Clinical Nursing Application of Tidal Peritoneal Dialysis

Transcription

1 Clinical Nursing Application of Tidal Peritoneal Dialysis 高雄長庚醫院腹膜透析室 郭麗雀 PD catheter implantation This 76 years old male has history of ESRD and initiated CAPD since 2005 PD catheter was implanted on 2005/07/12 OP finding : Left : marked adhesion was noted around the incision site Right : mild adhesion was noted around the incision site Exit site side : Right side 1

2 Past History DM : denied Hypertension (+) for 1+ years Chronic renal disease noted for 1+ years Denied have Hepatitis B or C Operation history (-) Admission history 2005/08/04 Right inguinal hernia Lapascopic repair of the right inguinal hernia Hold PD 3 weeks 2007/03/27 Left inguinal hernia Lapascopic repair of the left inguinal hernia Hold PD 3 weeks 2

3 Problem Inadequacy Peritoneal Dialysis Adhesion Course of illness 2005/07/12 PD catheter implantation 2007/03/27 Left inguinal hernia 2006/01/13 Exit site side infection (1) 2008/4/10 Tidal peritoneal dialysis 2005/08/04 Right inguinal hernia 2006/06/09 Exit site side infection (2) 2006/08/01 CCPD 2008/01/04 Creation of AVF Poor outflow 3

4 Laboratory data Date BUN Cr Na K CA P Alb. Hgb Hct Date PET PET and Prescription Dialysate KT/V Urine KT/V Total KT/V Dialysate Ccr Urine Ccr Total Ccr PCRn Prescription High A L* L* High A L* L* High A L* High A L*5 2005/08 Hernia CCPD 2007/03 Hernia TPD High A High A APD 12L*1 1.5L*1 APD 12L*1 1.5L*1 4

5 KT/V and Weekly Ccr TPD Total KT/V Total WCcr Residual renal function Urine amount Urine Ccr 0 0 5

6 Daily UF ml / / / / / / / /03 Blood Pressure Systonic BP Dystonic BP / / / / / / / /03 6

7 Tidal Peritoneal Dialysis 治療方式 :TPD 總治療量 :12000 ML 治療時間 :10:00 注入量 :1700 ML TPD 容量百分比 :80 % 總脫水量 :300 ML 最末袋注入量 :1500 ML 最末袋葡萄糖濃度 : 不同 週期數 :7 留置時間 :1:38 潮式容量 :1360 ML TPD and Daytime Exchange Extraneal 1500 ml Exchange 1500 ml TPD Volume: 9860 ml Daytime (14 hours) Night (10 hours) 20% 7

8 Tidal PD: Its role in the current practice of peritoneal dialysis International Society of Nephrology , S91 S95. Summary of studies comparing clearances with TPD and IPD 8

9 SUMMARY These studies suggest that TPD does not result in an increase in clearances when compared to conventional intermittent peritoneal dialysis (IPD). TPD can improve patient comfort with peritoneal dialysis by eliminating or reducing pain that occurs at the start of inflow and/or at the end of outflow. Drainage-related alarms may occur less frequently and patient sleep quality may be improved. TPD is being reexamined by defining the critical residual volume in the abdomen at which point drainage of fluid slows significantly. It is hoped that by utilizing a residual volume in the abdomen defined by this critical volume, the time when limited solute transport occurs can be reduced and clearances can be increased. Tidal Automated Peritoneal Dialysis Preserves Residual Renal Function Better Than Non Tidal Automated Peritoneal Dialysis Advances in Peritoneal Dialysis, Vol. 23,

10 Patients criteria Patients had to have started APD at less than 15mL/min renal creatinine clearance (Ccr). Peritoneal equilibration test and RRF data had to be available for 3 years. The APD prescriptions had to have been fixed for either tidal or non tidal APD for the entire 3-year period. Patients and methods A total of 29 patients fulfilled these criteria (10 on tidal and 19 on non tidal APD). Patients who complained of nocturnal drainage pain or discomfort from the alarm system on the APD machine were counseled to use tidal mode. The drainage volume for the tidal prescription was 50% 70% at each cycle. 4 cycles per night were used. 10

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12 RRF Discussion Better RRF in the tidal patients Patients on tidal APD receive a lesser dialysis dose Indicated by significantly lower UF volume lower RRF in the non tidal patients Increased dialysate volume or dextrose concentration Insufficient UF occurs as a result of decreased RRF. Creatinine generation rate (CGR) In the tidal group increased CGR is an indicator of nutrition status Normalized to age, sex, body weight, and muscular volume 12

13 Conclusions Tidal APD preserves RRF better than non tidal APD does. 結論 TPD 是 APD 另一種選擇 減輕病患在透析液注入初期及排出最末期所導致的疼痛與不適 正確評估最適當潮氣容量, 可達到最大的脫水率及廓清效果 改善病患的睡眠品質 13