by an osmotic gradient created by
    the high dextrose concentration in the dialysate; wastes are
    removed by diffusion from the peritoneal capillaries into the
    dialysate. Because peritoneal dialysis is not as efficient as
    hemodialysis, it must be performed daily rather than 3 times
    weekly as in hemodialysis. 7.2.1 The peritoneal membrane / P.
    Martin 26

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    7.2.1 The peritoneal membrane / P. Martin 27

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    7.2.1 The peritoneal membrane / P. Martin 28

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    Phases of A Peritoneal Dialysis Exchange Fill: fluid infused into
    peritoneal cavity Dwell: time fluid remains in peritoneal cavity
    Drain: time fluid drains from peritoneal cavity 7.2.1 The
    peritoneal membrane / P. Martin 29

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    7.2.1 The peritoneal membrane / P. Martin 30

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    INTERMITTEN PERITONEAL DIALYSISIPD (WILL DO IN IHO) 7.2.1 The
    peritoneal membrane / P. Martin 31 WARD 7 NEW BUILDING

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    1.Continuous Ambulatory PD SubIt is the most commonly used method
    of peritoneal dialysis. The filtration process occurs most hours
    of the day. The exchange usually take about 3 minutes , 3-4 times
    a day and only require a solution bag with tubing attached to it
    that connects to the child’s blood stream. It gives
    freedom. 7.2.1 The peritoneal membrane / P. Martin 32

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    2.Automated Peritoneal Dialysis Suba)Continuous Cyclic Peritoneal
    Dialysis Continuous regimen means that the dialysis solution is
    present in the peritoneal cavity continuously, with the exception
    of short significant periods between exchange. It uses duel lumen
    catheterization, i.e., 2 catheters, one for inflow and other for
    outflow. 7.2.1 The peritoneal membrane / P. Martin 33

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    Intermittent Peritoneal Dialysis Sub-USUALLY DONE IN HOSPITAL It
    means the dialysis sessions are performed several times a week.
    This technique uses one catheter for inflow and outflow. Flow is
    interrupted after both inflow and outflow during exchange. 7.2.1
    The peritoneal membrane / P. Martin 34

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    PROCEDURE The abdomen is cleaned in preparation for surgery, and
    a catheter is surgically inserted with one end in the
    abdomen and the other protruding from the skin. Before each
    infusion the catheter must be cleaned, and flow into and out of
    the abdomen tested. The warmed solution is allowed to enter the
    peritoneal cavity by gravity and remains a variable length of
    time (usually 10-15 minutes) according to the rate of solute
    removal and glucose absorption in individual patients. The total
    volume is referred to as dwell while the fluid itself is
    referred to as dialysate. 7.2.1 The peritoneal membrane / P.
    Martin 35

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    SubThe dwell can be as much as 2.5 litres, and medication can
    also be added to the fluid immediately before infusion. The
    dwell remains in the abdomen and waste products diffuse across
    the peritoneum from the underlying blood vessels. After a
    variable period of time depending on the treatment (usually
    4–6 hours), the fluid is removed and replaced with fresh
    fluid.  7.2.1 The peritoneal membrane / P. Martin 36

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