[Dialyzin' Dar]

We have a noncompliant patient at our unit (comes in late, terminates treatment early) whose doctor is setting up for PD. I did PD for 3 years, and it's difficult even when you're motivated!

My question is, why would a doctor recommend home treatment for a person who won't follow the rules for hemo? It just seems like a really bad idea since this person has already shown a lot of immaturity and irrational thinking at the unit.

[INtoFL_RN]

Hm...doesn't sound like a really good idea now, does it? Success of PD depends so much on the pt! I used to take care of a frequent flier who was totally non-compliant with his PD and was always admitted for.....you guessed it! Peritonitis. He had it so many times that his peritoneal membrane was scarred and was no longer useful. Then he HAD to go on HD. He hated HD in the first place because he said it made him cramp and made him too tired. He also ate whatever he wanted and was diabetic. No matter how much teaching and patience you used with this pt, he continued to be non-compliant. I think he was just mad at the fact his health was poor and he felt as if he had no control over it.

Maybe starting PD on your pt would make him happier and more likely to be compliant just based on the fact he has more control?? It could go either way. I guess you'll find out when he gets his first admission to the hospital for peritonitis!!

[Dialyzin' Dar]

... but in my case, I had nasal staph and was contaminating my catheter every time I hooked up! (No one thought to test me for it before I started PD, but that's a whole 'nother thread! Grrrr!) My technique was excellent, but that didn't matter because of the flimsy masks-- they didn't stop the staph at all.

Anyway, I learned the hard way that peritonitis doesn't always mean you are careless in your technique-- but for some people, it does mean that they're not doing things properly. I guess when this patient ends up in the hospital enough times, his doctor will realize PD wasn't the best thing. What this patient really needs is counseling, but of course won't go. Too bad it couldn't be a mandatory part of being accepted for PD-- problems could be identified before they became life-threatening.