Dr Surinder Sodhi
Continuous ambulatory peritoneal dialysis (CAPD) is done to remove wastes, chemicals, and extra fluid from your body. During CAPD, a liquid called dialysate is put into your abdomen through a catheter (thin tube).
The dialysate pulls wastes, chemicals, and extra fluid from your blood through the peritoneum. The peritoneum is a thin lining on the inside of your abdomen. The peritoneum works like a filter as the wastes are pulled through it. The process of filling and emptying your abdomen with dialysate is called an exchange. Exchanges may be done 3 to 5 times during the day, and once during the night.
Why do I need CAPD?
You may need CAPD if your kidneys are not working well, or if they have stopped working. Your kidneys remove wastes and extra fluid from your blood and leave your body through your urine. When your kidneys are damaged, they cannot remove wastes properly. This can cause serious problems in your body. You may need CAPD if you have acute (short- term) or chronic (long-term) kidney failure. During acute kidney failure, you may only need CAPD until your kidneys get better. If you have chronic kidney failure, you will need to have dialysis exchanges for the rest of your life.
How is a CAPD catheter put in?
A procedure will be done to place the catheter. Medicine will be given to make you relax and decrease pain. Your caregiver will make an incision below or beside your belly button, or just below your ribs. He will cut through your muscle and tissue to make a hole where the catheter will be placed. A catheter will be pushed into your abdomen through this hole. The end of the catheter may be placed just under your skin for 3 to 5 weeks. Your caregiver will put some liquid through the catheter to check that it works well. He may also put blood thinner medicine in it to help prevent your catheter from getting clogged. The catheter will be held in place with stitches, and the area covered with bandages.
How are CAPD exchanges done?
CAPD exchanges should be done in a well-lit room. There should be no pets, dander, strong breezes, or fans in the room. They can increase your risk of an infection. Gather your supplies. Place the following supplies on a clean table close to where you will be doing your CAPD exchange:
Dialysate bag and waste product bag
Y-shaped tubing
IV stand (used to hang your dialysate bag)
Disposable medical gloves
Medical mask to wear over your face during CAPD
Tubing clamps
New plastic syringe without a needle (if needed) Wash your hands with soap and water. Rub your hands together with soap for at least 15 seconds before rinsing them. Dry your hands with a clean towel or paper towel.
Do not touch the tubing or catheter without washing your hands and wearing gloves. Keep your fingernails short and clean.
Put on your gloves and mask. Put your mask on so that it covers your mouth and nose. Do not touch anything but the catheter and your supplies after you put the gloves on. Flush the tubing. Flush the tubing with dialysate liquid before your exchange to help prevent infections. Connect the lower end of the Y tubing to your catheter, and connect the 2 other ends of the tubing to the dialysate bag and the waste bag. Clamp the tubing that is attached to the catheter that goes into your abdomen. This will close off the tubing so that the dialysate does not go into your abdomen yet. Allow 100 milliliters (mL) of fresh dialysate to flow out of the bag, and down the tubing into the waste bag. After 100 mL of dialysate has drained, clamp the tubing that goes to the waste bag.
Let the dialysate flow into your abdomen. Hang the bag at a higher level than your abdomen. Take the clamp off of the tubing that is attached to the catheter that goes into your abdomen. Let the rest of the dialysate flow into your abdomen. This should take no more than 10 minutes.
You may lie down, sit, or stand up while the dialysate flows in. After all of the dialysate is in your abdomen, wash your hands and put on new gloves. Disconnect your catheter from the tubing. Clamp your catheter closed.
Leave the dialysate in your abdomen for 3 to 5 hours of dwell time. Drain the dialysate out of your abdomen, and into the waste bag.
After the dwell time, follow the steps of washing your hands and putting on your mask. Be sure the supplies that you need are easy to reach and use. Connect the Y tubing to your catheter again. Do this in the same way as you did to put the dialysate into your abdomen. Clamp the tubing that goes to the dialysate bag so that it is closed. Hang the bag at a lower level than your abdomen. Remove the clamps from the tubing that leads to the waste bag. Let the dialysate drain from your abdomen into the waste bag.
If the dialysate is not flowing out well, change your body position. If this does not make the dialysate flow out better, disconnect the end of the tubing that is attached to your catheter. Use a syringe to gently suck the dialysate out of your abdomen. It should take less than 45 minutes to drain the dialysate out of your abdomen. The dialysate that drains out should be clear.
After all the dialysate has drained out, close the waste bag and dispose of it as directed. Wash your hands.
Do I need to follow a special diet?
You will have to limit phosphorus and sodium (salt). You may need to decrease or increase potassium, depending on your blood levels. You will also need extra protein, because protein is lost through your exchanges. The dialysate contains sugar, which may cause you to gain weight. Your dietitian may want you to decrease the amount of calories you have each day if you gain weight. You may also need to limit liquid if your body is retaining (holding in) fluid. Your caregiver will tell you how much liquid to drink each day. Write down how much liquid you drink each day. Measure the amount of urine you pass each time you go to the bathroom. Your caregiver may ask you to weigh yourself each day. Show this information to your caregiver when you have follow-up visits. He will tell you if you have too much or too little fluid in your body, and what to do to correct it.
(The author is a faculty at Deptt. of Nephrology SSH Jammu)
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