You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining?
A. Check for kinks in the outflow tubing.
B. Raise the drainage bag above the level of the abdomen.
C. Place the patient in a reverse Trendelenburg position.
D. Ask the patient to cough.
Correct Answer: A. Check for kinks in the outflow tubing.
Tubing problems are a common cause of outflow difficulties, check the tubing for kinks and ensure that all clamps are open. Other measures include having the patient change positions (moving side to side or sitting up), applying gentle pressure over the abdomen, or having a bowel movement. Assess the patency of catheter, noting difficulty in draining. Note the presence of fibrin strings and plugs. Slowing of flow rate and presence of fibrin suggests partial catheter occlusion requiring further evaluation and intervention.
Option B: Check tubing for kinks; note the placement of bottles and bags. Anchor catheter so that adequate inflow/outflow is achieved. Improper functioning of equipment may result in retained fluid in the abdomen and insufficient clearance of toxins.
Option C: Turn from side to side, elevate the head of the bed, apply gentle pressure to the abdomen. May enhance outflow of fluid when the catheter is malpositioned and obstructed by the omentum.
Option D: Monitor BP and pulse, noting hypertension, bounding pulses, neck vein distension, peripheral edema; measure CVP if available. Elevations indicate hypervolemia. Assess heart and breath sounds, noting S3 and crackles, rhonchi. Fluid overload may potentiate HF and pulmonary edema.
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