Possible Problems with Peritoneal Dialysis - Patient Education Home

Possible Problems with
Peritoneal Dialysis
There are some possible problems you may experience with peritoneal
dialysis (PD). You will be able to care for many of the problems yourself;
however, some problems are emergencies and need medical care right
away.
PD Emergencies
• Cloudy bags
• Leaking from your catheter exit site
• Catheter adapter falls out or comes apart
• Contamination of any part of your PD system
• Your catheter falls out
• Hole in your catheter
Infections and Peritoneal Dialysis
Infections are one of the most common problems seen with peritoneal
dialysis (PD). Most infections can be prevented. Bacteria are normally
present in many parts of your body, such as your skin, nose and bowel. To
prevent the spread of these bacteria to unwanted areas, wash your hands
with an antibacterial soap for 20 seconds and dry them with a paper towel.
Make sure your hands are clean before any procedure.
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Medical Center, Dialysis Center - Upon request all patient education
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Condition Signs Treatment
Peritonitis
Peritonitis is an
inflammation of the
peritoneum, the
membrane lining the
abdominal wall,
through which your
catheter has been
placed and where the
PD occurs. Signs of
peritonitis may
include: cloudy PD
drainage, abdominal
pain or tenderness,
poor outflow, nausea
or vomiting, and
fever.
Exit Site Infection
An infection at the
site of your PD
catheter exiting from
your skin can occur.
• You are at risk for peritonitis
when your hands are not clean
or the correct procedure for
following PD is not used.
• You are also at risk for
peritonitis if you have any of
these factors:
Touch contamination
Improper taping of site
catheter or not protecting
from friction
Exit site infection
Bowel perforation
Carrier of Staph infection
Recent dental visit without
antibiotic coverage
Diabetes Mellitus
Invasive procedure such as
colonoscopy or abdominal
surgery within 24 hours
Diverticulitis
Constipation / Diarrhea
Poor hygiene
Supplies not kept sterile, or
a hole in tubing or bag
• Redness, pain and drainage at
the exit site are signs of
infection.
• Causes of infection can be
from:
Not cleaning your site daily
Not protecting your site
from irritation
Improperly taping your
catheter to your abdomen
If you see a cloudy bag, call
your doctor or CAPD unit
right away. Save the cloudy
bag.
If you have drainage from
the exit site, call your CAPD
unit right away.
• To promote healthy exit
sites:
Avoid submerging
exit site in bath water
Avoid "bending type"
exercises
Follow proper
procedure for PD
exchanges
Wear loose clothing
that will not rub the
site

How to Prevent PD Infections
• Use sterile technique.
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Wash your hands with soap and water before starting any procedure.
Place a mask on everyone in the room while you are performing PD
exchanges.
Clean your table or countertop with antibacterial cleaner before you
begin.
• Do all procedures the way you were taught by your CAPD unit.
• Make sterile, tight connections during bag exchanges and avoid
contamination when injecting medicines. If any piece of equipment or
materials may have been contaminated before use, throw it away it and
get new items.
• Pay attention to what you are doing, and do not allow distractions, such
as from children or pets.
• Do exit site care every day and protect it with a dressing. Tape the
tubing to the skin to prevent pulling on the site. Avoid tight fitting
clothing that can rub the site.
• Call your CAPD unit before any dental or diagnostic procedures.
Other PD Problems and Treatments
Following is a list of possible problems that may occur. Included is a
definition of the problem, actions to take to prevent it, what to watch for,
and what to do. If you are not certain of what to do, call your CAPD unit.
Condition Signs Treatment
Spike
Contamination
A spike
contamination
happens when the
end of the spike
touches something
that is not clean
(sterile).
• If you think that the spike
has been contaminated:
Stop the PD exchange!
Do not allow PD fluid
to flow in.
Call your CAPD unit
or doctor.
Do not do another
exchange until you
have talked to your
CAPD nurse or your
doctor.

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Condition Signs Treatment
Fluid Overload
Fluid overload is the
inability to remove
excess body fluid due
to the loss of kidney
function. It is
important to know
your dry weight and
to monitor your
weight and blood
pressure every day.
Dehydration
Dehydration is the
removal of too much
body fluid due to
diet, dialysis or
illness. It is important
for you to know your
dry weight, and
monitor your weight
and blood pressure.
Exit Site Leaking
Leaking can occur
where the dialysis
fluid leaks out around
the exit site of the
catheter.
Hernia or
Subcutaneous Leak
A small or large area
of tissue becomes
large and hard under
the skin, close to the
exit site of your
catheter.
• Shortness of breath
• Swelling in arms and legs,
face or abdomen
• Cough, especially when
lying flat at night
• Increase in weight and / or
increase in blood pressure
• Dizziness and / or ringing in
ears
• Decrease weight and blood
pressure
• Cramping in fingers, feet,
toes, stomach
• Increase fluid and salt in
diet
• Localized swelling on
stomach or groin area
• Decrease in amount of
drainage in bag
• Redness and pain in area of
swelling
• Increase in weight
Call your Doctor or CAPD
nurse right away if you have
signs of “fluid overload.”
• Follow your diet
restrictions.
Call your Doctor or CAPD
unit right away if you have
symptoms of “dehydration.”
• Call your Doctor or CA
PD unit right away if you
have leaking from your
exit site.
• To help prevent exit site
leaks:
Avoid heavy lifting,
contact sports or
strenuous activity
Wear clothing that
does not rub the site
Make sure there is
proper taping of the
catheter and exit site.
• Call your Doctor or CA
PD unit right away if you
have leaking from your
exit site.
• Follow the guidelines for
preventing exit site leaks
to help prevent hernia or
subcutaneous leaks.

