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Peritoneal dialysis nursing--we've come a long way.

Article Excerpt
When I was assigned my first patient on acute peritoneal dialysis (PD) in the 1970s, we used 2- liter glass bottles of dialysis solution warmed in a water bath, and dialysate was drained into open graduated cylinders. A few years later, the first patients on continuous ambulatory peritoneal dialysis (CAPD) performed a connection procedure to a Y-set for every single exchange. The early CAPD prescription was "one size fits all"--five 2-liter exchanges per day. And the peritonitis rate was high, one episode every 4-6 weeks, yet the survival was similar to that of patients on hemodialysis (HD).

By the late 1970s, when CAPD was first tested as a chronic therapy, the overnight dialysis with short exchanges done in the early 1970s had been almost completely abandoned, as it did not allow enough hours of therapy for adequate dialysis. But the PD machines were still available--washing machine-sized devices with reverse osmosis (RO) membranes and proportioning systems that made dialysis solution from RO water and concentrate (see Figure 1)--and these were used in some centers for acute PD and back-up dialysis for home patients on CAPD.

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When I attended my first ANNA National Symposium in 1978, PD was never mentioned, and the nursing literature contained only descriptions of acute dialysis in the hospital. However, one of the nephrologists thoughtfully supplied me with a copy of Boen's 1959 PhD dissertation, Peritoneal Dialysis, for my...

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