Ideal self-management, PD technique and regularty of testing

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  • 腹膜透析療法における自己管理・手技・定期検査のあり方
  • フクマク トウセキ リョウホウ ニ オケル ジコ カンリ シュギ テイキ ケンサ ノ アリカタ

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Abstract

About 25 years have passed since continuous ambulatory peritoneal dialysis (CAPD) was introduced in Japan. The time is ripe for reviewing PD procedures. In this regard, a questionnaire was sent out to physicians and nurses at 63 institutions in the Tokyo area where PD patients are treated to investigate self-management, PD technique and regularty of testing.<br>Thirty-two (50.8%) physicians and 37 (58.7%) nurses completed and returned the questionnaire. At the time of bag replacement, 100%, 100%, 97.0%, 81.8%, 9.1% and 6.1% of the institutions instructed the patient to wash their hands, wear a mask, close the window, stop air-conditioning, lock the door and wear a hair cap, respectively. As for the draining method, 75.7% and 13.5% of institutions encouraged complete drainage and time-limited drainage, respectively. As for self-measurement every day/every time, 100%, 100%, 91.9%, 86, 5%, 73.0%, 54.1%, 43.2%, 43.2% and 24.3% of the institutions instructed the patients to record the drainage volume, fluid removal volume, body weight, blood pressure, infusion volume, water content balance, urine volume, pulse rate and body temperature, respectively. Regarding care of the outlet port, 100%, 100%, 94.6%, 94.6%, 86.5%, 81.1%, 62.2%, 37.8%, 5.4% and 2.7% of the institutions instructed the patients to wash their hands, fix the catheter to the abdomen, care for the site every day, protect the outlet port, close the window, wear a mask, stop air-conditioning, protect the titanium adapter, lock the door and wear a hair cap, respectively. Patients were allowed to take shower from 30.6±25.5 days (median 25.5 days) and a bath from 36.7±26.2 days (median 30.0 days) after the start of PD. As for the washing method, 29.7%, 13.5%, 13.5% and 5.4% of the institutions instructed the patients to “wash lightly with soap and then shower off well”, “wash carefully with soap and then shower off well”, “use only the shower to wash off well” and “use only the shower to wash off lightly” respectively. Regarding catheter replacement, 100%, 100% and 91.9% of the institutions instructed those performing replacement, caregivers and patients, respectively, to wear a mask, and 16.2%, 15.2% and 5.4% of the institutions, respectively, instructed them to wear a hair cap. During catheter replacement, 97.3%, 70.3% and 16.2% of institutions instructed them to close the window, stop air-conditioning and lock the door, respectively. Concerning the frequency of regular tests, there was not much difference among the institutions in the frequency of blood and biochemical tests, abdominal echography, abdominal & cardiac echography, fecal occult blood test, endoscopy of upper digestive tract, funduscopy, bone density test or peritoneal membrane equilibrium function test. However, considerable differences were observed among the institutions in the frequency of chest X-ray, KUB, electrocardiography and optimal dialysis index determination (urine accumulation).<br>It is necessary to review the contents of self-management, PD technique and regular tests, which currently differ among institutions, in order to provide better medical care and nursing for patients as well as to establish a satisfactory medical care regimen.

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