Peritoneal Dialysis (PD): Peritonitis Information

What is peritonitis?

Peritonitis is an infection of the peritoneum which is the membrane that lines your abdomen (the belly).

What are the causes of peritonitis?

• The most common cause is a germ which usually lives harmlessly on your skin. This only causes a problem if it enters your body. The most common way for this to happen is when you are doing your exchange. Once the germ is inside, it can cause peritonitis.
• Germs can also enter the body through the Tenckhoff catheter exit site and cause peritonitis.
• Germs can also enter the peritoneal cavity from inside your own body and sometimes cause peritonitis.
• Germs can occasionally enter your peritoneal cavity if you have a sore throat or cough.

How would I know if I’ve got it?

If you have peritonitis you will have:

• A cloudy bag (once drained)

You may also have:

• Abdominal (tummy) pains
• Nausea/vomiting
• High temperature (fever)

Peritonitis can be serious, however if it is caught early and treated properly it can usually be sorted out. The first sign of peritonitis is usually a cloudy bag when draining out. If it is treated at this stage, it can sometimes be controlled without even a stay in hospital. If peritonitis is not noticed at this stage, you may then get abdominal pain which can become severe. You may also get a high temperature and feel sick.

If you would like to see pictures of clear bags and cloudy bags, please ask one of the home therapies nurses.

What should I do if I have these symptoms?

• You need to contact the Home Therapies Department (or C5 ward if it is the evening or weekend) as soon as you see the cloudy bag, or if you have tummy/abdominal pain.
• You will need to come in to hospital as soon as possible so you can be seen by a doctor and treatment (if necessary) can be started. .
• Please keep the cloudy bag you drained out and bring it with you to hospital.

What will happen next?

• On arrival at the hospital you will be seen by a doctor and a nurse.
• The cloudy fluid will be sent to the laboratory to be tested, you will have blood tests taken and your exit site will be swabbed if it appears to be infected.
• You will be given two different antibiotics. One will usually go into your dialysis fluid and be drained into you with your exchange (intraperitoneal). One is taken orally (by mouth).
• If you are feeling well enough you will be able to go home and continue your antibiotic treatment as an outpatient.
• You will be given antibiotic tablets to take home and will be booked to come in for a blood test to determine the next dose of the intraperitoneal antibiotic.
• If you are not feeling well, you will be admitted until you feel better.
• The results from the fluid we test help us decide which antibiotics you need to continue with. You will need at least two weeks of antibiotic treatment.

What else may happen?

• You may have slow or poor amounts of drainage from your dialysis bags whilst they are cloudy.
• You may be given protein supplements or advised to eat more protein as you will lose more protein into the bags while you have peritonitis.

How can I prevent peritonitis?

The most important way to prevent peritonitis is to follow the procedures you have been taught. Here are seven points to remember which will help you to minimise the risk of getting peritonitis.

1. Observe your exit site. Keep it clean and dry. If any redness or oozing starts, inform the home therapies department immediately.
2. Remember to use the Mupirocin ointment or gentamicin cream/drops prescribed for your exit site care; this will help prevent infections.
3. Maintain good hand hygiene and cleanliness. Remember what you were taught when you were training and always follow that procedure.
4. Before performing an exchange, ensure the table and equipment are clean.
5. Remember to always check the dialysate bag and lines for holes or splits.
6. Check your bag at each exchange to make sure it is clear. Remember, a cloudy bag will not go away, so please contact home therapies or ward C5 ward as soon as possible.
7. If you are in any doubt, or you have any problems, please contact home therapies or ward C5.

Contacts/further information

If you are worried or need any advice, please do not hesitate to contact us on the following number:

• Home Therapies: 01223 400184 Monday to Friday 08:30 to 17:00
• Ward C5: 01223 217195 Out of hours – evenings and weekends

Peritonitis is a serious condition and you must contact us immediately, whatever time day or night you discover the cloudy bag.