Module 8 — Peritoneal Dialysis

Study guide

• PD uses the peritoneum as a semipermeable membrane. Dialysate in the peritoneal cavity receives solutes from blood and draws water across the membrane; the used fluid is then drained.Play from here
• The peritoneum has a large surface area and blood supply. Small solutes move down concentration gradients, while osmotic agents pull water into dialysate. Exchange results depend on membrane pores, surface area, gradient, and local perfusion.Play from here
• Ultrafiltration (UF) is removal of water into dialysate. Dwell is the time fluid remains in the abdomen between fill and drain.Play from here
• PD can be done at home, is needle-free, and may fit work and travel. It requires reliable aseptic technique, supplies, training, and a clean treatment space.Play from here
• The abdominal catheter has an internal portion, subcutaneous tunnel, cuff(s), and an external segment connected to a transfer set. The cuff helps anchor the catheter and blocks bacterial migration; never tug, kink, clamp, or manipulate it outside training.Play from here

Why answers are correct

• Dialysis works only when the membrane, fluid, catheter, and exchange sequence all function. A contamination, blocked flow, incorrect solution, or missed drain can cause infection, inadequate clearance, fluid imbalance, or injury.Play from here

Limitations / traps

• PD is not automatically safer or simpler than HD. It trades needle access for continuous catheter and infection-management responsibilities.Play from here
• Do not improvise fill volume, dwell time, dialysate strength, additives, tubing connections, or troubleshooting. Use the prescription, manufacturer instructions, and clinic policy.Play from here

Clinical pearl / safety

• Observe the patient, catheter, connections, inflow, drain, effluent, weight, blood pressure, and symptoms every exchange; a change from the patient’s normal pattern is a reportable signal.Play from here

Exam cue

• PD = membrane + prescribed dialysate + sterile connections + complete drain.Play from here

Study guide

• Catheters are commonly silicone and may have one or two cuffs. The exit site and tunnel are infection-prone and require routine assessment and care.Play from here
• The transfer set connects the catheter to the disposable bag system. It includes a protective cap and may use a disinfecting sponge with povidone-iodine. It is sterile, single-use equipment: never reuse it; report contamination immediately.Play from here
• A 4-inch adapter may connect Luer-lock syringes to some Fresenius setups. Use only the connector and supplies approved for that system.Play from here
• PD bags and boxes are color-coded. Check patient, PD type, concentration, volume, expiration, clarity, ports, and packaging. Rotate stock so the oldest unexpired supplies are used first.Play from here
• Dialysate is warmed before use according to policy. A port on the fill bag is used for medication additions; drain bags provide a sample port. Maintain no-touch asepsis.Play from here

Why answers are correct

• The catheter creates a path from the environment to a normally sterile space. A contaminated cap, set, port, or connection can seed peritonitis.Play from here

Limitations / traps

• Do not open a sterile pathway casually, touch connection ends, puncture a bag, reuse a transfer set, or use a damaged/leaking package. Escalate contamination rather than trying to “clean it up.”Play from here

Clinical pearl / safety

• Keep the catheter secured with approved tape or belt and avoid traction, tight taping, clothing friction, and pressure on the exit site.Play from here

Exam cue

• Protect the sterile pathway; when in doubt, stop and call the PD nurse.Play from here

Study guide

• CAPD (continuous ambulatory PD) uses manual exchanges during the day and often a long overnight dwell. A Y-shaped two-bag system contains a drain bag and fresh dialysate bag.Play from here
• Patients are trained to clean the area, wear a mask, wash and dry hands correctly, keep connections sterile, inspect effluent, and recognize contamination or infection. Training commonly takes about a week; the patient should practice under supervision.Play from here
• A manual exchange follows this sequence:
  1. Set up: clean the treatment area, prepare supplies, select the prescribed warmed solution, and hang the bag.
  2. Connect: disinfect the transfer-set end and cap, remove caps, and connect the patient to the bag system aseptically; remove the mask only as taught.
  3. Drain: open the catheter clamp, confirm flow, let gravity drain the effluent, watch the fluid, and reposition the body as taught if flow slows. Inspect the effluent and drain until complete.
  4. Flush then fill: close the patient catheter as directed, prime lines from fresh bag to drain bag, reopen the patient catheter, and let gravity fill the peritoneum.
  5. Disconnect: prepare supplies, mask and sanitize hands, close the catheter, and apply a new sterile cap without touching sterile ends.
  6. Clean up: secure the catheter, weigh and document effluent volume, dispose of fluid and trash safely, and disinfect the treatment area.
  7. Dwell: the patient is disconnected and can usually continue normal activities while fluid remains in place until the next exchange.
  8. Routine tasks: record treatments and solutions, check daily weight and blood pressure, perform exit-site care, order supplies, and attend clinic visits.
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Why answers are correct

