Question About PD Solutions

[lifesabeach08]

Hi, I started work on the renal floor of our hospital not long ago and we frequently do CAPD. I was wandering if anybody has any info on the difference between different PD solutions or knew of a site I could look at on it? I've tried to look it up but haven't found much.

Also, I have a question...I had a patient who was getting dialysed with 4.25%, and the order read "Dialyse 4 times a day, dwell time 4 hours" which I realize doesn't add up so we had to call to clarify...but the patient's blood pressure had been high (it went down after each exchange but would go back up again) and another nurse who has been doing this a while said it was no wonder the patient's blood pressure was out of wack cause he had been getting dialysed with 4.25% solutions, a "high concentration", so often. But I noted that after each exchange the patient pulled off AT LEAST 800ml and thought that losing that much fluid each time would make the BP go down rather than out of wack? I asked the other nurse but he said no, that it had more to do with the concentration of the solution than that. So I'm confused.

Any info on this would be greatly appreciated.

[Happy2CU]

The 4.25 solution that your patient was receiving is the "strongest". It removes both fluid (usually a fairly large amount) and toxins in a short period of time and "generally" should only be used when patient is fluid overloaded. 2.5% solution removes both fluid and toxins. The 1.5% solution removes toxins only, generally little or no fluid removal and is used to maintain your patient or for a patient who is dehydrated.

There is also a fluid called Extraneal (icodextrin) which is different than the other three because is used once per day and stays in the peritoneal cavity for 8 - 16 hours.

Generally someone who is fluid overloaded and is using the 4.25% should see a decrease in their B/P as the fluid they have on their body decreases. If your patient is pulling off 3.2 liters of fluid per day with the 4.25, it may seem like a lot, but he/she may be waaaaay fluid overloaded and it may take a while. Also depends upon the residual renal function your patient has.

I would definitely recommend contacting the nephrologist to clarify the order based on pt weight, B/P etc.

[lifesabeach08]

Thanks for your answer, it was very helpful! :) So I guess I was right in thinking it would lower the blood pressure...just not right away. But the BP did go down after each exchange, it just kept going back up again.