Nephrology

313 Immediate Post-Operative Management on return to Ward

  • The Nephrologist takes responsibility for all orders

    Nursing Care

    • Routine post anaesthetic observations
    • Wound care (observe ooze/excess bleeding from incision site)
    • Strict Fluid Balance Chart
    • Ensure adequate pain relief
    • Attend in/out exchanges (using Fresenius Stay.Safe manuel system) of 5-10ml/kg of 1.5% 2 Litre Balance until return is clear (please contact PD Coordinator if you require assistance), also see  3.3.3 In/Out flushes

    Any complications to be immediately notified to the nephrologist and peritoneal dialysis nurse (during business hours) and the oncall nephrologist (after hours via switch #91).

    If dialysis is not required immediately - weekly flushes of tenckhoff catheter (+/- heparin 1000u/L, followed by +/- heparin lock 1000u in 9ml Normal Saline)

    If dialysis is required immediately the Nephrologist in charge will specify dialysis orders.

    Guidelines for Starting Dialysis

    • After attending in/out exchanges there must be no evidence of swelling or ooze (haemoserous, blood or dialysis fluid), around the Tenckhoff Catheter.
    • Rest the patient in bed for 24 hours (if possible).  The supine position is preferable, (if not contraindicated) to reduce intra-abdominal pressure when dialysing. This will minimise the risk of Dianeal leak and haemorrhage.
    • Continue peritoneal dialysis exchanges with increasing volumes and dwell times as per medical orders. 

    For example:

    1. Increase volume to 10ml/kg with 1 hour dwell for 24 hours
    2. Increase volume to 20ml/kg with 1 hour dwell for 24 hours
    3. Increase volume to 30ml/kg with 4 hour dwell for 24 hours
    4. Commence maintenance PD regime.  Increase volume to 40ml/kg

    Daily PD fluid specimens for microbiology while in Hospital.

     

    Exit site care

    See protocol 3.2.1 for immediate post operative exit site management

    • No shower or bath 2-6 weeks until completely healed. Sponges only