Peritoneal Dialysis Machine
Essential information for parents, caregivers, and healthcare professionals
Introduction to Peritoneal Dialysis Machines
A peritoneal dialysis machine, also called a cycler, is a medical device that helps children with kidney failure by filtering waste products and excess fluid from their blood. Unlike manual peritoneal dialysis, this automated machine performs the treatment while the child sleeps, making it convenient for families.
Peritoneal dialysis uses the lining inside the abdomen called the peritoneal membrane as a natural filter. The machine pumps a special cleaning solution called dialysate into the abdomen through a soft tube called a catheter. The solution absorbs waste and extra fluid, then drains out. This process repeats several times during treatment.
Purpose and Medical Uses
Primary Purpose
Peritoneal dialysis machines perform the vital function of artificial kidneys for children whose own kidneys cannot work properly. The machine removes harmful waste substances and extra water from the blood that healthy kidneys would normally eliminate.
Medical Conditions Requiring PD
- Chronic kidney disease in children
- End-stage renal disease requiring dialysis as a bridge to kidney transplant
- Acute kidney injury in pediatric patients
- Kidney failure in infants and newborns
Where These Machines Are Used
- Home: Most common setting for pediatric peritoneal dialysis
- Hospitals: Pediatric intensive care units and nephrology departments
- Dialysis Centers: Training facilities and backup treatment locations
Types of Peritoneal Dialysis
1. Automated Peritoneal Dialysis (APD)
APD uses a machine called a cycler to perform dialysis automatically, usually during nighttime sleep.
Characteristics:
- Treatment done overnight for 8-10 hours
- Machine performs 4-6 automatic exchanges
- Child remains free during daytime
- Suitable for most children and families
- Requires electricity and machine setup
Types of APD Machines:
| Machine Type | Features | Best For |
|---|---|---|
| Standard Cycler | Basic automated exchanges, programmable settings | Most pediatric patients |
| Pediatric-Adapted Cycler | Low-fill volume option (minimum 100ml), suitable for small children | Infants and young children |
| Portable Cycler | Compact, travel-friendly design | Active families who travel |
2. Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD is a manual method that does not require a machine. Exchanges are performed by hand 3-5 times daily.
Characteristics:
- No machine required
- Each exchange takes 30-40 minutes
- Uses gravity to fill and drain
- Performed during daytime hours
- Suitable when machine is unavailable or impractical
Equipment Components
| Component | Purpose |
|---|---|
| PD Catheter | Soft tube placed in abdomen to allow fluid exchange |
| Dialysate Bags | Contain cleaning solution (usually 6 liters per bag) |
| Tubing Set | Connects machine to catheter and drainage |
| Cassette | Organizes tubing and warms fluid |
| Drain Bag or Line | Collects used dialysate for disposal |
| Heating System | Warms dialysate to body temperature |
How to Use Peritoneal Dialysis Machine - Step by Step
Preparation Phase
Wash hands thoroughly with soap and water for at least 20 seconds. Dry with clean towel.
Put on surgical mask covering both nose and mouth. Wash hands again after putting on mask.
Set up machine in clean, designated area. Ensure surfaces are wiped with disinfectant. Keep pets and other people away.
Verify you have: dialysate bags, tubing cassette, drain bag or line, clean towels, and all prescribed materials.
Machine Setup
Place cycler on stable surface at child's bedside. Plug into electrical outlet. Ensure drain line reaches toilet or drain area.
Open cassette package using sterile technique. Insert cassette into machine according to manufacturer instructions.
Connect 2-3 dialysate bags (as prescribed) to cassette tubing. Hang bags on machine hooks. Ensure connections are secure and not contaminated.
Attach drain bag to cassette or position drain line toward disposal area (toilet or sink).
Enter prescribed settings: fill volume, number of cycles, therapy time, dwell time. Machine stores this information for future use.
Treatment Process
Allow machine to run initial prime cycle to remove air from tubing and warm the fluid. Follow machine prompts.
Using sterile technique, connect catheter to machine tubing. Ensure connection is secure and not contaminated.
Press start button. Machine will automatically perform cycles of filling, dwelling, and draining throughout the night.
Typical Treatment Cycle
- Fill: Machine pumps dialysate into abdomen (usually takes 5-10 minutes)
- Dwell: Fluid stays in abdomen to absorb waste (45 minutes to 3 hours)
- Drain: Used fluid drains out (usually takes 10-15 minutes)
- Repeat: Process repeats 4-6 times during treatment period
Morning Disconnection
When machine signals completion, wash hands and put on mask. Machine performs final drain.
