Peritoneal Dialysis - Acute

Peritoneal Dialysis - Acute
Title of Guideline Guideline for the nurses undertaking acute peritoneal

dialysis in children and infants.
Contact Name and Job Title (author)

Roy Connell – Clinical Nurse Specialist
Directorate & Speciality

Family Health – Paediatric Nephrology
Date of submission
January 2018
Date on which guideline must be reviewed (this should

be one to three years) May 2021
Guideline Number 2118

Explicit definition of patient group to which it applies Children and Young People treated with peritoneal
(e.g. inclusion and exclusion criteria, diagnosis) dialysis under the care of the Children’s Renal Unit,
Nottingham Children’s Hospital.
Abstract This guideline describes the Assessment, set-up and

management of acute peritoneal dialysis in paediatric
patients.
Key Words Dialysis, Peritoneal, Acute, Child, Young Person,

Renal. Paediatric
Statement of the evidence base of the guideline – has 1b

the guideline been peer reviewed by colleagues?
Evidence base: (1-5)

1a meta analysis of randomised controlled trials
1b at least one randomised controlled trial
2a at least one well-designed controlled study
without randomisation
2b at least one other type of well-designed quasi-
experimental study
3 well –designed non-experimental descriptive
studies (ie comparative / correlation and case
studies)
4 expert committee reports or opinions and / or
clinical experiences of respected authorities
5 recommended best practise based on the clinical
experience of the guideline developer
Consultation Process Children’s Renal Unit guideline review.
Paediatric Clinical Guidelines Group
Target audience Clinicians and healthcare professionals caring for
children and young people treated with peritoneal
dialysis at Nottingham University Hospitals NHS Trust
This guideline has been registered with the trust. However, clinical guidelines are guidelines only.
The interpretation and application of clinical guidelines will remain the responsibility of the individual
clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines
after the review date.
Roy Connell 1 of 17 January 2018

Document Control
Document Amendment Record
Version Issue Date Author

V1 January 2011 Roy Connell
Summary of changes for new version:
 No significant changes required
Statement of Compliance with Child Health Guidelines SOP

This guideline refers to activities of only one specific team and consultation has taken place with relevant
members of that team. Therefore this version has not been circulated for wider review.
Maria Moran
Clinical Guideline Lead
2 May 2018

These guidelines are to be used by nurses undertaking acute peritoneal dialysis in
children and infants in any clinical setting. Initial treatment will be commenced by the
on-call paediatric Nephrologist. The on-call paediatric renal nurse will also be
informed and can be available to commence treatment if required. The nurse will also
be available for telephone advice thereafter.
After the patient has been seen and assessed by the paediatric Nephrologist on-call
and peritoneal dialysis has been prescribed, these guidelines should be adhered to
unless instructed otherwise by the Nephrologist on-call.
The weight and fill volume of the child will determine whether a manual PD set or
Homechoice machine will be used to perform the dialysis. However, for insertion of
the catheter and the first 12 – 24 hours of therapy, it is recommended that a
manual set be used for all patients to make assessment and troubleshooting
easier.
 Fill volumes below 100mls will require a manual PD set.
 Fill volumes 100mls - 500mls will require Homechoice Pro (low fill mode).
 Fill volumes above 500mls will require Homechoice Pro (standard mode).
(all peritoneal dialysis equipment and consumables are available from Ward E17)
Contents
Section 1: Catheter selection .................................................................................. 4

Section 2: Dressing, Exit site and Immobilisation. ................................................ 4
Section 3: Choice and composition of PD fluids. .................................................. 4
Section 4: Calculating therapy. ............................................................................... 6
Section 5: Adding heparin to PD fluid. ................................................................... 7
Section 6: Adding Potassium to PD fluid. .............................................................. 7
Section 7: Adding Sodium to PD fluid. ................................................................... 7
Section 8: Adding Antibiotics to fluid. ................................................................... 8
Section 9: Setting up PD .......................................................................................... 8
Section 10: Flushing a PD catheter ......................................................................... 9
Section 11: Trouble shooting .................................................................................... 9
Section 12: Infection ............................................................................................... 13
Section 13: References ........................................................................................... 14
Appendix 1................................................................................................................ 15