• Drain, flush, fill, and dwell must occur in order. Gravity, not force, moves fluid in a manual exchange; visible effluent provides an early clue to bleeding, infection, or another complication.Play from here

Limitations / traps

• Never rush a connection, force a sluggish drain, or disregard a changed effluent. Troubleshooting and any change in exchange plan belong to the PD nurse/prescriber.Play from here

Clinical pearl / safety

• Report a missed drain, unusually low output, slow flow, pain, cloudy or abnormal effluent, fever, or a break in sterile technique promptly.Play from here

Exam cue

• CAPD safety is sequence and asepsis: drain, flush, fill, dwell, document.Play from here

Study guide

• APD/CCPD uses a cycler to perform the same general drain–flush–fill–dwell sequence, commonly through several short overnight exchanges while the patient sleeps; some patients retain a daytime dwell.Play from here
• The patient or helper loads a sterile disposable cassette, connects dialysate bags, and follows color-coded clamps and lines. The cycler uses air pressure to prime and move fluid, warms solution, measures volumes, and runs the prescription; typical treatment lasts about 6–12 hours.Play from here
• Effluent may drain to a household drain, toilet, bucket, or collection bags as prescribed. The first drain should be checked: clear fluid is expected; cloudy fluid can indicate peritonitis.Play from here
• The PD nurse programs the cycler. Alarms may signal slow drain, a kink, or incorrect temperature. Cyclers start in a drain phase to reduce overfill risk and have a stop function for a patient who feels too full. Remote software may transmit treatment data and permit authorized prescription review.Play from here

Why answers are correct

• Automation improves convenience but adds device, tubing, programming, and overfill risks. A cycler alarm is a safety signal, not something to silence without assessing the patient and cause.Play from here

Limitations / traps

• Do not change a program, bypass an alarm, or reconnect a line without training. Use the manufacturer’s troubleshooting path and contact the PD nurse/manufacturer support line as directed.Play from here

Exam cue

• APD is still sterile PD; the cycler changes the mechanics, not the infection-control rules.Play from here

Study guide

• Residual kidney function (RKF) is remaining native filtration and urine production. Even small urine output contributes to clearance and survival; it generally declines more slowly on PD than on standard HD.Play from here
• Incremental PD begins with less than a full standard treatment when RKF allows. Fill volume, number of exchanges, and frequency can be increased as native function declines.Play from here
• Track urine output, weight, blood pressure, fluid status, labs, and symptoms. Do not assume a stable early prescription remains adequate.Play from here

Exam cue

• PD dose is individualized and may increase as RKF falls.Play from here

Study guide

• Dialysate contains an osmotic/oncotic water-removing agent, electrolytes, and a buffer. Agents include dextrose, amino acids, and icodextrin; buffers include lactate or bicarbonate/bicarbonate-lactate. Standard fluids may be acidic, with pH reported as low as about 5.2.Play from here
• Common U.S. color-coded strengths:
  • Yellow, 1.5% dextrose: removes wastes with relatively little water; often used when the patient is euvolemic to avoid excessive UF and dehydration.
  • Green, 2.5% dextrose: intermediate water removal.
  • Red, 4.25% dextrose: greatest water removal for fluid overload, but absorbed sugar can raise glucose and add calories/weight.
  • Purple, 7.5% icodextrin: a non-sugar polymer used for long dwells, often 8–16 hours; it can draw substantial water and requires specific training.
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• Higher concentration creates a larger blood-to-dialysate gradient. Water enters dialysate while glucose or icodextrin is absorbed toward equilibrium. Repeated exposure to glucose, acidic fluid, and glucose-degradation products can inflame and injure the membrane.Play from here
• Icodextrin may cause rash or serious allergy, and some glucose meters read falsely high with it. Use a compatible glucose-monitoring method and report symptoms.Play from here
• Amino-acid dialysate can provide protein building blocks, pull water osmotically, and reduce glucose exposure. A glucose-plus-amino-acid solution may provide intraperitoneal nutrition, but availability is limited in the United States.Play from here
• Add medications only through the designated port using policy-approved, no-touch technique. Drain bags can be sampled for testing.Play from here

