Which of the following action is necessary to prevent major complication of peritoneal dialysis?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2022

Medical & Surgical Nursing

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2022

Explanation

Peritonitis, an infection of the peritoneum, is the most common and severe complication of peritoneal dialysis.
This infection typically occurs due to contamination when connecting or disconnecting the dialysis bags, which is considered a break in sterile technique.
Maintaining a strict aseptic (sterile) technique during all exchange procedures is the most crucial action to prevent the introduction of bacteria into the peritoneal cavity.
Patient and family education on sterile technique is a cornerstone of safe home peritoneal dialysis.

Option A: This is a general nursing assessment. While important for overall patient monitoring, it does not directly prevent the primary complication of peritonitis. A change in consciousness would be a late sign of severe infection (sepsis), not a preventive measure.
Option C: Heparin is an anticoagulant. It is sometimes added to the dialysate to prevent the formation of fibrin clots, which can obstruct the catheter. It has no role in preventing infection.
Option D: While proper exit-site care, including dressing changes, is important to prevent tunnel and exit-site infections, peritonitis is more commonly caused by contamination during the exchange process itself. Therefore, aseptic technique during exchanges is the highest priority. The frequency of dressing changes also varies by institutional protocol and may not be daily.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Prevention of complications in peritoneal dialysis as background academic context rather than a clinical decision trigger.
Nurses play a vital role in educating patients and families on performing PD exchanges at home, with a major focus on flawless aseptic technique to ensure patient safety.
A key nursing assessment is to teach the patient to monitor the dialysis effluent (drained fluid) for cloudiness, which is an early and critical sign of peritonitis requiring immediate medical attention.
What if? If a patient on PD reports abdominal pain and the drained fluid appears cloudy, the nurse must instruct the patient to cap the catheter, bring the cloudy fluid bag with them, and report to the emergency department immediately for evaluation and treatment of peritonitis.

How to Approach the Question

First, identify the core subject of the question: preventing complications of peritoneal dialysis (PD).
Recall or deduce the most significant and common complication associated with PD. The presence of a permanent catheter providing access to the abdominal cavity points towards infection (peritonitis) as a major risk.
Analyze each option to determine which one directly addresses the prevention of this primary complication.
Evaluate 'Maintain strict aseptic technique'. This is the gold standard for preventing infection during any invasive procedure.
Consider the other options: monitoring consciousness is assessment, not prevention; adding heparin is for preventing clots, not infection; changing the dressing is for exit-site care, but the exchange itself carries a higher risk for peritonitis.
Conclude that maintaining a sterile field during the exchange procedure is the most direct and essential preventive action.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 2 p. 305-307