Section 1: Catheter selection
Acute patients have a ‘long term’ PD catheter inserted surgically under GA. The
current catheter of choice is a double cuff, coiled swan-neck catheter.
Catheter Size Priming volume Child weight

Infant (Flexneck) 23cm 1.7ml Under 8kg
Paediatric 42cm 2.4ml 8 – 30kg
Adult 62.5cm 3.6ml Over 30kg
Nb: Priming volume is catheter only. Not inclusive of extension set.

Nb: The weight guidance is approximate and should be assessed along with
height/length.
*** An access checklist should be commenced prior to theatre ***
(see appendix 2)
Section 2: Dressing, Exit site and Immobilisation.
After the catheter has been inserted, it will need to be dressed and immobilised
appropriately. Dry, non-occlusive dressings are recommended. If possible the initial
dressing should remain undisturbed for 5 – 7 days. If oozing and/or bleeding occur,
the exit site should be cleaned with Normasol and a new dry dressing applied.
Silicone catheters are flexible and will exit the abdomen flush with the skin. They can
therefore have a dry Mepore dressing applied and a tube holder or tape used to
anchor it.
Section 3: Choice and composition of PD fluids.
A wide range of commercially made peritoneal dialysis fluids are available with
varying compositions. To avoid confusion in this area only two are stocked but others
are available at short notice if required.
Dianeal PD4 is at present the routine solution of choice for both hospital and home
peritoneal dialysis in patients over 5 years of age. The buffer solution in Dianeal is
lactate, which in normal circumstances would be well tolerated but can become a
problem with certain patients. Lactate is converted into bicarbonate mmol for mmol as
long as the Liver is functioning normally. Neonates may be particularly intolerant of
lactate because of the severity of illness and immature livers. For patients who have
immature livers or are already suffering from a lactic acidosis, bicarbonate based
fluids may be required. Pure bicarbonate based fluids can be hand made on the unit
or in pharmacy if required and can be tailor made to suit the patients’ needs. It is
recommended that the fluid should be made in a sterile production area. Unit
prepared solutions are however, time consuming and require more frequent

changes and blood tests. Commercially available reduced lactate fluid is now
available in the form of Physioneal 40 and is suitable for most neonates. As well as
the obvious advantages of the reduced lactate buffer, Physioneal 40 has also been
shown to reduce pain on infusion during dialysis and is the fluid of choice for patients
under 5 years of age.
The composition of P.D. solutions currently recommended for the use in acute
patients are;
 Dianeal PD4
Available in 1.36%, 2.27% & 3.86% glucose concentrations.
Sodium 132 mmol/l
Calcium 1.25 mmol/l
Magnesium 0.25 mmol/l
Chloride 95 mmol/l
Lactate 40 mmol/l
Osmolarity 344, 395 & 483 mOsmol/l.
PH 5.3
 Physioneal 40
Available in 1.36%, 2.27% & 3.86% glucose concentrations.
Sodium 132 mmol/l
Calcium 1.25 mmol/l
Magnesium 0.25 mmol/l
Chloride 95 mmol/l
Bicarbonate 25 mmol/l
Lactate 15 mmol/l
Osmolarity 344, 395 & 483 mOsmol/l.
PH 7.4
Other fluids available:
Physioneal 35 - Higher calcium (1.75mmol/l) and magnesium (0.75mmol/l)

Lower lactate (10mmol/l) than Physioneal 40.
Specially prepared pure bicarbonate based solutions can be made. See

appendix 1.
Bags can be changed using a strict aseptic non-touch technique at any time without
having to change the whole manual set.
 Bags should be changed routinely every 24 hours
 The whole PD set changed every 48 hours. (24 hours if infected)

