[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › Peritoneal dialysis: exchanges, the exit site and the signs of peritonitis # Peritoneal dialysis: exchanges, the exit site and the signs of peritonitis - Procedure In peritoneal dialysis fluid goes into the abdomen through a catheter and drains out; the nurse keeps it clean and watches for cloudy fluid and infection. Updated Nov 13, 2026 ## Key points - Cloudy or unusually coloured drained fluid is peritonitis until proven otherwise: keep the bag and call. - Hand hygiene and a mask for every exchange; skipping the mask is a risk factor for peritonitis. - Inspect each solution bag for leaks or signs of contamination before use. - Clean the exit site with antiseptic every day and look for redness, swelling, bleeding or pus. - Do not skip exchanges: it is dangerous; follow the prescription and the institutional protocol. ## What it is Peritoneal dialysis uses the lining of the abdomen as the filter. A solution runs into the abdomen through a permanent catheter, stays for a set time (the dwell) and is drained: one fill and drain is an exchange. It is done by hand several times a day or by a machine at night. The main risk is infection of the peritoneum (peritonitis) or of the catheter exit site. In hospital the nurse does or supervises the exchanges exactly as prescribed, never skips one, uses strict hand hygiene, a mask and aseptic technique, checks every bag and every drained fluid, cares for the exit site and reinforces the patient's training. ## Indications - A patient on peritoneal dialysis admitted to the ward, by hand (continuous ambulatory) or by machine at night. - Daily exit-site care and checking each drained fluid. - Reinforcing the training of the patient or caregiver before discharge. ## Contraindications and precautions - Only staff trained in the institution's peritoneal dialysis protocol do exchanges. - The solution, the number of exchanges and the dwell time come from the prescription; the nurse does not change them. - Strict aseptic technique: the catheter leads straight into the peritoneum. - The solution contains a sugar; the team checks how much the body absorbs. - Never use a bag that leaks, is damaged or looks contaminated. ## Equipment - The prescribed solution bag, checked before use. - Surgical masks for the patient and the nurse, and hand hygiene supplies. - Antiseptic and dressing for the exit site. - Scale and the exchange record sheet. ## Step by step (and why) - Check the prescription and the patient's usual routine — skipping or changing exchanges is dangerous. - Weigh the patient and take vital signs as the protocol sets — they show fluid status over time. - Clean your hands and put on masks for the patient and yourself — poor technique and no mask are risks for peritonitis. - Inspect the solution bag for leaks, damage or contamination — a faulty bag can carry germs into the abdomen. - Do or supervise the exchange with aseptic technique, step by step as the protocol sets — every connection is an entry point. - Look at the drained fluid for colour and clarity and record it — cloudy fluid is the early sign of peritonitis. - Record each fill and drain as the protocol requires — the balance shows how much fluid is being removed. - Clean the exit site with antiseptic every day and inspect it — exit-site infection is a common cause of treatment failure. - Ask about bowel movements, nausea and abdominal pain — being unable to pass gas or stool needs a call. - Watch the patient do an exchange and correct technique before discharge — training by nurses lowers infection. ## Complications - Peritonitis: cloudy drained fluid, abdominal pain or swelling, fever, nausea or vomiting. - Exit-site or tunnel infection: redness, swelling, warmth, soreness or pus around the catheter. - Constipation or being unable to pass gas or stool. - Fluid build-up if exchanges are skipped. ## Next step: when to call for help - Call at once if the drained fluid is cloudy or an unusual colour; keep the bag for the team. - Call for fever, abdominal pain or a swollen abdomen, nausea or vomiting. - Call for redness, swelling, pus or bleeding at the exit site. - Call if the patient cannot pass gas or stool, or for signs of shock (low blood pressure, fast pulse). - Call for itching, sleep problems, diarrhoea, constipation or drowsiness that are severe or last more than 2 days. ## Test yourself Think of the answer, then tap the question to see it. ## What is the earliest sign of peritonitis the nurse looks for in peritoneal dialysis? Cloudy or unusually coloured drained fluid; the nurse keeps the bag and calls at once. ## Why do the patient and the nurse wear a mask during an exchange? Because skipping the mask and other steps is a risk factor for peritonitis; the catheter opens straight into the abdomen. ## What does the nurse check on a solution bag before using it? That it has no leaks or damage and no sign of contamination, and that it is the solution prescribed. ## What is a peritoneal dialysis exchange? Filling the abdomen with dialysis solution, letting it dwell for the prescribed time, then draining it. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/peritoneal-dialysis-exchanges-the-exit-site-and-the-signs-of-peritonitis/) ## Connections ## Related 2 - [Chronic kidney disease: fluid and diet limits, protecting the fistula arm, medicines and teaching](https://durgical.com/en/nursing/chronic-kidney-disease-fluid-and-diet-limits-protecting-the-fistula-arm-medicine/) - [Clean and sterile technique: medical and surgical asepsis](https://durgical.com/en/nursing/clean-and-sterile-technique-medical-and-surgical-asepsis/) ## Related conditions 2 - [Chronic kidney disease](https://durgical.com/en/conditions/chronic-kidney-disease/) - [Peritonitis](https://durgical.com/en/conditions/peritonitis/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Dialysis - peritoneal, MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/007434.htm) (MedlinePlus, US National Library of Medicine, 2024); [Peritonitis - secondary, MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000651.htm) (MedlinePlus, US National Library of Medicine, 2026); [Jaelani TR et al. Peritoneal Dialysis Patient Training Program to Enhance Independence and Prevent Complications: A Scoping Review. Int J Nephrol Renovasc Dis](https://europepmc.org/article/PMC/PMC10505035) (International Journal of Nephrology and Renovascular Disease (Europe PMC, open access), 2023). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/peritoneal-dialysis-exchanges-the-exit-site-and-the-signs-of-peritonitis/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/peritoneal-dialysis-exchanges-the-exit-site-and-the-signs-of-peritonitis/