Why answers are correct

• Stronger solution does not mean “better” for every patient. It is selected for the desired fluid removal while balancing dehydration, hyperglycemia, calories, membrane injury, and prescription goals.Play from here

Limitations / traps

• Never select a bag by color alone; verify concentration, patient, expiration, and prescription. Dextrose strength is not a substitute for assessing weight, blood pressure, edema, symptoms, and drain results.Play from here
• Neutral-pH, lower-GDP solutions may be more biocompatible and may preserve RKF, but described products are not all FDA-approved in the U.S. Follow the actual formulary.Play from here

Exam cue

• Yellow = least UF; green = middle; red = most dextrose/UF; purple = long-dwell icodextrin.Play from here

Study guide

• PD adequacy includes clearance, fluid removal, nutrition, symptoms, labs, blood pressure, weight, and preserved RKF. Patients collect all urine for 24 hours and accurately measure the dialysate used and drained, including samples from exchanges.Play from here
• Monthly labs should remain reasonably stable when treatment is working. Low Kt/V or uremic symptoms may lead to larger fills, additional exchanges, or adjusted dwell times. Because Kt/V includes RKF, losing urine function can require more PD.Play from here
• A peritoneal equilibration test (PET) classifies membrane transfer status after about the first month. It compares urea, creatinine, glucose, and water in dialysate after a 4-hour dwell with blood values.Play from here
• Standard PET timing is critical: drain the overnight dwell at 0 hours, obtain the starting sample, instill prescribed 2 L of 2.5% fluid, collect a 2-hour dialysate and blood sample, then drain/weigh and collect the 4-hour sample with the final blood sample. Diabetic hyperglycemia can distort interpretation.Play from here
• Transfer categories range from low/slow to high/fast. Faster transport absorbs glucose quickly, so it may require shorter dwells, more exchanges, APD/CCPD, and sometimes icodextrin. Slow transport may benefit from longer dwells and may fit CAPD; the actual prescription is individualized.Play from here
• Peritonitis can temporarily make transfer faster and reduce water removal. Repeat PET if a clinically important membrane change is suspected.Play from here

Exam cue

• Adequacy is measured, not guessed: collect completely, sample on time, trend results, and adjust only through the care team.Play from here

Study guide

• A patient needing immediate dialysis may initially receive a central venous catheter and later transition to PD, or may start PD urgently to avoid CVC complications such as central venous stenosis.Play from here
• Urgent-start PD begins within roughly two weeks of catheter placement, generally in a clinic or hospital before home training is complete. The patient is supine, uses low volumes (around 500 mL), dwells briefly, drains, and repeats; volumes increase gradually because leak risk is higher.Play from here
• Emergent-start PD begins within 48 hours of catheter placement with small volumes. Early flow problems are more likely from malposition, fibrin, or omental wrapping and may require surgical correction. Not every clinic offers this pathway.Play from here

Study guide

• PD patients can lose protein in effluent and may have chronic inflammation and poor appetite. They are vulnerable to protein, calorie, vitamin, and mineral deficiencies and commonly need roughly 1.2–1.3 g protein/kg/day, individualized by the dietitian.Play from here
• Protein supplements may improve albumin. Dialysate glucose adds about 300–450 calories daily and can contribute to weight gain and hyperglycemia, especially with diabetes.Play from here
• Supplements may include bars, protein drinks, gelatin, ice cream, or other foods. New products should be reviewed by the renal dietitian rather than assumed safe.Play from here