Section 4: Calculating therapy.
Cycle = Fill / Dwell / Drain.
Fill.
This is when the prescribed amount of dialysate fluid is infused into the patients
peritoneum.
Dwell
This is the length of time the dialysate fluid stays in the peritoneum.
Drain
This is when the dialysate and any extra fluid removed from the patient are taken out
of the peritoneum.
Fill volumes
Fill volumes in acute patients are calculated as ml/kg. As an initial therapy, it is
advisable to commence on 10 – 20 ml/kg. This can be increased slowly dependent on
patient tolerance. A fill volume of around 30 – 50 ml/kg is usually well tolerated and
should provide adequate dialysis.
Dwell times
Dwell times can vary throughout a patient’s treatment and it is advisable to check
blood chemistry levels at least twice a day in order to adjust the dialysis to meet the
patient’s requirements. As a starting point, hourly cycles are usually prescribed.
 When using a manual PD set this will give a 5-minute fill, 45-minute dwell and
a 10-minute drain. When making adjustments to dwell times it is not necessary
to alter fill and drain times unless needed.
 When using the Homechoice machine, the dwell time is automatically worked
out using a calculation of the fill volume, total therapy volume and the therapy
time. The formula below can be used to calculate the total therapy volume
based on hourly dwells and continuous therapy.
Fill volume x 24 = Total therapy volume.
Nb: see ‘Setting up the Homechoice’ for how to program and examples of therapies.
See section 12 ‘Troubleshooting’ for information on adjusting dwell times.

ADDITIVES
Heparin, antibiotics and electrolytes can be added to new bags at any time. All
additives are prescribed in a concentration per litre to avoid errors when different sized
bags are used. Adding drugs to PD bags requires 2 staff members (one of whom is IV
drug competent) and should be done as a non-touch procedure.
A wide range of additives can be added to PD fluid including various electrolytes and
drugs. Discussion with your pharmacist is advisable to avoid precipitation.
Before adding to dialysis fluid bags, the expiry date, type of fluid and fluid strength
should be double checked.
Section 5: Adding heparin to PD fluid.
The dose of Heparin for PD fluid is 500units/litre – unless prescribed otherwise.
Heparin should be added to the PD bags for the first 24 hours of therapy to avoid any
problems with blood clots from surgery. It can also be added to the bags if
experiencing any problems on drainage or fibrin is visible in the drainage bag.
(See also – PD Nursing Procedure.)
Section 6: Adding Potassium to PD fluid.
Potassium can be added to fresh bags at any time and the bag changed without
having to change the whole set. It is common to add potassium after dialysis has
been running for a while as PD is a very effective way of removing potassium even in
an anuric patient.
The dose of Potassium is patient and condition dependant. The usual accepted dose
for maintenance is 4 mmol/litre. This can vary between 3 – 5 mmols/litre.
Section 7: Adding Sodium to PD fluid.
In cases of hypernatraemia in patients requiring PD it may be necessary to add

sodium to PD fluids to ensure sodium correction does not occur too rapidly. The
sodium content of both Physioneal & Dianeal is 132mmol/L, so without the addition
there is a significant risk the patient’s serum sodium could drop too quickly.
If the patient’s plasma sodium is greater than 150mmol/L it will be necessary to add
sodium chloride (5mmol/ml) to bags of Physioneal or Dianeal to prevent a rapid fall in
plasma sodium. It should never fall >10mmol/L in 24 hours.

