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Automated peritoneal dialysis is performed mainly while a patient is asleep, using a permanently implanted abdominal catheter which provides access to the peritoneal cavity. The device removes metabolic wastes through selective diffusion across peritoneum. These dialysis units infuse and remove a specially designed dialysate by means of the catheter and a sterile disposable tubing system.
1. Safeguards such as a low-drain alarm and a fluid-retention alarm should be in place to prevent overfilling a patient's peritoneum with dialysate. When less than a set percent of the infused dialysate volume is drained from the patient after each drain cycle, the low drain alarm should be set.
2. It is important to prevent overfilling because besides discomfort from the intra-abdominal pressure, it can cause serious complications, such as decreased pulmonary function, and decreased cardiac performance, periatherter leakage, and hernia.
3. The low drain alarm should be set to a point between 60% and 85%. A fluid retention alarm is generated by the ultra filtration monitor and activates in case of a significant discrepancy between the dialysate-fill volume and the drain volume.
4. If the patient cumulatively retains over one half of the fill volume setting, it is recommended that the fluid retention alarm go off.
5. Facilities should carefully consider the dialysate temperature. It must be warm enough so that the patient is comfortable, and cool enough not to damage the peritoneum. Warm dialysate increases patient comfort by avoiding body cooling and is also thought to increase the effectiveness of dialysis by causing vasodilatation and increased diffusion.
6. The patient should be protected from receiving cold dialysate fluid by disallowing dialysate infusion until it is warmed. If the dialysate enters the patient when it's too warm, it can cause peritoneal sclerosis. If the unit starts to deliver dialysate over 43
7. Other alarms are recommended to alert users to the disruption of dialysis to the patient. The unit should also alarm upon power failure or an insufficient volume of dialysate delivered to the patient.
8. In units used at home, reliability is a special concern. No backup unit or repair technician is usually available at home, and if the unit ceases to function in the middle of a treatment, the consequences can be serious.
9. In homes, power, water pressure, and temperature may not be regulated as well as in medical facilities. Therefore, limited acceptable ranges of supply voltage and water temperature become important issues in selecting a unit.