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[Audio] Good day colleague. Welcome to this training session which aims to introduce you to Peritoneal Dialysis. Peritoneal dialysis type of dialysis treatment that uses the peritoneum the membrane through which fluid and dissolved substances are exchanged. This treatment modality is used to remove excess fluid, correct electrolye imbalances and remove toxins and waste in patients with kidney failure. Peritoneal dialysis has been shown to have better outcomes during the first couple of years of treatment and it allows for greater flexibility and better tolerability in those with significant heart disease. Peritoneal dialysis uses the patient's abdominal cavity as a reservoir for dialysis solution whilst waste and excess water pass into the solution. The solution is infused into the peritoneum. Movement of waste and water is facilitated by the concentration gradient and osmotic forces through the peritoneum. Once these shifts have occurred, the fluid is drained via a thin flexible plastic tube, permanently inserted into the abdominal cavity. This is known as a peritoneal catheter. The so-called Tenckhoff catheter is most often used..

[Audio] Before being found competent in administering Peritoneal Dialysis Treatment, we will be reviewing the anatomy and key functions of the peritoneum, principles of peritoneal dialysis treatment. We will the explore the procedure to commence and discontinue peritoneal dialysis treatment. We will end by discussing the potential complications of peritoneal dialysis and review your knowledge..

THE PERITONEUM. Serous membrane lines the abdominal cavity; Covers abdominal organs; Essential roles in: Protection; Support; Immune defense..

[Audio] The Peritoneum is characterized by three key components. These include the Parietal and Visceral Peritoneum and the Peritoneal Cavity. The Parietal peritoneum is attached to the walls of the abdominal cavity and serves to line and protect the abdominal wall. The Visceral Peritoneum covers the surface of abdominal and pelvic organs and functions to protect these organs, facilitates movement of these organs and reduces friction. The Peritoneal Cavity however is the potential space between the parietal and visceral layers. This space contains approximately fifty milliliters of serous fluid to maintain moisture around the organs within the peritoneum. This serves to reduces friction as organs move during digestion and respiration..

[Audio] The mesentery, an organ that attaches the intestines to the posterior abdominal wall. It comprises the double fold of the peritoneum. The mesentery has several functions, yet most importantly it helps in storing fat and allowing blood vessels, lymphatics, and nerves to supply the intestines..

[Audio] The greater omentum is a large apron-like fold of visceral peritoneum hangs down from the stomach. It extends from the greater curvature of the passing in front of the small intestines and folds back to ascend to the transverse colon before reaching to the posterior abdominal wall. The lesser omentum is a smaller fatty tissue anchor, which hangs down from the liver to the lesser curvature of the stomach and acts as a conduit for blood vessels..

[Audio] The peritoneum is vital for protection, support, and immune defense. Understanding its structure and function is crucial in clinical practice. Significant clinical presentations realted to the peritoneum, include ascites and peritonitis. One must also consider the implications of surgery on the peritoneum and the role that it plays in overall well being and organ function. Patients who develop ascites – or fluid accumulation in the abdomen often do so as a result of liver pathology and can do so in instances of renal pathology too. Fluid build up in the abdominal cavity is often painful and progressive accumulation results in cardiovascular and respiratory compromise. Inflammation of the peritoneum is known as peritonitis. This is largely attributed to infection. These can be internal or systemic in origin or introduced by means of surgical or invasive procedures. Sepsis is a significant complication that can be life threatening. It is also important to note that invasive and surgical procedures interfere with the integrity of the internal abdominal organs. A well functioning peritoneum prevents adhesions after surgical procedures. This is an important function of the peritoneum with life long effects and implications..

[Audio] Let's recap the main functions of the peritoneum. These include protection and ensuring a moist environment that surrounds the abdominal and pelvic organs. The peritoneum provides organ support and nutrient bioavailability. The omentum, which surrounds the abdominal organs is rich in immune cells and thus provides protection. The omentum, being a fatty layer contains a rich supply of energy for the cells of the organs within the abdominal cavity..

[Audio] That concludes our anatomy recap. Next we will look at the principles of treatment and those principles related to caring for patients receiving peritoneal dialysis treatment..

