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PERITONEAL DIALYSIS
Peritoneal dialysis is achieved by introducing dialysis solution into the peritoneal cavity using a silastic catheter that is inserted through the patient's abdominal wall. This catheter is tunneled under the skin for stability and terminates in the peritoneal space. Using this catheter, the dialysate solution is drained into the peritoneal space by gravity and it is removed from the peritoneal cavity by the same means. The natural membrane lining of the peritoneal cavity acts as a dialysis membrane through which waste products and excess water from the body can pass through into the peritoneal dialysate fluid. This waste-containing dialysate solution is drained out of the abdomen into a plastic bag and is discarded and a new quanity is reintroduced. The dialysis solution or dialysate must be sterile and contains salts and a high concentration of glucose relative to the patient's own blood. The highly osmolar dialysis solution causes water to move from the patient's circulation through the peritoneal membrane and into the dialysate fluid within the peritoneal cavity by the process of osmosis. Waste products and excess electrolytes move from the patient's circulation into the dialysate solution by the process of diffusion. Each exchange, that is draining of the old solution and replacing it with a fresh solution, takes about 45 min.
The X-Ray on the right shows a continuous ambulatory peritoneal dialysis setup.
This dialysis technique is less efficient than hemodialysis and therefore takes longer to achieve satisfactory results. This technique is not a satifactory technique in patients who are catabolic and produce high levels of nitrogenous wastes, i.e. sepsis, ARDS. Peritoneal dialysis should always be used with caution in patients having difficulty breathing since this technique will interfer with diaphragmatic movement and may decrease alveolar ventilation.
X-Rays taken during infusion and drainage of peritoneal catheters
- X-ray taken after 1 second of flow as dye reaches the
tip of the catheter.Arrow indicates dye in catheter.
- X-ray taken after 3 seconds of inflow. Arrows indicate dye flowing backwards along catheter through narrow channels and dye diverting laterally after exiting from tip.
- X-ray taken after 3 seconds of outflow of dye. Arrow indicates catheter, now radiolucent. Note that the last fluid in--the dye--is not the first to leave.
