The nurse is preparing to care for a client receiving peritoneal dialysis. Which of the following would be included in the nursing plan of care to prevent the major complication associated with peritoneal dialysis?
A. Monitor the client's level of consciousness.
B. Maintain strict aseptic technique.
C. Add heparin to the dialysate solution.
D. Change the catheter site dressing daily.
Correct Answer: B. Maintain strict aseptic technique.
The major complication of peritoneal dialysis is peritonitis. A strict aseptic technique is required in caring for the client receiving this treatment. Observe meticulous aseptic techniques and wear masks during catheter insertion, dressing changes, and whenever the system is opened. Change tubings per protocol. Prevents the introduction of organisms and airborne contamination that may cause infection.
Option A: Be alert for signs of infection (cloudy drainage, elevated temperature) and, rarely, bleeding. Cloudy effluent is suggestive of peritoneal infection. Investigate reports of nausea and vomiting, increased and severe abdominal pain; rebound tenderness, fever, and leukocytosis. These are signs and symptoms suggesting peritonitis, requiring prompt intervention.
Option C: Heparin is useful in preventing fibrin clot formation, but it does not prevent peritonitis. Apply povidone-iodine (Betadine) barrier in a distal, clamped portion of catheter when intermittent dialysis therapy used. Reduces risk of bacterial entry through catheter between dialysis treatments when the catheter is disconnected from the closed system.
Option D: Although this may assist in preventing infection, it relates to an external site. Change dressings as indicated, being careful not to dislodge the catheter. Note character, color, odor, or drainage from around the insertion site. A moist environment promotes bacterial growth. Purulent drainage at the insertion site suggests the presence of local infection.
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