Injectable Sodium chloride contains 5mmol/ml of sodium.
Target Na+ Addition to 5 litre bag Addition to 2.5 litre bag
(mmol/L)
150 18mls of sodium chloride 9mls of sodium chloride
Remove same volume from PD fluid bag before addition (i.e. for target 150mmol/L
remove 18mls from Physioneal/Dianeal, then add 18mls sodium chloride (5mmol/ml)
Section 8: Adding Antibiotics to fluid.
Most antibiotics are compatible in PD fluid but if using one that has not been tried
before – advice should be sought from pharmacy in case of precipitation.
The main reason for antibiotics to be added to PD fluid is to treat peritonitis (see
Peritonitis section 12 and Peritonitis in Paediatric Peritoneal Dialysis Patients. Other
uses include; Prophylaxis for condition or leakage, Precautionary use due to
suspected contamination.
For loading and maintenance doses of antibiotics please refer to Peritonitis in

Paediatric Peritoneal Dialysis Patients
Section 9: Setting up PD
For setting up PD for either manual or Homechoice please refer to PD Nursing

Procedure.

Section 10: Flushing a PD catheter
The flushing of an acute PD catheter is done to combat poor filling and drainage
caused by a potential blockage and should be done using a strict aseptic non-touch
technique. The flushing of a PD catheter should be undertaken after discussion with
the paediatric Nephrologist or renal nurse on-call. It should only be performed by
central line competent nurses.
Do not aspirate as this can cause damage to the peritoneum.
Section 11: Trouble shooting
Troubleshooting and alarms for the Homechoice are covered in the Homechoice
manual. The problems listed below relate mainly to manual set use.
Flow problems:
No/reduced flow on fill.
Cause Solution
Clamped or kinked lines or catheter. Unclamp or un-kink lines.
Fibrin blockage. Flush catheter with heparin & NaCl
- Fibrin is a form of protein that looks like strands And add heparin to bags.
of cotton wool.
Position of catheter obstructing drain. Reposition patient.
Fluid may have fully drained out Clamp drain clamp. Fill and drain
straight into drain bag because drain patient (no dwell) observing closely for
clamp not clamped. signs of over filling.
No/reduced flow on drain.
Cause Solution
Clamped or kinked lines or catheter. Unclamp or un-kink lines.
Fibrin blockage Flush catheter with heparin & NaCl
And add heparin to bags.
Position of patient obstructing fill. Reposition patient.

Therapy problems:
More fluid removal required.
Suggestion Action
Increase strength of dialysis fluid. Add more glucose to bag if using unit
prepared solution.
Use higher strength bag if using pre-made.
Nb: try using a mix of two strengths as
opposed to going straight to next one up.
Decrease dwell times. Shorten the length of time the dialysate
stays in the patient.
This can increase the fluid removal but
can also have an effect on solute removal.
Increase fill volumes. Increasing the amount of fluid going into
the patient can sometimes increase fluid
removal but should be done cautiously.
This will also increase the solute removal.
Too much fluid being removed
Suggestion. Action
Decrease the glucose concentration. Add less glucose to the bag if using
unit prepared solution.
Use a weaker strength bag if using
pre-made.
Nb: try using a mix of two strengths.
Lengthen the dwell time. Leaving the dialysate in the patient for
longer will remove less fluid.

More clearance of waste and electrolytes required.
Urea One hour dwell times are usually sufficient to remove urea at
an acceptable rate. Dwell times can however be lowered to
remove more urea
Potassium Shorter dwell times are required to remove more potassium.
Half hourly rapid cycling can be used if required.
Continuous dialysis can reduce potassium levels too far and
may require adding it to bags.
Sodium High plasma sodium should be lowered slowly to avoid any
adverse effects. 1mmol per hour is a safe reference to use.
Very hypernatraemic patients (eg: >150mmols) should have
sodium chloride added to the dialysate to avoid lowering
levels too quickly.
Calcium Calcium contents of the unit prepared solutions can be
adjusted according to patient’s status. Pre-made solutions are
available with different calcium concentrations ranging from 0
– 1.75mmols/litre.
Creatinine Creatinine is not removed very well during peritoneal dialysis

and requires longer dwell times to increase removal. It is
however, a useful indicator of kidney function and should be
observed in the acute setting for any improvement.
Nb: Unit prepared solutions can be made patient specific if required or

additives can be put into pre-made dialysis fluid.

