A client is undergoing peritoneal dialysis. The dialysate dwell time is completed, and the dwell clamp is opened to allow the dialysate to drain. The nurse notes that the drainage has stopped and only 500 ml has drained; the amount the dialysate instilled was 1,500 ml. Which of the following interventions would be done first?
A. Change the client’s position.
B. Call the physician.
C. Check the catheter for kinks or obstruction.
D. Clamp the catheter and instill more dialysate at the next exchange time.
Correct Answer: C. Check the catheter for kinks or obstruction.
The first intervention should be to check for kinks and obstructions because that could be preventing drainage. Peritoneal catheter outflow problems are common and many PD patients transfer to hemodialysis because of catheter related issues. Peritoneal outflow failure can be defined as the incomplete recovery of instilled dialysate consistently within 45 minutes of beginning a drain.
Option A: After checking for kinks, have the client change position to promote drainage. Check tubing for kinks; note 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 B: If unable to get more output despite checking for kinks and changing the client’s position, the nurse should then call the physician to determine the proper intervention. Evaluate the development of tachypnea, dyspnea, increased respiratory effort. Drain dialysate, and notify the physician. Abdominal distension and diaphragmatic compression may cause respiratory distress.
Option D: Don’t give the next scheduled exchange until the dialysate is drained because abdominal distention will occur unless the output is within parameters set by the physician. Alter dialysate regimen as indicated. Changes may be needed in the glucose or sodium concentration to facilitate efficient dialysis
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