[Local Medical Care]Home-based peritoneal dialysis treatment for dialysis patients at home without having to travel

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Written by ◆Dr. Chen Huiting and compiled by ◆Liang Yingxiu

The peritoneum refers to the membrane covering the internal organs in the abdominal cavity. The peritoneum is rich in microvascular distribution.

If you choose peritoneal dialysis, you will first undergo “peritoneal dialysis catheter implantation” to permanently implant the peritoneal dialysis catheter into the abdominal cavity, allowing the patient to operate it at home.

(Kuala Lumpur) According to the 2018 Malaysian Kidney Dialysis and Transplantation Registration Report, the number of dialysis patients in Malaysia has been rising steadily in the past 10 years. This year, it has reached 44,000 and is expected to have exceeded the 50,000 mark.

In addition to the most well-known hemodialysis (HD), peritoneal dialysis (PD) is actually a type of kidney dialysis treatment, but currently only 10% of Malaysian kidney dialysis patients receive this treatment.

Peritoneal dialysis uses the peritoneum to replace the kidneys as the “human body filter”. Dialysate is injected into the abdominal cavity through a catheter and stored for a period of time. The high-concentration pure dialysate “filters” the metabolic waste and excess water in the body into the dialysate, and then discharges it. Come. Peritoneal dialysis can be described as an “inferior treatment.”

A treatment session only takes 20 minutes

Dr Bee Boon Cheak, senior consultant at the Department of Nephrology at Selayang Hospital, Selangor, pointed out that hemodialysis and peritoneal dialysis are actually complementary to each other. Peritoneal dialysis is very common abroad, such as Thailand, Hong Kong and Mexico. In “peritoneal dialysis” Under the “dialysis first” policy, all patients with kidney failure will receive abdominal dialysis treatment first, unless there are medical contraindications.

“Peritoneal dialysis can be divided into two types,

They are continuous portable peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD).

CAPD requires dialysis and fluid exchange 3 to 4 times a day.

Each time takes 20 to 30 minutes;

APD uses a machine to perform 8 to 10 hours of dialysis treatment while the patient is sleeping.

Patients can do this without affecting their daily life.

Work activities as usual. “

He said that the advantages of peritoneal dialysis treatment are home-based treatment and flexible time arrangement.

“Patients receiving hemodialysis have to go to the dialysis center for 4 hours of dialysis three days a week, and their personal life is completely disrupted; patients with peritoneal dialysis can get dialysis without going out, and one treatment only takes a few hours from drainage to water filling. 20 minutes. At other times, patients can move on their own. Patients can also travel with dialysate and dialysis machines, and their schedules are not restricted. Unlike hemodialysis, which is performed three times a week, peritoneal dialysis needs to be performed every day. This is non-intermittent The treatment is milder and more effective in preserving remaining kidney function.”

He said that because the treatment is gentle and balanced, it can avoid problems such as dizziness, arrhythmia or cramps caused by low blood pressure caused by efficient extraction of water in patients with heart disease or hypotension during hemodialysis treatment. Therefore, peritoneal dialysis treatment is very suitable for patients with heart disease or hypotension. It is more suitable for patients with existing heart disease.

The catheter is inserted into the abdominal cavity without needing a needle

“Patients only need to undergo a minor surgery to insert the catheter into the abdominal cavity before treatment. It can be used after the wound heals in two weeks, avoiding the pain of needle insertion that must be experienced every time hemodialysis treatment.”

He pointed out that because no needles are needed, infectious diseases such as hepatitis B, hepatitis C, and AIDS through the blood can be greatly reduced.

When patients perform peritoneal dialysis on their own, they must rely on vision and manual coordination to connect the catheter and dialysate. Therefore, it is not suitable for those with blurred vision and trembling hands. People who have had abdominal surgery, have a stoma, hernia, or have severe gastrointestinal diseases can also consult a nephrologist first.

