Peritonitis is the most common complication of peritoneal dialysis and directly affects the continuation of peritoneal dialysis and the survival of the patient. The pathogen enters the peritoneal cavity mainly along the dialysis tubing lumen and around the tubing, with a few cases caused by the spread of infection from adjacent organs.
Prevention.
1. neat indoor environment, fresh air, ultraviolet radiation twice a day for 30 min each time. when changing dialysis fluid, try to do it in the dialysis room.
2, dialysis concentration to 37-39 ℃ is appropriate, with dry thermostat heating, do not use hot water humidification, thermostat disinfection scrub once a week.
3, strict aseptic operation, careful inspection of the dialysis fluid for impurities, precipitation, broken dialysis bags, etc..
4.Change the dressing twice a week at the dialysis tubing outlet, and also check the skin around the outlet for hematoma, and strengthen the dressing change if infection is suspected, and change the dressing daily.
5.Observation of dialysis fluid, bacterial culture once a week under normal circumstances. patients with abdominal pain, dialysis fluid should be released in a timely manner, observe whether cloudy, specimens should be retained to send routine biochemical and bacterial culture, and give abdominal dialysis fluid flushing to clear.
6.Improve the immunity of the patient’s organism, encourage the patient to exercise, prevent colds, and remove psychological factors such as depression.
7, strictly in accordance with the aseptic operating procedures for fluid and drug exchange, and must wash hands before changing fluid and drugs.
8, pay attention to the care of the catheter, observe the catheter outlet and tunnel for redness, swelling, pressure pain, and timely bacterial smear culture of secretions.
9, febrile patients should check the catheter outlet and tunnel for signs of infection.
10, pay attention to personal hygiene, change clothes regularly, and prevent water from entering the catheter port when bathing.
11.Keep the stool unobstructed, do not eat cold and unclean food to prevent intestinal infection.
Peritoneal canal episiotomy and tunnel infection
Peritoneal tube episiotomy and tunnel infections can lead to incurable or recurrent peritonitis and even necessitate removal of the peritoneal dialysis tubing. The immunocompromised nature of dialysis patients can allow bacteria to cause an inflammatory response at the external peritoneal dialysis tubing port if the concept of aseptic technique is not strong and the procedure is not performed carefully. The pathogenic bacteria of infection are mostly Staphylococcus aureus, with Pseudomonas aeruginosa being rare. Others are gram-positive bacteria, negative bacilli and fungi.
Prevention
1. strict asepsis and standardization of cannulation procedures.
2.Reducing trauma to the external port and tunnel, and paying attention to the care of the external port.
3.Avoid twisting of the catheter, and the catheter should be fixed properly.
4. not forcibly removing crusts and scabs in routine care, applying hydrogen peroxide, saline or iodine attachment to soak the external orifice to soften it and then remove it.
5. advocate the use of mupirocin nasal drops or oral rifampicin treatment for patients with nasal carriage of staphylococci.
6.Strictly train the patients and standardize the operation steps.
Prevention of abdominal bleeding
1.Patients are advised to protect the wound and catheter, and prevent the lower abdomen from local vigorous activities or squeezing and collision, etc.
2.To ensure the effect of dialysis, try not to add or add less drugs to the dialysis fluid to avoid affecting the osmotic pressure, acidity and alkalinity to stimulate the peritoneum and cause infection or adhesions.
Prevention of hypoproteinemia and electrolyte disorders
1. Ask the patient to give a high quality and high protein diet according to the requirements of dialysis, with a daily protein intake of 1.0~1.2g/kg・d.
2. Pay attention to vitamin supplementation, both medication and dietary supplements can be taken.
3. Intravenous input of albumin or amino acids if necessary.
4.Prevent abdominal dialysis infection to prevent protein loss.
Lung infection
Due to the increased pressure in the abdominal cavity and incomplete expansion of some alveoli, lung infection is easily combined with abdominal dialysis. Patients should be encouraged to take deep breaths before dialysis in the morning.
Poor drainage of the abdominal dialysis tubing
It is mainly one-way obstruction, that is, fluid can enter, but the outflow is not smooth, and two-way obstruction occurs less often. The causes are as follows: blockage of dialysis catheter, fibrin clot obstruction or large omentum wrapped dialysis tubing; improper position of dialysis tubing or outward shift so that part of the drainage hole is exposed above the abdominal fluid surface; excessive gas in the lumen, intestinal cavity, displacement of dialysis tubing or distortion of dialysis tubing. Peritoneal adhesions, etc., should be actively searched for the cause to do the appropriate treatment. In addition, the patient should be encouraged to walk around, change position to lightly press the abdomen or slightly change the direction of the catheter, abdominal massage, use laxatives to enhance intestinal peristalsis, and to prevent blockage of the tubing, or use heparin 625u or use urokinase 5000~10000u with 20ml saline to inject into the dialysis tubing and keep it for 30~60min, and replace the dialysis tubing if necessary.