General problems
Pain on infusion:
Cause Solution
Internal position of catheter. Tidal dialysis can be tried in order to
keep a pool of fluid in the peritoneum
and hopefully float the catheter.
Change patient’s position.
Repositioning of catheter can be tried if

an acute line is being used.
Intra-abdominal pressure Reduce fill volume
Cross flow dialysis

Air under diaphragm Usually self-correcting within 30
minutes.
Analgesia
Cross flow dialysis

Dialysate too acidic. Switch to a more bicarbonate based
fluid. Eg: Physioneal 40.
Pain on outflow:
Cause Solution
Internal position of catheter. Tidal dialysis can be tried in order to
keep a pool of fluid in the peritoneum
and hopefully float the catheter.
Change patient’s position.
Repositioning of catheter can be tried if

an acute line is being used.
Breathlessness:
Cause Solution
Intra-abdominal pressure Reduce fill volume
Cross flow dialysis
P.D fluid passing into chest Change to extracorporeal therapy.

Leakage:
Leakage is a common problem with acute peritoneal dialysis. The main cause for this
is the early use of PD catheters without the recommended resting period enable
adequate healing or the use of acute PD catheters, which are inserted directly into the
peritoneum without tunnelling. If the entry site of the catheter becomes enlarged due
to movement, fluid can easily escape along the tract. The patient then becomes an
even higher risk for infection.
To avoid leakage the catheter should be well anchored to restrict any movement in
the entry site.
If leakage occurs a slight pressure dressing should be applied around the site in order
to stem the flow of fluid.
Nb: the dressing should be weighed prior to application in neonates so it can be re-
weighed if fluid continues to leak and fluid loss is inaccurate.
Suturing around the entry site may be attempted by the medical staff.
If leakage continues and becomes a problem then a new catheter should be
considered.
Section 12: Infection
Patients are at a high risk of infection when receiving acute peritoneal dialysis. This is
due to the position and placement of the PD catheter and the flow of a glucose based
solution in and out of the peritoneum. Potential sites of infection are the peritoneum
(Peritonitis) and the catheter exit site. Observations of these two areas are simple to
carry out and can aid quick recovery.
Exit site.
 The catheter exit site should be carefully examined when changing the
dressing. Signs of infection such as redness, oozing, pain and swelling should
be looked for and the site should be swabbed if infection is suspected.
 Oral or intravenous antibiotics should be prescribed if infection is proved or
strongly suspected.
 Topical agents such as Mupirocin ointment (Bactroban) can also be used, but
long term usage has been shown to cause some resistance.
Peritonitis
Peritonitis is an inflammation of the peritoneum caused by infection. This infection is
can be introduced to the peritoneum in various ways such as:
 Contamination
 Poor set-up technique
 Exit/tunnel infection
 Through gut wall.

See peritonitis guideline for more information.
The signs of peritonitis are:

o Cloudy fluid
o Temperature
o Abdominal pain.
Advice should be sought if any of these are seen in an acute patient.
Section 13: References
Baxter Renal Replacement Product information guide.

Baxter Healthcare Ltd 2003.
Consensus guidelines for the treatment of peritonitis in paediatric patients

receiving peritoneal dialysis.
International Society of Peritoneal Dialysis (ISPD). 2012.
Advisory committee on Peritonitis Management in Paediatric Patients.
Guidelines by an Ad Hoc European committee on adequacy and the paediatric

peritoneal dialysis prescription.
Fischbach, Stefanidis & Watson. 2002.
European Paediatric Peritoneal Dialysis Working Group.
Guidelines for children starting or receiving peritoneal dialysis for chronic renal
failure. Roy Connell. 2018. (Revised edition)
.
Schaefer et al. (2007). Worldwide variation of dialysis associated peritonitis in
children. Kidney International. 72, pp. 1374-1379.

