1-Surgery to put in your catheter

Before your first treatment, you will have surgery to place a catheter into your belly. Planning your catheter placement at least 3 weeks before your first exchange can improve treatment success.
Although you can use the catheter for dialysis as soon as it’s in place, the catheter tends to work better when you have 10 to 20 days to heal before starting a full schedule of exchanges.
Your surgeon will make a small cut, often below and a little to the side of your belly button, and then guide the catheter through the slit into your peritoneal cavity. You’ll receive general or local anesthesia, and you may need to stay overnight in the hospital. However, most people can go home after the procedure.
You’ll learn to care for the skin around the catheter, called the exit site, as part of your dialysis training.

2-Dialysis training

 After training, most people can perform both types of peritoneal dialysis on their own. You’ll work with a dialysis nurse for 1 to 2 weeks to learn how to do exchanges and avoid infections. Most people bring a family member or friend to training. With a trained friend or family member, you’ll be prepared in case you have a sick day and need help with exchanges.

If you choose automated peritoneal dialysis, you’ll learn how to prepare the cycler connect the bags of dialysis solution place the drain tube If you choose automated peritoneal dialysis, you also need to learn how to do exchanges by hand in case of a power failure or if you need an exchange during the day in addition to nighttime automated peritoneal dialysis.

3-performance of dialysis therapy

You’ll need the following supplies:

• Transfer set
• Dialysis solution
• Supplies to keep your exit site clean
• If you choose automated peritoneal dialysis you’ll need a cycler.

Your health care team will provide everything you need to begin peritoneal dialysis and help you arrange to have supplies such as dialysis solution and dialysis set delivered to your home, usually once a month. Careful hand washing before while you connect your catheter to the transfer set can help prevent infection.

Use a transfer set to connect your catheter to the dialysis solution. A part that called patient connector, which is connected to the catheter on one side and to the transfer set on the other side, and has a secure cap at the end to prevent infection. You can keep your patient connector and transfer set hidden inside your clothing. At the beginning of dialysis, you should remove the cap from the patient connector and connect it to the y-shaped branch of the set .One branch of the y-tube connects to the drain bag, while the other connects to the bag of fresh dialysis solution.

Use dialysis solution as prescribed Dialysis solution comes in 1.5, 2, 2.5, or 3 liter bags. Solutions contain a sugar called dextrose or a compound called icodextrin and minerals to pull the wastes and extra fluid from your blood into your belly. Different solutions have different strengths of dextrose or icodextrin. Your doctor will prescribe a formula that fits your needs.You’ll need a clean space to store your bags of solution and other supplies. Doing an exchange by hand after you wash your hands, drain the used dialysis solution from your belly into the drain bag. Near the end of the drain, you may feel a mild tugging sensation that tells you most of the fluid is gone. Close the transfer set. Warm each bag of solution to body temperature before use. You can use an electric blanket, or let the bag sit in a tub of warm water. Most solution bags come in a protective over wrap, and you can warm them in a microwave. Don’t microwave a bag of solution after you have removed it from it’s over wrap.

 Hang the new bag of solution on a pole and connect it to the tubing. Remove air from the tubes—allow a small amount of fresh, warm solution to flow directly from the new bag of solution into the drain bag. Clamp the tube that goes to the drain bag. Open or reconnect the transfer set, and refill your belly with fresh dialysis solution from the hanging bag. Using a cycler for automated peritoneal dialysis exchanges.In automated peritoneal dialysis, you use a machine called a cycler to fill and drain your belly. You can program the cycler to give you different amounts of dialysis solution at different times.

Each evening, you set up the machine to do three to five exchanges for you. You connect three to five bags of dialysis solution to tubing that goes into the cycler—one bag of solution for each exchange. The machine may have a special tube to connect the bag for the last exchange of the night.

At the times you set, the cycler releases a clamp and allows used solution to drain out of your belly into the drain line warms the fresh dialysis solution before it enters your body releases a clamp to allow body-temperature solution to flow into your belly.

A fluid meter in the cycler measures and records how much solution the cycler removes. Some cyclers compare the amount that was put in with the amount that drains out. This feature lets you and your doctor know if the treatment is removing enough fluid from your body.

Some cyclers allow you to use a long drain line that drains directly into your toilet or bathtub. Others have a disposal container.