Condition Signs Treatment
Cuff Erosion
Cuff erosion is when
the cuff of the
catheter is seen at the
skin exit site.
Blood in Effluent
If dialysis effluent
(drained dialysis
solution) appears
pink or red, you may
have blood in
effluent.
Pain
• Possible pain and purulent
drainage at the exit site
• Cuff seen at the exit site
• Pink-tinged drained dialysis
solution
• For women: menstruation
may cause bleeding in
drained dialysis solution
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• Call your Doctor or
CAPD unit right away if
you can see your cuff.
• Call your Doctor or
CAPD unit right away if
you see blood in your
effluent.
• To prevent blood in
effluent:
Always tape the tubing
to your skin, to avoid
pulling on the catheter.
Avoid heavy lifting,
strenuous exercise or
contact sports.
If you have pain with peritoneal dialysis, talk with your doctor or CAPD
unit for treatment.
Type of Pain Treatment
Inflow Pain
Inflow pain can occur
depending on the
position of the
catheter.
Empty Pain
Empty pain is a sharp
pain at the end of
drain.
Back Pain
Solution in the
abdomen can cause
pressure on the lower
back.
Shoulder pain
May occur after your
catheter is placed.
• Tell your Doctor or CAPD unit if you have pain with your
exchanges.
Decrease inflow of dialysis solution using roller clamp
Change position: stand, sit, or lie down
• Tell your Doctor or CAPD unit if you have pain with your
exchanges.
• Tell your Doctor or CAPD unit if you have back pain.
Remove all air from tubing before inflow of solution
Have good body posture to reduce this pressure.
• Tell your Doctor or CAPD unit if pain does not improve.

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Problems with Solution Flow
If you have trouble with solution flow during PD exchanges call your
doctor or CAPD unit.
Solution Problem Treatment
Poor solution flow
into peritoneal
cavity
Fibrin
White strands of
protein or “egg
white” seen in the
drained dialysis
solution can cause
slow drainage or
inflow
Poor Solution Flow
out of Peritoneal
Cavity
Constipation
Constipation is the
most common cause
of poor outflow in
peritoneal dialysis.
• Call your Doctor or CAPD unit if you are unable to
perform your exchange.
Make sure correct clamps are open
Check for kinks along tubing & catheter
Change position: sit, stand or lie down
Cough
Repeat exchange with new supplies
• Tell your Doctor or CAPD unit if you see fibrin in your
effluent (drained dialysis solution bag).
• Call your Doctor or CAPD unit if you are unable to
perform your exchange.
Make sure correct clamps are open.
Check for kinks along tubing and catheter
Check for kinked tubing
Change position
• Call your Doctor or CAPD unit if you are unable to
perform your exchange.

Other Problems
Here are common problems that some people have with PD. Call your
doctor or CAPD unit with questions or concerns.
Solution Problem Treatment
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Hole in transfer set • If you have a hole in your transfer set or catheter, stop
dialysis right away. Call your doctor or CAPD unit.
Do not use pins or scissors anywhere near your
CAPD catheter.
Clamp the transfer set or catheter ABOVE the hole.
Anemia
Low red blood cell
counts.
High phosphorous
This is the inability
to remove
phosphorus due to
the loss of kidney
function.
Itching
Also called Pruritus
Low on Dialysis
Supplies
• Call your Doctor or CAPD unit if you have any signs of
anemia:
Low energy, feel tired or weak
Possible shortness or breath
Chest pain
• Call your Doctor or CAPD unit if you have any signs of
high phosphorus:
Extreme itching
Bone pain
• Call your Doctor or CAPD unit if you have severe
itching:
High levels of phosphorous can cause itching
Take calcium (phosphate binder) as prescribed
Lotions may be given to reduce itching
• Call your CAPD Unit if you are running low on
supplies.
Talk to your doctor or others on your health care team if you have
questions. You may request more written information from the
Library for Health Information at (614) 293-3707 or email: healthinfo@osu.edu.