Synopsis
Explain peritoneal dialysis physiology and delivery, monitor prescription and membrane performance, and respond safely to peritonitis, catheter problems and fluid imbalance.
- Peritoneal dialysis uses the patient's peritoneal capillaries as the blood compartment and instilled dialysate as the receiving compartment for diffusive solute clearance and osmotic ultrafiltration.
- Continuous ambulatory peritoneal dialysis uses manual daytime exchanges; automated peritoneal dialysis uses a programmed cycler, usually overnight, and modality choice should reflect physiology, lifestyle and support.
- A clean connection technique, daily exit-site care, a trained patient or assistant and rapid access to the PD team are core safety interventions, not optional extras.
Key red flags
Cloudy drained fluid needs same-day renal contact even if pain is mild; delay in effluent testing and antimicrobial treatment increases technique failure and sepsis risk.
Investigation priorities
Confirm inflammatory dialysate and support the diagnosis of PD-associated peritonitis.
Management branches
A PD patient reports cloudy drainage, white flecks, abdominal discomfort or systemic illness.
- Tell the patient to contact the PD unit immediately, retain the bag if locally advised and attend the agreed urgent assessment route rather than waiting for the next exchange.
- Assess sepsis and abdominal red flags, examine the exit site and tunnel, and obtain effluent cell count, differential, Gram stain and culture correctly.
Key medicines
Empirical intraperitoneal antibioticsThere is no universal agent or dose. Obtain the patient’s current PD-programme protocol and prescribe its intermittent or continuous intraperitoneal regimen after sampling, adjusted for modality, dwell, residual kidney function, allergy, compatibility and local susceptibility data; if that protocol is unavailable, contact PD nephrology and microbiology urgently.
Antifungal prophylaxis with antibiotic exposureGive the centre-approved oral antifungal regimen for the duration specified whenever qualifying antibiotic treatment is used in a PD patient.