KEY ACTIVITIES

Initiate the following:

Performed by the PD nurse in the dialysis unit:

1. 1Perform physical exam including abdominal palpation, degree and location of pain, exit-site and tunnel assessment
2. 2Disconnect drained bag and send sample to laboratory for cell count with differential, Gram stain, and culture. Dwell time should be at least 1–2 hours.¹
3. • Innoculate 2 (aerobic and anaerobic) blood culture bottles with 5–10 mL of effluent (yield enhanced with rapid blood-culture bottle kits)¹
     or
   • centrifuge 50 mL PD effluent at 3000g for 15 minutes followed by resuspension of the sediment for inoculation into blood culture bottles¹
4. 3In presence of cloudy effluent with pain and/or fever:
5. • Initiate empiric antibiotic therapy as soon as possible while waiting for test results¹
6. 4In presence of cloudy effluent, add heparin 500 U/L to new bag until effluent clears (usually 48 to 72 hours)¹
7. 5Initiate adequate pain management intervention. Peritonitis-related pain may require analgesics for adequate control, which should be prescribed in adequate amounts to control pain appropriately¹
8. 6Assess for need for hospitalization¹
9. 7Review with patient:
10. • Discuss possibility of break in technique, compliance to hand washing, mask use
    • Inquire about recent procedures, constipation, diarrhea, and antibiotic use
11. 8Review:
12. • Peritonitis and exit-site infection history and treatment
    • Review use of exit-site prophylaxis
13. 9Schedule retraining for technique issues