Peritonitis is one of the common complications in peritoneal dialysis patients, which can result in technical failure and patient hospitalization. The causes of peritonitis are often associated with fluid exchange operations that do not strictly follow aseptic requirements, or improper care of the tunnel port, or gastrointestinal infections, or a decrease in the body’s ability to resist disease. Therefore, peritoneal dialysis patients should pay attention to the prevention of peritonitis and learn something about it. Once the occurrence of peritonitis should be timely detection, timely consultation.
1, fluid change environment and requirements
Peritoneal dialysis fluid exchange requires a small site, only about 3 m2 of space separated as a fixed fluid exchange area, but must meet the following conditions.
(1) clean and dry. Fans, doors and windows should be temporarily closed during fluid exchange to prevent dust from flying or entering the room. Desktop and items should be kept clean.
(2) adequate light. Natural light source or artificial light source can be used.
(3) It is recommended not to have pets at home. Pets are not allowed to be present when you are changing fluids for dialysis, nor are they allowed to stay in the room where you place your dialysis items.
(4) Please do not answer the phone while changing fluids.
(5) The room used for fluid exchange should be cleaned and disinfected regularly.
2.Tunnel exit care
Good tunnel exit care is important for the prevention of catheter-associated infections and peritonitis, and hands should be thoroughly washed and dried before tunnel exit care is performed.
(1) The tunnel outlet should be kept dry until it is completely healed after laparotomy, which usually takes 2 weeks, during which time showers and tub baths should be avoided.
(2) After the tunnel exit site has healed, a bacteriostatic solution containing iodine or chlorhexidine, or antibacterial soap, may be used, but the flow of detergent into the exit site and into the tunnel should be avoided.
(3) Under normal circumstances, a change of medication can be done in the shower once a day or every other day. In case of infection, change the medication at least once a day.
(4) Normal tunnel exit changes do not necessarily require masks and gloves under normal circumstances. However, you must wear a mask if you have a cold or respiratory illness, and gloves if there is an infection at the exit.
(5) When bathing, shower from top to bottom with clean water, no tub baths, and do not allow the exit area to be immersed in water.
(6) If there is a scab at the outlet, it cannot be forcibly removed, but can be gently removed after softening with saline.
3.Care of dialysis catheter and external short tube
(1) The catheter and external short tubing should be tightly connected to avoid falling off.
(2) Keep the peritoneal dialysis catheter fixed to avoid pulling and damaging the outlet. When fixing, follow the natural trend of the peritoneal dialysis catheter and external short tubing, do not bend or crush them.
(3) The external short tubing must be replaced after 6 months of use, and should be replaced immediately if it is broken or the switch does not work. If a patient develops damage or leakage from the catheter or external short tubing during home dialysis, dialysis should be terminated, the tubing should be clamped shut, and the patient should be immediately seen by a peritoneal dialysis center.
(4) If the catheter is fixed with adhesive tape, it is forbidden to use scissors or sharp instruments to break it off so as not to manipulate the catheter.
4.Standardized fluid exchange steps
4.1 Preparation
(1) Clean the bench.
(2) Prepare the required items: peritoneal dialysis fluid, mask, iodophor cap, and line clamp.
(3) Wear a mask and wash hands, open the outer bag of peritoneal dialysis fluid, remove the peritoneal dialysis fluid, and check whether the interface pull ring, pipeline, outlet race and dialysis fluid bag are intact.
(4) Remove the short tubing on the body to ensure that the short tubing is in a closed state.
(5) If medication is to be added, add it to the dialysate through the dosing port as prescribed by the physician.
(6) Weigh the peritoneal dialysis fluid and keep records.
4.2 Connection
(1) Pull off the connector pull ring.
(2) Remove the iodophor cap from the external short tubing.
(3) Quickly connect the peritoneal dialysis fluid to the external short tubing, with the opening of the short tubing facing downward, and twist the peritoneal dialysis fluid line until it is completely tightened with the short tubing.
4.3 Drainage
(1) Hang the dialysis fluid bag.
(2) Clamp the inlet line with a line clamp.
(3) Break the outlet race at the mouth of the dialysate bag.
(4) lower the drainage bag.
(5) Turn the short tube switch halfway, stop when resistance is felt, and start drainage, while observing whether the drainage fluid is cloudy.
(6) close the short tube after the drainage is complete.
4.4 Flushing
(1) Remove the line clamps from the inlet line.
(2) Observe the flow of dialysate into the drainage bag.
(3) After counting slowly to 5 for a total of 5 seconds, clamp the drainage tube again with the line clamp.
4.5 Perfusion
(1) Open the short tube knob to start perfusion.
(2) Close the short tube after the perfusion is finished.
(3) Clamp the inlet line with another line clamp.
4.6 Separation
(1) Tear off the outer packaging of the iodophor cap.
(2) Check to see if the sponge inside the cap is moistened with iodine solution.
(3) Separate the short tubing from the peritoneal dialysis fluid.
(4) Turn the short tube face down and tighten the iodophor cap until it is completely tight.
(5) Weigh the dialysate and make a record.
5.The correct way to wash hands
(1) Wear a mask and remove the watch, ring, bracelet or bracelet.
(2) Adjust the water temperature, rinse wet hands and use soap or hand sanitizer, and form a rich foam on the hands.
(3) Scrub the fingertips, backs of fingers, backs of hands, palms and wrists in order.
(4) Rinse hands well with running water.
(5) Dry your hands with a clean paper towel and turn off the tap with the paper towel.
6.Daily precautions
(1) Enhance immune function. Abdominal dialysis patients have low immunity and are susceptible to colds. During the cold-prone season, attention should be paid to keeping warm and avoiding public places to reduce the possibility of infection.
(2) Increase nutrition. Patients with abdominal dialysis lose about 5-15g of protein per day, so it is advisable to eat more high-quality animal protein to strengthen nutrition and improve immunity.
(3) Avoid intestinal infections. Attention should be paid to dietary hygiene, the purchase of food must be fresh, good quality, cooked, cooked thoroughly, do not eat overnight meals, spoiled and irritating food, avoid gastrointestinal infections, the occurrence of infection should be actively treated. It is also important to keep the stool open, when constipation filled with feces intestinal tube will compress the peritoneal dialysis tube, so that the dialysis fluid infusion and discharge obstacles, while bacteria will penetrate the intestinal wall into the peritoneal cavity cause peritonitis. Prevent constipation can eat more high-fiber foods, such as brown rice, high-fiber cereals, daily moderate activity, constipation can take some laxatives.
7, early detection of peritonitis
Once the dialysis drainage fluid is found to be cloudy, or there is unexplained abdominal pain or diarrhea, or the amount of dialysis fluid out is reduced, you should pay great attention to it, contact your doctor or dialysis nurse in time, and keep the abdominal dialysis fluid for examination. If gastrointestinal infection or biliary tract infection occurs, you should seek medical attention in time to avoid inducing peritonitis.