During the client’s dialysis, the nurse observes that the solution draining from the abdomen is consistently blood-tinged. The client has a permanent peritoneal catheter in place. Which interpretation of this observation would be correct?
A. Bleeding is expected with a permanent peritoneal catheter.
B. Bleeding indicates abdominal blood vessel damage.
C. Bleeding can indicate kidney damage.
D. Bleeding is caused by too-rapid infusion of the dialysate.
Correct Answer: B. Bleeding indicates abdominal blood vessel damage.
Because the client has a permanent catheter in place, blood-tinged drainage should not occur. Persistent blood-tinged drainage could indicate damage to the abdominal vessels, and the physician should be notified. Catheter insertion, manipulation, and trauma/pulling of the external limb of the catheter can all cause local tissue damage at the peritoneal entry site, which could lead to blood staining.
Option A: Insertion-related trauma to intra-abdominal organs and/or vasculature can also cause more serious and more persistent bleeding. This may be reduced by laparoscopic-assisted placement of catheters, which allows more direct visualization of the catheter during insertion. The risk of bleeding obviously increases if patients have significant adhesions and previous surgeries (often relative contraindications to successful PD).
Option C: The bleeding is originating in the peritoneal cavity, not the kidneys. Hemoperitoneum is seen in patients receiving peritoneal dialysis (PD) because the PD catheter provides a window to the peritoneum. Gynecological-associated phenomena account for the majority of cases. Intra-abdominal pathology of solid organs such as the kidney, liver, and spleen as well as the gastrointestinal tract is recognized. Unique to PD patients, hemoperitoneum may be associated with the catheter itself, uremic bleeding, or peritonitis.
Option D: Too rapid infusion of the dialysate can cause pain. Infusion pain is a frequent problem in peritoneal dialysis (PD), and can markedly vary in intensity and risk. Among the many etiologies are peritonitis and other inflammatory processes of the peritoneum, accidental infusion of air, and acidic pH of the dialysate, and expired dialysate with high concentrations of glucose degradation products or GDPs, extreme temperatures of dialysis solution, hypertonicity of the solution, rapid infusion rates and high pCO2 levels in the peritoneal dialysis fluid.
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