No medical attention Patients need a high degree of self-discipline

Nurses Hayati and Zailis, who have worked in the peritoneal dialysis department for many years, pointed out that if you want to receive peritoneal dialysis, you must go through the following procedures:

1. Professional evaluation:

Once a patient understands and is interested in trying peritoneal dialysis, the peritoneal dialysis treatment team will conduct a series of assessment tests for the patient. The treatment team will review everything from the patient’s own vision, physical strength, hand grip strength, and even the environmental sanitation and storage space of the home.

They will use puppets to demonstrate the steps of peritoneal dialysis to patients and their families on site, and then the patients or family members will simulate it themselves, while nurses will observe and evaluate. If the patient does not meet the standard and is unable to perform peritoneal dialysis on his own, a family member who lives with the patient and is able to take the time to treat the patient can be considered to do it for him. If there are no family members to help, the patient must give up the option of peritoneal dialysis.

2. Implantation of catheter:

After passing the assessment, the nephrologist will arrange a time for surgery, and they will implant a dialysis catheter for the patient under local or general anesthesia. After the wound heals in about two weeks, peritoneal dialysis can be started.

3. Training and assessment:

At the beginning of treatment, patients must undergo training and assessment by the peritoneal dialysis treatment department until they pass each step. Nurses will also share with patients how to deal with emergencies during home dialysis through two-way communication of questions and answers.

Because patients or family members perform peritoneal dialysis treatment on their own without the care of medical staff, a high degree of cooperation and self-discipline from patients and relatives is required. Every step must be strictly implemented. No step should be missing and the order cannot be disordered. Any mistake in one step may cause peritonitis. Seemingly insignificant steps, such as washing hands and wearing a mask, are often the source of bacterial infections.

The Peritoneal Dialysis Unit at Selayang Hospital was established in 2000 and is staffed by nephrologists and a group of professionally trained nurses. The number of patients increased from 12 at the beginning to 520 at the peak. The team is responsible for any matters related to peritoneal dialysis, including pre-treatment assessment and post-treatment training.

This medical team also makes home visits to ensure that patients have a suitable environment for peritoneal dialysis. The peritoneal dialysis treatment department provides patients with a good platform. If they have any questions, they can call or see a doctor immediately. The good doctor-nurse relationship makes them more confident in doing dialysis at home.

Travel with your instrument Ms. Luo (48 years old, patient, peritoneal dialysis for 12 years)

Ms. Luo was in her early 30s when she was told she needed kidney dialysis. At first, I felt that hanging the tube on my belly would be detrimental to my image. In addition, I love outdoor sports, especially swimming. I was worried that I would no longer be able to swim after undergoing peritoneal dialysis, so I resisted peritoneal dialysis.

After Dr. Ma’s enlightenment, she realized that life is more important than image, and she started peritoneal dialysis. Fortunately, peritoneal dialysis did not deprive her of her wonderful life.

“I have been doing APD for 12 years now. I only need to connect the APD machine before going to bed at night, and I can still do my favorite children’s photography during the day. I have also traveled to South Korea with my friends and taken the APD machine with me, and I have also gone swimming in the sea. Although it’s a bit heavy to carry the instrument when traveling, but after thinking about it, it’s better than losing your health, so it doesn’t matter if it’s a bit hard.”

Lead step by step with more confidence Ms. Chen (60 years old, family member, husband has been undergoing peritoneal dialysis for 3 years)

“When the doctor told my husband that he needed kidney dialysis, I saw the people around me getting thinner and thinner due to hemodialysis treatment, and his heart function was weak. I was really worried that he would not be able to bear the load. We started with peritoneal dialysis. We don’t know anything, but thanks to Dr. Ma’s careful explanation of the advantages and disadvantages of blood and peritoneal dialysis, we finally chose the milder peritoneal dialysis treatment,” Ms. Chen recalled.

Fortunately, the nurses and doctors in the peritoneal dialysis treatment department guide them step by step. If there are any conditions during the treatment, they can directly call and discuss with the doctor during office hours, so that the patient and their family members feel at ease and have more confidence to receive treatment at home.

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