I don’t think I really explained the difference between PD and HD other than with definitions. Sorry about that.
PD, Peritoneal Dialysis per the National Kidney Foundation:
the inside lining of your own belly acts as a natural filter. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out of your belly in cycles.
HD, Hemodialysis per the National Kidney Foundation:
blood is pumped out of your body to an artificial kidney machine, and returned to your body by tubes that connect you to the machine
I prefer more detail. I mean, seriously did I ever consider I’d get to use the word osmosis outside of biology class?
How it works is that you fill your abdomen with the dialysate fluid, which is a dextrose solution behind your peritoneal wall. The fluid basically attracts and traps toxins and relieves your kidneys of the work. Your peritoneum works as a filter so that when everything passes back out into the body, it’s clean (osmosis!). The amount of dextrose corresponds with the amount of fluid that will be taken off. The higher the dextrose (1.5%, 2.5%, and 4.25%), the more fluid you’ll drain.
Pro tip: The higher the dextrose, the more uncomfortable and full you’ll feel unit you get used to it.
Just out of ICU, my nephrologist sent me to the PD department to watch a 20 (or so) minute video that briefly explains the process, technique and lifestyle effects. Yeah, right.
I found it rather amusing that the first video talks about how an exchange takes 20 minutes and is easy to fit into your lifestyle.
That script was clearly written by someone who hadn’t had to do a manual exchange (CAPD).
With PD, a tube is surgically inserted into your abdomen. In my story, the tube and the insertion site remained bandaged and covered with a transparent dressing for 4 weeks, entirely. During that really obnoxious time when I couldn’t shower, I had some creepy looking seepage that the nurses kept track of by drawing a circle on the bandage and checking the color. Once the bandage comes off and I was assured I wasn’t terribly infected, the staff flushes the PD tube with warmed solution (dialysate). The flushing is done a few times on separate occasions, then training starts.
Training takes place over 2-3 weeks during which you spend several hours a day in the PD unit with the nurses learning how to hook yourself up to the warmed bag of dialysate. During this time I remained on HD until I began the PD in earnest.
You don’t just grab everything and hook up.
Preparation begins a couple of hours before I start the drain. I have to heat up the solution in the bag. I was given a heating pad to wrap around the bag – that takes forever but you can really hurt yourself if you put cold solution into your body. Cold solution can cause cramps anywhere from your abdomen to your shoulder. They hurt a lot.
Once the bag is warmed, I have to wash my hands with antibacterial soap under running water for 60 seconds. Then I dry them with a fresh paper towel for 45 seconds. I use the paper towel to turn off the water and turn any door handles or lights between the sink and my room. This gets done 3 times before I actually hook up because I have to check the bag of dialysate for leaks or discoloration and the tubing for cracks as I lay it out on a non-porous surface that has been cleaned with anti-bacterial wipes when I remove the outer bag. Then I hang the full bag on the IV pole and place the drain bag on the floor, clamp the tubing, and break the frangibles.
Now that everything is ready and I have my transfer set free from my clothing, I put on a mask (anyone in the room with me has to have a mask on) and go wash my hands for the third time. I then remove the cap from my transfer set and the cap from the connector to the bag and attach the two ends and unclip the tube to the drain bag.
Once I’ve drained, I close my transfer set and unclamp the line to the fill bag for a sec to flush the line. I clamp the drain line and open my transfer set to fill.
Filling is weird. If the fluid is warm enough, you barely notice the change in temperature. It makes you feel like you ate and drank too much. You know when you feel like you might need to lie down because you ate too fast so you’re over full? Like that. Your clothes feel tight and, honestly, my shape changes a little when I’m full. Once the bag is empty, it’s time to disconnect.
To disconnect, I don the mask again and use hand sanitizer (since I don’t have a sink in my bedroom) to clean my hands, disconnect and put on a new mini cap with providone iodine solution. The fluid will dwell in my abdomen for the next several hours.
See? Simple and easy.
Most of the materials are provided for you by the PD supply company: IV pole, dialysate, tubing, blood pressure machine, scale, masks, clips, tape, & gauze to name a few. I actually have no idea what they cost. No one discussed that with me. My Medicare dates back to the day I started dialysis as did my Medicaid (once I finally got that ironed out).
When I first started PD at home on my own, it often took me half an hour just to drain, during which I was never sitting pleasantly reading like the video. I was shifting, rocking side to side, doing forward folds, and dancing – dancing was the most fun. I had a real problem draining for the first few weeks. It got to a point that I was also adding heparin to the dialysate because I was also have a fibrin problem. Fibrin, an insoluble protein that is produced in response to bleeding and is the major component of the blood clot, can clog your transfer set and slow draining and fill It’s a creepy fibrous glob that looks like whitish string. It sometimes forms in the solution and can clog the tube and make draining difficult.
Fortunately we got that under control and was tested for the auto cycler (APD). Switching to APD would allow me to cycle at night and free my days up for actually doing things for more than and hour and a half at a time.
I now cycle 8 hours every night (during which I drain, fill, and dwell four times) on the machine and I’m dry during the day. Thank god!