Using sterile technique, disconnect catheter from machine tubing. Place sterile cap on catheter.
Empty drain bag in toilet. Discard used cassette, tubing, and bags in regular trash (not medical waste for home use). Clean machine exterior.
Document treatment details: child's weight, total fluid removed, any alarms or problems, appearance of drained fluid.
Safety Precautions and Best Practices
Infection Prevention
- Always wash hands before and after handling equipment
- Wear mask during all connections and disconnections
- Never touch catheter connection points
- Keep catheter exit site clean and dry
- Change dressing according to nurse instructions
- Keep pets away from dialysis area and equipment
- Inspect drained fluid daily - it should be clear like urine
Machine Safety
- Keep machine on stable, flat surface away from edges
- Do not expose to water or moisture
- Ensure proper ventilation around machine
- Check power cord for damage before each use
- Never ignore machine alarms - address immediately
- Have backup power plan for electricity failures
Catheter Care
- Secure catheter to prevent pulling or tugging
- Check exit site daily for redness, swelling, or drainage
- Avoid tight clothing over catheter area
- No swimming in lakes or pools (bathing allowed per care team guidance)
- Report any catheter problems immediately
Fluid Management
- Use only prescribed dialysate solutions
- Check expiration dates before use
- Store dialysate bags in clean, dry area at room temperature
- Never use bags that appear damaged or leaking
- Warm bags to room temperature before use (never microwave)
- Cloudy drained fluid - may indicate infection
- Fever, abdominal pain, or nausea during or after treatment
- Severe catheter site redness, swelling, or pus
- Difficulty draining fluid from abdomen
- Blood in drained fluid (small amounts may be normal during menstruation in adolescent girls)
- Severe abdominal bloating or pain
Contact your dialysis care team immediately if any of these occur.
Potential Dangers and Complications
Infectious Complications
1. Peritonitis (Abdominal Infection)
Most common and serious complication of peritoneal dialysis.
- Signs: Cloudy drained fluid, fever, abdominal pain, nausea, vomiting
- Causes: Bacteria entering through catheter connections or from intestines
- Treatment: Antibiotics added to dialysate solution, sometimes catheter removal
- Prevention: Strict hand washing, proper connection technique, clean environment
2. Exit Site Infection
- Signs: Redness, swelling, warmth, pain, or drainage at catheter exit site
- Treatment: Topical or oral antibiotics
- Prevention: Daily exit site care, keep area clean and dry
3. Tunnel Infection
- Signs: Tenderness along catheter tunnel under skin, may have fluid collection
- Treatment: Antibiotics, sometimes requires catheter replacement
Non-Infectious Complications
1. Catheter Malfunction
- Obstruction - catheter blocked by blood clots or tissue
- Migration - catheter moves from proper position
- Kinking - tubing bends and blocks flow
2. Fluid Leakage
- Dialysate leaking around catheter exit site
- Usually occurs in first few weeks after catheter placement
- May require temporary treatment pause
3. Hernias
- Abdominal wall weakness from increased pressure
- More common in infants and young children
- May require surgical repair
4. Metabolic Issues
- High blood sugar from glucose in dialysate
- Protein loss into dialysis fluid
- Weight gain from fluid absorption
5. Encapsulating Peritoneal Sclerosis (Rare)
- Serious complication from long-term dialysis
- Peritoneal membrane becomes thick and scarred
- Causes intestinal blockage symptoms
- More common after several years of treatment
Risk Factors for Complications
| Risk Factor | Associated Problem |
|---|---|
| Young age (infants) | Higher infection risk due to diapers near exit site |
| Poor hand hygiene | Peritonitis |
| Gastrostomy feeding tube | Increased infection risk |
| Improper technique | Contamination and infections |
| Long duration on dialysis | Membrane damage, encapsulating peritoneal sclerosis |
Frequently Asked Questions
Q: How long does each treatment session take?
Automated peritoneal dialysis typically runs for 8-10 hours overnight while the child sleeps. Manual CAPD exchanges take 30-40 minutes each, done 3-5 times daily.
Q: Can my child feel the fluid in their abdomen?
Most children adapt quickly and do not feel discomfort. Some may feel fullness initially, but this usually improves. The fluid during APD while lying down creates less pressure than during CAPD while sitting.