[Audio] Peritoneal dialysis is a type of renal replacement therapy where the peritoneum serves as the dialysis membrane. The goal of treatment being to remove waste products, excess fluid as well as to balance electrolytes in patients with kidney failure..

[Audio] Peritoneal dialysis involves the process of introducing sterile dialysate into the peritoneal cavity via a flexible, silicone catheter. The dialysate is infused into the peritoneal cavity. The peritoneum serves as the membrane across which renal replacement therapy will be facilitated. Exchange and replacement occurs via the dialysate within the peritoneal cavity. Waste and excess fluid transfer from the blood into the dialysate is then drained away from the cavity via the catheter. Several exchanges may be required to achieve treatment goals. This means that several infusions and drains occur during the treatment session. There are typically two types of peritoneal dialysis. These are Continuous Ambulatory Peritoneal Dialysis or Automated, which means that a mechanical device is used to infuse and drain dialysate..

[Audio] P D involves three distinct stages known as the exchange process or dialysis cycle. The fill stage involves dialysate being introduces into the peritoneal cavity. The dwell stage is the period during which the dialysate remains in the cavity to allow for waste and fluid transfer. The last stage is the drain stage and this is when waste-laiden fluid is removed. These three stages, or exchanges, are typically repeated three to five times a day with C A P D but are automated in patients receiving dialysis via an automated device..

[Audio] Peritoneal dialysis does pose some important benefits to patients. This treatment modality does have many benefits. A few of the main advantanges include increased flexibility and independence. P D can be carried out in the comfort of the patient's home, subject to the patient meeting set eligibility criteria. P D is largely patient led meaning that patients are in control of their treatment. This ownership is empowering to patients on life long treatment. This modality is less restrictive in terms of timing and diet. Treatment can be scheduled around the patient's activities of daily living and schedules. This promotes quality of living. With P D being largely continuous, outcomes are shown to be better and kidney function and better balance of fluid and electrolytes. In addition, no repeated needling or invasive access, means less pain and discomfort. These benefits make the treatment modality attractive to patients..

[Audio] Treatment is not without its risks. Important principles when administering P D include: Infection Prevention. Practitioners and patient who self administer must ensure that the catheter exit site is clean and dry. An aseptic technique must be adopted for all exchanges. Due to the risk of infection, patients must be monitored for signs of peritonitis. This is suspected when the dialysate that drains is cloudy, the patient complains of abdominal pain and or fever. Another very important principle of care is close monitoring of fluid and hydration status. As in other treatment modalities, ppatients must be monitored for signs of fluid overload or dehydration. Fluid removal must be adjusted as prescribed and any concerns should be discussed with the treating nephrologist. Lastly, as in all other modalities, patient education is important. Given that this modality is largely patient led, this principle in emphasised. Patients must be taught proper technique, correct hygiene principles and practices as well as how to troubleshoot when concerns arise. The importance of hand hygiene and use of sterile supplies must be reinforced and patients must be able to comply with these practices consistently., Lastly, empowering patients with the ability to recognize complications early and when and who to reach out to for intervention..

[Audio] The most common complications of Peritoneal Dialysis include Peritonitis As mentioned before, inflammation of the peritoneum is likely to have an infective cause. Patients typically present with with abdominal pain, fever, and cloudy dialysate. Aseptic technique and hand hygiene go a long way in preventing infection. Another complication could be catheter malfunction. This typically occurs when the peritoneal catheter becomes blocked or it migrates. Hernia formation is also a significant complication which can occur due to an increase in intra-abdominal pressure. As a result, patients are required to be assessed regularly. Assessments include assessment of kidney function, electrolyte balance, and well-being. Routine blood tests monitor dialysis efficacy and a basis for adjustment of treatment. In addition, those on home based treatment need monitoring and assessment to promote effective and safe practice, to increase independence and the feeling of empowerment, however it is a means of providing much needed psychosocial support..

CONCLUSION. PPD is a flexible, effective home-based therapy Proper patient education and Infection prevention are key..

THANK YOU.