Appendix 1
Unit prepared solutions.
Take a 1000ml bag of sterile water for irrigation, remove 90mls and discard, then add:
Additive Strength Volume to Final

add concentration
Sodium 8.4% 40mls 40mmols/litre
Bicarbonate (1mmol/ml)
Sodium Chloride 30% 18mls 90mmols/litre
(5mmols/ml)
Potassium Chloride 20mmol/10mls 2mls 4mmols/litre
Magnesium 50% (2mmol/ml) 0.4mls 0.8mmols/litre
Sulphate
Dextrose 50% (0.5g/ml) 30mls 15g/l (1.5%)
This solution contains:

Na 130mmols/litre
Cl 92mmols/litre
HC03 40mmols/litre
Mg 0.8mmols/litre
K 4mmols/litre
Gluc 1.5%
It does not contain phosphate. This can be added in the form of Potassium acid
phosphate.
It does not contain calcium. This should be administered separately as an infusion of

0.5 – 1.0 mmols/kg/day.
The solution may be adapted as required but should be done by somebody familiar
with manipulating dialysate fluid contents.

Please affix patient label
Date:_______________________
Patient Name:
Planned surgical list [ ] Emergency list [ ]. (Tick)
Date of birth:
Time leaving ward:_________________AM / PM
NHS / K Number:
Initial.
1. Childs MRSA and MSSA status has been confirmed. Date:____________
 Decolonisation required? Yes / No (Circle)
 Decolonisation performed? Yes / No

(Consider if child at higher risk of infection or status unknown)
 Prophylactic Mupirocin required? Yes / No

(Consider if child at higher risk of infection or status unknown)
2. Bloods taken for Virology (Hep B/C, HIV)? (CVL insertion only)Date:____________
 Haemo machine isolated (if required or result unknown) Yes / No. Machine No:_________
 Results checked Date:____________
Parents informed of results Yes / No
Appropriate access chosen.

(Guidance on sizes overleaf)
Access details (type/size)__________________________________________
4. Volume of line lock required (per lumen) – Heparin 10 units/ml. ___________ml

(Guidance on sizes and volumes overleaf)
Replace line lock with prescribed amount and strength when returned to ward.
5. Imaging - Required Yes / No

Reason_______________________________________________
6. Appropriate antibiotics should be given prophylactically.

(See overleaf and/or guidelines for appropriate dosing)
Given before leaving ward Yes / No

(Ensure drug chart signed)
To be given on induction Yes / No Theatre staff informed: Yes / No

(Ensure written on once only section)
Antifungal prophylaxis required? Yes / No - Given before leaving ward

(See guidance on patient group overleaf) (Ensure drug chart signed)
- To be given on induction
(Ensure written on drug chart)
7. Training performed on appropriate devices prior to discharge (Including gastrostomies)
Type of device(s)__________________________________________________

Acute line sizes
Supplier Name Line size Single/double Heparin Weight

lumen Lock guide.
Gambro Gamcath 6.5fr - 7.5cm Double 0.9ml < 10kg
Gambro Gamcath 6.5fr - Double 1ml < 10kg

12.5cm
Gambro Gamcath 8fr - 12.5cm Double 1.1ml 10 - 20kg
Gambro Gamcath 11fr - 15cm Double 1.3ml > 20kg
Gambro Gamcath 11fr - 20cm Double 1.4ml > 30kg
Long term line sizes
Supplier Catheter Size Lock Required Patient Size

(priming volume)
Kimal 8 fr -12cm 0.8 ml per lumen Infant Under 8 Kg
Medcomp 8 fr – 18cm 1.1 ml per lumen Infant/Child

8 fr – 24cm 1.2 ml per lumen 8 - 20 Kg
Medcomp 10 fr – 18cm 1.2 ml per lumen Infant/Child

(Split-cath) 10 fr – 24cm 1.3 ml per lumen 10 - 30 Kg
Medcomp 12.5 fr – 24cm 1.5ml per lumen Child 30 - 60 Kg

