Peritoneal dialysis and ending of the second placement

So, the second placement is behind now and the assessment is done. As we said in the previous post, we went to visit the peritoneal side for one duty. Here are some points we found out during the duty we spent with peritoneal side staff;

Peritoneal dialysis is the same procedure than the haemodialysis but it’s done in different way. Instead of “cleaning” the patient via bloods, the main elements are patient’s peritonium and dialysis fluids. The dialysis is done by flowing the dialysis fluids to patient’s peritoneal cavity. The cleaning process happens through the peritonium and it is based on differences in concentration. There are different dialysis fluids to different needs; the bigger the concentration is, the more the extra fluids, toxins and substances it absorbs from the body. The dialysis fluids includes an certain amount of glucose which absorbs the toxins and other substances. After the dialysis fluid has flowed to the peritoneal cavity and the absorption has happened, it is drained out from the cavity. One session takes about half an hour and it is done in every four hour. Before the patient starts the peritoneal dialysis, doctors insert the catheter through his/her abdomen to the peritoneal cavity. The biggest difference to the haemodialysis is that the patient does the cleaning procedure in his/her home. Here in Malta, all the health care services are free so the dialysis fluids are transported to patients home from the hospital, free of charge of course.

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Appointment room in peritoneal side

Another option is to use the machine which does the dialysis during the night. This option is used usually when the patient is young and has an active lifestyle and it’s not possible to do the dialysis during the day. The machine is free for patients. In the evening the patient connects the dialysis fluids to the machine and the machine does the dialysis procedure during the patient is sleeping.

If we compare to Finland; The doctor writes a prescription for the dialysis fluids and saves it to the database (e-receipe). The patient goes to the pharmacy and pays some prize for the fluids. Of course the patient doesn’t have to pay the whole prize because there’s a discount system for the medicines used to these kind of diseases. Anyhow, patient has to pay from 1,5€-3€ for their fluids instead of getting them free of charge. Transportion is usually provided by the pharmacy. In Finland the medicines goes to patients via pharmacies, not via hospitals.

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Prescription sheet

Here in the Renal Unit there’s a peritoneal side where the peritoneal dialysis patients goes to visit nurses every 4 to 6 weeks to check their condition. During the appointment, the nurses take blood samples, blood pressure, blood sugar, weight and interviews the patient about his past weeks. They check the skin around the catheter as well to ensure that there’s no symptoms of infection. The nurses observes the possible symptoms of dehydration and the opposite, overloading. The symptoms of overloading are for example high blood pressure, swelling (especially in the limbs) and problems with breathing. Because there’s no doctor in the unit, the prescriptions are written by the nurses and the doctor just signs them for the patients. Usually the medicines are some food supplements such as calcium etc. Peritonitis is the most common problem within the peritoneal dialysis patients. Good hand hygiene and personal hygiene prevents the infections and complications and it’s very important to educate the patient to take care about his/her condition and treatment.

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We found the peritoneal side very interesting. When taking a look for the results of blood samples and other interventions, the peritoneal dialysis is a better option to patients. Of course because the patients can do it at home without nursing staff but also because the dialysis is done every day instead of three times a week as in haemodialysis. The amount of toxins and extra fluids stay more stabile during the days and it’s more comfortable for patients. Unfortunately, the doctors here prefer haemodialysis. We had good coversations with the staff about this and we pondered if one of the reasons could be money. If it is so, it’s umbelievable that the doctors make their decisions thinking about the money, instead of the patient’s best.

 

The Renal Unit was a very interesting experience and we have learned a lot about the kidney failure, dialysis and kidney functions. Thanks for our mentor and all the staff for these three weeks! Now we continue to the operating side to see how the body looks like from the inside. Those feelings in the next post. 🙂

 

Love,

Katariina & Tiia