Abdominal pain
Abdominal pain can be caused by too high or too low temperature of dialysis fluid, too fast infusion or discharge of fluid, too deep position of dialysis tubing, dialysis fluid PH <5.5 or hypertonic dialysis fluid.
The causative factors should be removed as much as possible, and 3-5 ml of 1~2% procaine or lidocaine should be added to the dialysis fluid, and the number of dialysis sessions should be reduced or the retention time should be shortened when ineffective. If the pain is caused by the swelling of the abdomen at the end of peritoneal dialysis fluid infusion, the fluid can be drained or the exchange volume can be adjusted immediately, and the abdominal pain can be relieved. If the abdominal pain is fixed when the large omentum wraps the dialysis tubing, especially when the pain is obvious when the fluid is injected, and is accompanied by poor drainage, you should come to the hospital for consultation.
Metabolic abnormalities
Peritoneal dialysis has a high loss of protein and ammonia, which can cause hypoalbuminemia. The daily protein intake of patients on peritoneal dialysis should be 1.2 g/kg per day, and because a large amount of sugar is absorbed by the body in the peritoneal dialysis fluid, it can cause obesity and hypertriglyceridemia; therefore, the use of high sugar dialysis fluid should be limited, and 4.25% glucose should be used once a day for those on ambulatory dialysis.
Hemodialysis fluid
It is common in cases of poorly closed peritoneal suture, vascular injury on the surface of abdominal organs and menstrual period in female patients, etc. If it is a small amount of blood leakage, it is not necessary to stop dialysis, but the cause should be sought.
Leakage of dialysis fluid
It can be caused by poor suturing of the catheter peritoneal packet, loosening of the fixation line or too shallow placement of the dialysis tubing, mostly in the elderly, those with significant abdominal wall edema or hypoproteinemia.
Excess water or pulmonary edema
During the interdialysis period, improper water and salt control, drug titration, poor drainage of dialysate, and loss of ultrafiltration can exacerbate the patient’s water retention, and if accompanied by difficult-to-control hypertension, pulmonary edema is likely to occur.
Loss of ultrafiltration of peritoneal dialysis
Recurrent episodes of peritonitis lead to peritoneal fibrosis, which decreases its ability to ultrafiltrate water and solute removal. Peritoneal amyloidosis leads to thickening of the basement membrane of peritoneal capillaries, resulting in decreased glycemic gradient and decreased ultrafiltration.
Health education]
1, peritoneal dialysis should be fixed in a room, indoor furnishings should be simple and easy to clean. Wipe the table and sterilize the utensils with wet towels disinfected with 500mg/L chlorine-containing disinfectant solution before operation. Require air circulation and adequate light in the abdominal dialysis room, regular ventilation twice a day, and install ultraviolet disinfection lamps in the room, irradiating twice a day for 30 min each time to disinfect the air.
2. Keep the skin around the tube opening clean and dry, and change the dressing as it gets wet. The abdominal dialysis patients should not bathe, shower with disposable anal bag properly protected to prevent the fistula mouth moisture, underwear should be soft, loose, to reduce stimulation.
3, according to the season to add clothes and blankets, to avoid getting cold. Do not go to public places when you have a cold, and refuse and reduce human contact. Keep your mouth and skin clean. Keep the perineum clean to prevent abdominal infection due to retrograde infection of the blood and urinary tract.
4. Check the quality of the abdominal dialysis fluid. Carefully check the color, transparency and expiration date of the abdominal dialysis fluid before performing abdominal dialysis. If turbidity, precipitation, leakage, expiration, etc. are found, the use should be strictly prohibited. The color and transparency of the permeate should be closely observed during the process of abdominal dialysis. If there is fever, abdominal pain, turbidity of the dialysate, etc., abdominal infection should be considered. It should be treated promptly at the hospital.
5. Diet should be based on the principles of moderate amount of protein, rich in vitamins, low calories and low salt. Take high-quality animal and dairy protein as the main protein source, and consume less soy products. Eat more fresh fruits and vegetables to replenish vitamins, avoid or reduce the consumption of foods containing high potassium such as bananas, oranges, mushrooms, etc. Eat less animal offal, seafood, fish and shrimp, etc.