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| Nephrologist should make sure that PD catheter is adequately inserted preferably chronic catheter and has no issues with flow of the fluid. PD orders need to be individualized depending upon hemodynamic status of the patient, laboratory work, and volume status. PD orders need to be reviewed and written daily as patients with AKI usually fluctuate acid base and electrolyte balance daily | |
| Nursing orders | |
| Dialysis session length …… hours | |
| Dialysis volume per exchange …… L | |
| Dialysis dextrose concentration % | |
| Inflow time …… min Dwell time …… min, Outflow time …… min | |
| Vital signs q …… hours | |
| Weigh patient q …… hours | |
| Warm dialysate fluid to body temperature | |
| Maintain strict intake and output | |
| Additives to dialysate Heparin yes/no, Insulin yes/no, Potassium yes/no | |
| Medication dose frequency | |
| Vancomycin …… mg/L of exchange, Tobramycin …… mg/L of exchange other antibiotic …… mg/L | |
| Catheter care and dressing change every day | |
| Full chemistry panel including blood glucose level to be done every 12 hours each day during dialyisis | |
| Send 15 cc of dialysate fluid from catheter every morning during dialysis and send it for cell count with differential, gram staining, and culture and sensitivity yes/no | |
| Renal Physician to be notified immediately for the following situations: | |
| Poor dialysate flow | |
| Severe abdominal pain or distention | |
| Change in color of dialysate, bloody, or cloudy drainage | |
| Dialysate leak or purulent drainage around catheter exit site | |
| Patient hypotensive with systolic blood pressure of < …… mm Hg | |
| Respiratory rate of ≥ …… per minute or severe shortness of breath in non ventilated patient | |
| Temperature of ≥ …… C | |
| Two consecutive positive exchanges | |
| Single positive exchange balance (dialysate IN-dialysate OUT) of >1000 mL | |
| If negative balance exceeds …… L over …… hours | |
| Notification of abnormal laboratory values | |
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