The peritoneal cavity is a sterile environment. If the bacteria enter the peritoneal cavity, the peritoneum will be infected and patients get peritonitis. Peritonitis is a major complication of peritoneal dialysis.

Causes

Peritonitis and Its Symptoms

• After dialysate exchange, if the drainage fluid is turbid, it is usually the first symptom of peritonitis, accompanied by abdominal pain, fever, chills, nausea, vomiting, diarrhea and other symptoms.

Adverse Effects of Peritonitis

• Edema, peritoneal adhesions and fibrosis caused by insufficient filtration function and peritoneal damage. In severe cases, catheters need to be removed, so peritoneal dialysis cannot be continued.

Prevention

• Perform the correct fluid change technique by following the procedure instructed by the nursing staff, and do not change or simplify the procedure.
• Choose an appropriate place for fluid exchange: clean, separate space, with plenty of light or lighting, doors/windows closed and air conditioning turned off, and keep pets out of the room.
• Keeping the fluid change space clean won't eliminate all bacteria, but it will reduce their numbers considerably.
• Aseptic techniques must be applied when connecting and separating joints.
• When possible catheter contamination is suspected, contact peritoneal dialysis personnel as soon as possible and do not infuse dialysate.
• Do check for dialysate and discontinue use immediately and inform peritoneal dialysis personnel if any dialysate damage is found.
• If you feel any discomfort, you should return to the hospital for consultation. Do not take over-the-counter medicines and delay treatment.
• Avoid gastrointestinal tract and urogenital tract infection.
• Prophylactic antibiotic therapy is required prior to colonoscopy or tooth extraction.

Treatment

• When abnormal turbidity of peritoneal dialysate is detected, contact the peritoneal dialysis unit immediately without delay, and bring the turbid dialysate retained for at least 4 hours back to the hospital for examination.
• Return to the hospital as directed by medical staff and receive antibiotics. Do not stop the drug without instruction, or it will easily cause incomplete treatment of peritonitis and relapse.
• The daily ultrafiltration volume from dialysis should be recorded. If the ultrafiltration volume is insufficient, a high concentration of dialysate should be used if necessary to improve edema.
• Do check if there is any improvement in the turbidity of drainage fluid. If the dialysate is not clear yet after 3 days of antibiotic use, contact peritoneal dialysis personnel.
• Eat small high-protein meals a day and limit water intake to reduce edema.
• Check whether drainage fluid is unobstructed and there is no fibrin produced.
• Discuss the cause of peritonitis with peritoneal dialysis personnel.
• Reexamine your dialysate exchange technique.