Peritoneal dialysis in the critically ill patient

The use of peritoneal dialysis on an acute basis is increasing each year. Peritoneal dialysis pulls waste products and excess water out of the blood stream and into dialysate solution in the peritoneal cavity. When patients are unstable hemodynamically, have severe cardiovascular disease, already require peritoneal dialysis, or are small children, peritoneal dialysis is the preferred treatment. Patients may be dialyzed using either a cycler or manual peritoneal dialysis. Patients should be monitored carefully for volume status, bowel status, and infection. Potential complications include problems with access, infection, pain, respiratory status, fluid imbalance, and potassium imbalance. Special consideration should be given to nutritional status because critically ill patients often need increased intake. Drug therapy needs modification because excretion of drugs by the kidney is delayed. Patient and family support is important because of decreased ability to understand, anxiety, loss of control, and change in body image. Treatment termination also may be an issue.