What is the definition of slow inflow and slow outflow in PD? What is the ideal time in which dialysate should run in and what is ideal time in which dialysate should be drained in CAPD and APD?

Questions About PD

Salman Rouf, Doctor/MD from Saudi arabia asked
What is the definition of slow inflow and slow outflow in PD? What is the ideal time in which dialysate should run in and what is ideal time in which dialysate should be drained in CAPD and APD?

1 answer

Nurse Canada with members of the ISPD Nurse Committee April 29, 2022

We thank you for your interesting question.  In the UHN Division of Nephrology Housestaff/NP Guidebook it is mentioned “Ideally it takes 30 minutes for the fluid to fill and drain in and out of the peritoneum” (1, page 68). With this timeline in mind, it would be common practice to allow 20 minutes for the drain and 10 minutes for the fill, using 2 L of PD fluid. Dr. Burkhart in his recent contribution to “Patient Education: Peritoneal Dialysis – beyond the basics”, also notes “The process of connecting the bag of new dialysis fluid, emptying, and filling for each exchange takes 30 to 40 minutes when done manually” (2). We would add, it is a good practice for the home training nurse to note the time it takes for a patient to drain then fill during training to provide a benchmark for that patient going forward.
 
Some factors that can affect drain and fill times include: the height of the chair or bed the patient is in, the position of the patient (sitting, semi-recumbent or supine) and the height of the solution bag. Small variations can be expected for each patient from what is normal for them.
 
1.Gozdzik, A. editor. UHN Division of Nephrology House Staff/NP Guidebook. January 2022. Toronto, ON. Available at: https://ukidney.com/nephrology-publications/nephrology-manuals/university-health-network-nephrology-manual
 
2.Burkhart JM. Patient education: Peritoneal dialysis (Beyond the Basics). In: Golper TA, Lam AQ, Editors. UpToDate Waltham, MA. Uptodate; June 2021. Accessed April 29, 2022. Available at: https://www.uptodate.com/contents/peritoneal-dialysis-beyond-the-basics
 

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