Q: Can children go to school while on peritoneal dialysis?
Yes. With automated dialysis done at night, children are free during the day to attend school and participate in most activities.
Q: What happens if the power goes out during treatment?
The machine will stop. You should manually drain the fluid from your child's abdomen and disconnect them from the machine. Contact your dialysis team for guidance. Have a backup plan ready.
Q: How often should the machine be serviced?
The dialysis company typically performs routine maintenance and exchanges machines as needed. Report any malfunctions immediately.
Q: Can we travel with peritoneal dialysis?
Yes. The cycler is portable and can travel with you, even on airplanes. Dialysis supplies can be shipped to your destination. Coordinate with your dialysis team before traveling.
Q: What activities are restricted for children on PD?
Avoid swimming in lakes, ponds, or public pools due to infection risk. Contact sports should be limited to prevent catheter injury. Most other activities are allowed. Consult your care team.
Q: How do I know if the dialysis is working properly?
Your care team will check blood tests monthly. The drained fluid should be clear. Your child should feel well, maintain good energy, have good appetite, and proper growth. Regular monitoring is essential.
Q: What is the success rate of pediatric peritoneal dialysis?
Peritoneal dialysis is highly effective for children. Success depends on proper technique, infection prevention, and regular monitoring. It successfully supports children until kidney transplant becomes available.
Q: How long will my child need dialysis?
This varies. Some children need dialysis temporarily until their kidneys recover. Others require it until they receive a kidney transplant. Your nephrologist will discuss your child's specific situation.
Q: Are there dietary restrictions?
Dietary needs vary by child. Generally, peritoneal dialysis allows more flexibility than hemodialysis. A pediatric renal dietitian will create a specific plan for your child.
Q: What should I do if I suspect an infection?
Contact your dialysis care team immediately if you notice cloudy fluid, fever, abdominal pain, or exit site problems. Do not wait. Early treatment is crucial for preventing complications.
Device Maintenance and Storage
Daily Maintenance
- Wipe machine exterior with damp cloth
- Check all connections for security
- Inspect power cord for damage
- Remove and discard used cassette and tubing
- Clean work surface with disinfectant
Storage Requirements
- Machine: Keep in clean, dry area at room temperature
- Dialysate: Store at room temperature (15-25 degrees Celsius), away from direct sunlight
- Supplies: Keep in designated clean storage area, organized and easily accessible
- Space needed: Approximately 30 boxes (each about 30cm x 60cm) per month for supplies
Machine Safety Checks
- Ensure machine is on stable surface
- Verify heating system functions properly
- Test alarms periodically as instructed
- Report any unusual sounds, errors, or malfunctions
- Keep manufacturer contact information accessible
Supply Management
- Order supplies monthly to maintain adequate stock
- Check expiration dates regularly
- Keep 1-2 weeks extra supplies for emergencies
- Maintain inventory log
- Have backup manual supplies available
Training and Support
Required Training
Before beginning home peritoneal dialysis, families must complete comprehensive training with a certified PD nurse. Training typically includes:
- Understanding how dialysis works
- Machine operation and troubleshooting
- Sterile connection and disconnection techniques
- Catheter care and exit site management
- Recognizing and responding to complications
- Emergency procedures
- Record keeping and monitoring
Ongoing Support
- Monthly clinic visits for monitoring
- 24-hour phone access to PD nursing team
- Regular retraining and competency assessments
- Home visits for troubleshooting (availability varies by region)
- Support groups for families
Important Resources
For comprehensive guidelines and current best practices, healthcare professionals should refer to:
- International Society for Peritoneal Dialysis (ISPD) Guidelines
- Pediatric nephrology textbooks on dialysis
- Regional pediatric nephrology centers
- Manufacturer technical manuals for specific machines
Medical Disclaimer
This guide is for educational purposes only and does not replace professional medical advice. Peritoneal dialysis is a complex medical treatment that requires proper training and ongoing supervision by qualified healthcare professionals. Always follow your child's specific treatment plan as prescribed by their nephrologist and PD care team. Never attempt to perform dialysis without proper training. Contact your healthcare provider immediately for any concerns about your child's treatment or condition.
Emergency situations require immediate medical attention. If your child experiences severe symptoms such as difficulty breathing, severe abdominal pain, signs of infection, or other concerning symptoms, seek emergency medical care right away.
Labels: Renal-System