12.5 fr – 32cm 1.8ml per lumen
Kimal 14 fr – 28cm 2.1 ml per lumen Child over 60 Kg
Single lumen 10Fr 35cm 1.9ml (1.7ml)

Tesio 7Fr 30cm 1.6ml (1.4ml)
Peritoneal dialysis catheters

Size Length Estimated weight guide
Infant (Flexneck) 23cm (Child under 7kg)
Paediatric 42cm (Child 6 – 30kg)
Adult 62.5cm (Child over 30kg)
Antibiotic dosing:
- IV dose at induction – Follow with oral doses.
PD catheter - Flucloxacillin 25mg/kg (max 1 gram)
Central Venous Line - Flucloxacillin 25mg/kg (max 1 gram)
PD catheter and gastrostomy – Cefuroxime [30mg/kg – max 750mg (BD)] and
Metronidazole [7.5mg/kg (TDS)]
Antifungal (if required): Fluconazole 3mg / kg (Max 150mg)

Peritoneal Dialysis - Acute

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Peritoneal Dialysis - Acute

Title of Guideline Guideline for the nurses undertaking acute peritoneal

Contact Name and Job Title (author)

Directorate & Speciality

Date on which guideline must be reviewed (this should

Guideline Number 2118

Abstract This guideline describes the Assessment, set-up and

Key Words Dialysis, Peritoneal, Acute, Child, Young Person,

Statement of the evidence base of the guideline – has 1b

Evidence base: (1-5)

Roy Connell 1 of 17 January 2018

Document Amendment Record

Version Issue Date Author

Summary of changes for new version:

 No significant changes required

Statement of Compliance with Child Health Guidelines SOP

Roy Connell 2 of 17 January 2018

 Fill volumes below 100mls will require a manual PD set.

Section 1: Catheter selection .................................................................................. 4

Roy Connell 3 of 17 January 2018

Catheter Size Priming volume Child weight

Nb: Priming volume is catheter only. Not inclusive of extension set.

Section 2: Dressing, Exit site and Immobilisation.

Section 3: Choice and composition of PD fluids.

Roy Connell 4 of 17 January 2018

Other fluids available:

Physioneal 35 - Higher calcium (1.75mmol/l) and magnesium (0.75mmol/l)

Specially prepared pure bicarbonate based solutions can be made. See

Roy Connell 5 of 17 January 2018

Cycle = Fill / Dwell / Drain.

Fill volume x 24 = Total therapy volume.

See section 12 ‘Troubleshooting’ for information on adjusting dwell times.

Roy Connell 6 of 17 January 2018

Section 5: Adding heparin to PD fluid.

The dose of Heparin for PD fluid is 500units/litre – unless prescribed otherwise.

(See also – PD Nursing Procedure.)

Section 6: Adding Potassium to PD fluid.

(See also – PD Nursing Procedure.)

Section 7: Adding Sodium to PD fluid.

In cases of hypernatraemia in patients requiring PD it may be necessary to add

Roy Connell 7 of 17 January 2018

Section 8: Adding Antibiotics to fluid.

(See also – PD Nursing Procedure.)

For loading and maintenance doses of antibiotics please refer to Peritonitis in

For setting up PD for either manual or Homechoice please refer to PD Nursing

Roy Connell 8 of 17 January 2018

Do not aspirate as this can cause damage to the peritoneum.

Section 11: Trouble shooting

No/reduced flow on fill.

No/reduced flow on drain.

Roy Connell 9 of 17 January 2018

More fluid removal required.

Too much fluid being removed

Roy Connell 10 of 17 January 2018

Creatinine Creatinine is not removed very well during peritoneal dialysis

Nb: Unit prepared solutions can be made patient specific if required or

Roy Connell 11 of 17 January 2018

Change patient’s position.

Repositioning of catheter can be tried if

Cross flow dialysis

Cross flow dialysis

Change patient’s position.

Repositioning of catheter can be tried if