Welcome to your Reading Comprehension Passage II

1. Peritoneal dialysis (PD) is a procedure that can be used by people whose kidneys are no longer working effectively. It is intended to replace as many functions of the failing kidneys as possible. The procedure is performed at home and primarily works to remove excess fluid and waste products from the blood. As the kidneys lose their ability to function, fluid, minerals, and waste products that are normally removed from the body in the urine begin to build up in the blood. When these problems reach a critical stage, excess fluid and waste must be removed either by getting a kidney transplant or with renal replacement therapy, also called dialysis.
2. Before peritoneal dialysis can begin, a catheter must be inserted in the abdomen, which allows for transfer of fluid into and out of the abdominal cavity. The catheter is made of a soft, flexible material, usually silicone and has velcro-like cuffs, which are placed under the skin. Skin tissue grows into them to hold the catheter in place. The end of the catheter inside the abdomen has multiple holes to allow fluid to flow in and out. The area should be kept dry until it is well healed, usually for 10 to 14 days.
3. It is important to avoid becoming constipated after the catheter is inserted. Straining to move the bowels can increase the risk of developing a hernia. In addition, not moving the bowels regularly can lead to problems with catheter function and slow drain time or difficulty draining the abdomen completely. With appropriate catheter placement and exit-site care, most peritoneal dialysis catheters are problem free and work for many years.
4. In peritoneal dialysis, dialysis fluid, called dialysate is infused into the peritoneal cavity through the catheter. The fluid dwells within the abdomen for a prescribed period of time; the peritoneum acts as a membrane to allow excess fluids and waste products to pass from the bloodstream into the dialysate. When the dwell is completed, the used dialysate can then be drained out of the abdomen into a sterile container or into a shower or bathtub. This used fluid contains the excess fluid and waste that has been removed from the blood that was normally eliminated in the urine. The peritoneal cavity is then filled again with fresh dialysate, and the process starts again.
5. The process may be done manually four to five times during the day by infusing the fluid into the abdomen and later allowing it to run out by gravity. The process of connecting the bag of new dialysis fluid, emptying, and filling for each exchange takes 30 to 40 minutes when done manually. In some cases, a person is not able to do the dialysis exchanges themselves. Peritoneal dialysis could still be used, but the person would need a partner to do the exchanges. In these cases, ambulatory peritoneal dialysis (APD) works best so the partner is able to be free during the day.
6. The exchange may also be done using an automated cycler. In this case, the fluid exchanges are done automatically while the person sleeps, and, because the catheter is already connected to the machine by a long tube, each exchange takes less time. At times when the abdomen is full of dialysate, there may be a feeling of fullness or bloating, although painless. However, most people have no abnormal sensations, and, despite the fluid in the abdomen, most do not look or feel any different themselves or look different to other observers.
7. There may be changes in treatment type, dwell time, number of exchanges, or type of dialysate after beginning treatment based upon how the body responds. Periodic blood and urine tests, as well as tests of the used dialysate, are used to fine tune peritoneal dialysis treatment. One of the most serious complications of peritoneal dialysis is infection, which can develop in the skin around the catheter or inside the abdominal cavity and is called peritonitis. Another potential, but less serious, complication of peritoneal dialysis is the development of a hernia in the abdomen.