Renal Medicine
Peritoneal Dialysis Catheter Pre and Post Insertion Advice
Preparing for your procedure 1. Clear your bowels Regular laxatives or modification to your diet can relieve you of constipation. 2. Nasal preparation Apply the ‘Bactroban Ointment for Staphylococcus Aureus carriers’ prescribed to you. For instructions on how to use them, please speak to our Peritoneal Dialysis (PD) nurse.
Shower Instructions (Evening before surgery, morning of surgery)
• Wet your body and apply all contents of the undiluted Hibiscrub to your body from the neck down. • Pay attention to the groins and umbilicus (belly button). • Leave Hibiscrub on your skin for two to three minutes before you shower. Rinse thoroughly. • Avoid contact with your eyes, ears and mouth. Use a clean set of towel and clothing. • Do not apply powder, deodorants, perfume etc after shower. • If itching or redness persists, stop using Hibiscrub on the morning of your surgery. Inform our PD nurse. The department of Renal Medicine at JurongHealth offers screening for the early detection of kidney problems. Our team comprises of specially-trained clinical coordinators, nurses, educator / counselors, dietitians, medical social workers and specialist clinicians who can address specific needs and offer one-stop, coordinated care that is seamless as we manage your well-being. We offer personalised clinical care, education and counseling to stop kidney diseases from progressing and any complications from worsening. We see various kidney inflammatory conditions, such as glomerulonephritis and tubulo-interstitial nephritides and kidney problems associated with familial, urological, rheumatological, various cancers and multi system conditions. 2
Day of Operation • Be punctual • Report to the Day Ward (if you are undergoing a day surgery) Local anaesthesia is used for most surgeries. General anaesthesia is used for more complicated cases. Your doctor will advise you.
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What to expect
• Avoid pulling or twisting your catheter • Do not scratch or rub the area around your wound
Day of Insertion of catheter Operation and flushing Patient learns how to care for the exit site
PostExit site is reviewed Operation Change of dressing (Day 7) Confirm training date
PostTraining (3 to 4 days) Operation Exit site is reviewed, (Day 14) flushing Start using Gentamicin (antibiotic) cream Initiate peritoneal dialysis
PostRemove stitches Operation (as required) (Day 10) Review of exit site Change of dressing & flushing
• Do not wear tight clothing or a belt round your waist. This may cause friction and an infection • Wear your belt below the wound • Constipation can cause pain and poor drainage
Post-Operative Care
• Do not keep furry pets • Monitor your weight and blood pressure daily • Keep all your appointments at the PD Unit
Contact us if you experience: 1. Signs of infection
Cloudy outflow (once you have started on peritoneal dialysis)
Pain, redness and warmth around the exit site
• Sponge your body with a clean towel
Fever, rigors and chills
Pus discharge from the exit site
• Do not shower until your wound has healed well (usually two to three weeks after the operation). Your nurse will inform you when you can take a shower
Diarrhoea
Abdominal pain
• Do not change your own dressing unless you are trained. It is not necessary to change your dressing frequently Please come to the PD Unit at Alexandra Hospital for a dressing change (during office hours) if your dressing is:
2. Bleeding from the surgery sites
• Keep your dressing and catheter clean and dry
- Wet or dirty - No longer sticky - Soaked with blood • Avoid exposing your wound to strong sunlight. Perspiration can cause your wound to become damp and lead to an infection • Immobilise your catheter to avoid trauma to the wound • Do not do strenuous exercise or carry heavy objects 4
3. Fluid overload / Uremia Like:
Nausea, vomiting and loss of appetite
Poor concentration
Increased swelling around the ankles and puffiness around the eyelids
Weight gain but decrease in daily urine output
Increased blood pressure
Breathlessness
You feel tired all the time
Important: If you experience breathlessness, notice your dressing is soaked with blood or feel unwell, please visit an emergency department immediately. 5
Follow-up Care
Notes:
1-2 weeks: Your exit site is reviewed along with your Total Ultrafiltration (TUF), Blood Pressure (BP), pulse rate, edema and weight. Please bring:
1) 2) 3) 4) 5)
Estimated time: 1 hour
Ultrabag × 1 (for CAPD* patient) Minicap × 2 (for CAPD patient) Dressing Materials CAPD / CCPD** record book Records on blood pressure, pulse rate and blood glucose (for diabetic patients)
CAPD*: Manual CCPD**: Machine
1 month:
Baseline Peritoneal Equilibrium Test (PET) and Dialysis Adequacy Test (Kt/V) test.
PET checks your peritoneal membrane status. It is done once unless your condition changes.
Estimated time: 5 hours
Kt/v (Dialysis Adequacy Test) checks the adequacy of your dialysis. Your dialysis regime may be modified according to your needs.
Every four to six months - Repeat Kt/V test
Estimated time: 30 minutes
Details of test will be given to you before your test date. Every six months - Change of transfer set Please bring:
6
1) Ultrabag × 1 2) Minicap × 2 3) Transfer set × 1
Estimated time: 1 hour
Enquiries Should you have any enquiries, please contact the PD Unit at 6379-3808 / 3889 (8am to 5pm, Monday-Friday), or 8126-5436 (after office hours).
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For more information Alexandra Hospital 378 Alexandra Road Singapore 159964 Tel (65) 6472 2000 Fax (65) 6379 3880 www.ah.com.sg Clinical and appointment hours Monday – Friday 8.30am to 5.30pm To make an appointment please call: Appointment Centre: 6476 8828 Getting to Alexandra Hospital
Free shuttle service Provided for visitors alighting at Queenstown MRT Station. Buses available from AH SBS 14, 33, 51, 93, 100, 120, 195, 197, SMRT 61 Disclaimer: The information in this brochure is meant for educational purposes and should not be used as substitute for medical diagnosis or treatment. Please seek your doctor’s advice before starting any treatment or if you have any questions related to your health, physical fitness or medical condition.