Procedure

The peritoneal catheter is inserted via a trocar into the abdominal cavity using an entry site in the midline just below the umbilicus. The catheter is directed down towards the pelvis. A purse-string suture secures the catheter and the procedure is carried out using local anesthetic. About 1 to 2 liters of dialysis solution is run in quickly, left to dwell in the abdomen for 30 to 40 min, and then drained. Once dialysis is established, the dwell time and volume used can be increased; 2 liters are often used with the whole cycle of running in, dwell time, and draining taking 2 to 3 h. The dialysis solutions are warmed to body temperature and, in the initial stages, 2000 IU of heparin are added to each liter of fluid to prevent blockage by fibrin deposition within the catheter. The volume of fluid infused and drained should be accurately measured and recorded, allowing the overall balance of dialysate to be calculated. If the patient is overloaded with fluid, a hypertonic solution containing 6.36 per cent dextrose can be used and a negative balance achieved. The isotonic solution containing 1.36 per cent glucose is used when no fluid removal is required. Care has to be taken, as a large negative balance can be achieved even with isotonic solutions. When using a hypertonic solution, the blood glucose should be measured to ensure that significant hyperglycemia does not develop. In the early stages no additional potassium is added to the dialysate but, after several cycles, excess potassium is often removed and so potassium chloride is added to give a potassium concentration of 2 to 3 mmol/l in the dialysate.

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