When receiving a PD treatment, dialysate will flow into the peritoneal cavity through the catheter. The solution will remain in the cavity for several hours. During this time, waste products and excess fluid pass from the blood into the peritoneal cavity. After the complete dwell time (period the dialysis solution is in your abdomen), the solution will be drained from the cavity. You will then fill the cavity with fresh solution and the process begins again. The process is called an exchange.
There is potential for infection with any surgical or invasive procedure; therefore, you will need to follow proper techniques for performing your treatments. Different types of PD have different schedules of exchanges. Some PD treatments are done during the day while others are at night. Your doctor will prescribe how many exchanges you will do each day, as well as the amount and type of dialysis fluid you will use. It is important to follow your PD prescription and do all of the exchanges as instructed.
Since you don’t have to go to a dialysis center for treatment, PD gives you more control. You can do treatments at home, at work or on vacation. This independence makes it especially important to work closely with your healthcare team: your nephrologist, dialysis nurse, dietitian, and social worker.
Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD does not require a machine. It can be done in any place that is clean and well lit. The only equipment you need is a bag full of dialysate fluid and the plastic tubing that comes attached to the bag. A mask is also strongly recommended to prevent the risk of infection. As the word ambulatory suggests, you can walk around with the dialysis solution in your abdomen. CAPD is performed manually and can be done almost anywhere. With CAPD, dialysis takes place 24 hours a day, seven days a week. The peritoneal membrane acts as a filter, removing toxins and excess fluid from the blood. The toxins and fluids your kidneys cannot remove cross the membrane into the dialysis solution. They are removed from the body when the dialysis solution is drained during an exchange into a pre-attached drainage bag.
CAPD requires that you have dialysis solution in your abdomen. The amount of dialysate will vary depending on your specific needs. Exchanges are usually performed every four to six hours during the day. After a specified time, the solution, which now contains toxins, is drained into the drainage bag. You then repeat the cycle with a fresh bag of solution. An exchange of dialysis fluid in CAPD is simple. You will be able to do it yourself once you have been trained by a specialized CAPD nurse. This training usually takes one to two weeks.
The solution bag is hung on an IV pole, using gravity to allow dialysate to flow into the peritoneal cavity. First, empty the abdomen of the old fluid, and then add fresh solution. Once you have filled your peritoneal cavity with the clean dialysate solution, you can detach the tubing and empty the used dialysate into the toilet. The clean fluid then sits in the peritoneal cavity until your next exchange. During this time, you are free to go about your regular activities. Each exchange takes about 30 minutes to complete. Your doctor will prescribe the number of exchanges you’ll need, typically three or four exchanges during the day and one evening exchange with a long overnight dwell time while you sleep. A usual prescription will have you performing exchanges when you wake, at lunchtime, at dinnertime and at bedtime.
Continuous Cycling Peritoneal Dialysis (CCPD)
Sometimes called automated peritoneal dialysis (APD), this treatment is done at home with your catheter connected to the cycler machine. CCPD is a simple procedure. The machine automatically controls the timing of exchanges, drains the used solution, and fills the peritoneal cavity with new solution. This machine is designed and prescribed to be used at night while you sleep. The machines are easy to operate and have built-in safety devices. CCPD machines are portable and about the size of a small suitcase. They can be used wherever there is a grounded electricity supply.