Constipation

• Constipation is the most common reason for a PD catheter to malfunction. A full bowel can displace or compress the catheter, usually impairing outflow first. Slow or unexpectedly small drains require bowel assessment even when the patient does not feel constipated.Play from here
• Walking, prescribed bowel routines, and laxatives may restore position; constipation also increases infection risk because bowel bacteria can cross into the peritoneum.Play from here

Catheter malposition, migration, fibrin, and clots

• A kink or migrated tip can obstruct inflow/outflow. Imaging such as X-ray or CT may locate the problem. Repositioning can use a guidewire; laparoscopic revision and internal fixation, or removal/replacement, may be needed.Play from here
• Fibrin or clot can plug the catheter. Heparin may be prescribed in dialysate; a nurse may irrigate with a syringe, and tPA may be instilled under order if appropriate. Never force a flush.Play from here

Adhesions and omental wrapping

• Adhesions are abnormal tissue bridges after trauma, surgery, bleeding, or inflammation. They can wall off the catheter, reduce membrane area, and decrease treatment; adhesiolysis may be needed.Play from here
• The omentum can wrap a catheter or organize around it. Omentectomy removes omentum; omentopexy moves/folds it away. These procedures can be done with placement but add surgical and infection risk.Play from here

Overfill

• Overfill is too much fluid in the abdomen, commonly from filling without fully draining the prior dwell. It is more common with APD/CCPD and can produce pressure, distress, or death.Play from here
• Risks include skipped drain/tidal settings, excessive UF, cycler malfunction, incorrect minimum-drain programming, and ascites from liver disease. Follow the cycler’s safety response and contact the PD nurse immediately.Play from here

Leaks and hernias

• Dialysate can escape beneath skin, into the chest, or into the genital area, causing pain, swelling, and infection risk. Risk rises with birth or surgical defects, large volumes, incomplete healing, obesity, prior hernia/surgery, pregnancy, steroids, activity, or high intra-abdominal pressure.Play from here
• A leak at the exit site can be confirmed with glucose testing. Pleuroperitoneal leak is fluid entering the pleural space, usually right-sided and often in the first PD year; shortness of breath is an early clue, with chest pain or low drain volume possible. It may need a sealing procedure and temporary HD.Play from here
• Hernias may need repair before or during catheter placement; mesh may reduce recurrence. Fluid near the catheter can mimic a hernia but be a pseudohernia because the abdominal wall is not involved.Play from here
• Report exit-site fluid, new bulge, genital or abdominal swelling, low drains, or vaginal leakage. Management may be surgical repair, low-volume supine APD, or a short PD pause with backup HD.Play from here

Peritoneal fibrosis, UF failure, and EPS

• Repeated exposure to glucose, low pH, inflammation, infection, and time can thicken/fibrose the peritoneum, narrow vessels, reduce filtering surface, and increase transfer speed.Play from here
• In UF failure, fast transport absorbs glucose before it can pull enough water; fluid overload and cardiovascular risk rise. When the membrane no longer clears solute or water, PD must end and another modality is needed.Play from here
• Encapsulating peritoneal sclerosis (EPS) is rare but devastating: severe fibrosis encases and entangles bowel, causing obstruction, ischemia, perforation, sepsis, malnutrition, pain, distention, nausea, and vomiting. Risk rises with long PD exposure, high-glucose fluid, infection, and fibrosis; treatment may include stopping PD, steroids/chemotherapy, and high-risk surgery only when necessary.Play from here

Pain

• Fill pain may reflect acidic/glucose fluid, catheter position pressing an organ, or temperature. Body-position changes, pausing, or body-temperature solution may help under policy.Play from here
• Air in the abdomen (pneumoperitoneum) can cause referred shoulder pain. Dwell pain commonly signals excessive fullness/pressure; drain promptly and review fill volume.Play from here
• Drain pain reflects negative pressure. It is less common with gravity CAPD; APD suction may pull the catheter against bowel, bladder, or rectum. A tidal prescription leaves some fluid to reduce pain but can increase overfill risk and does not correct malposition.Play from here
• Persistent or severe pain is not normal; notify the nurse and assess for infection, leak, malposition, or other cause.Play from here

Study guide

• Expected effluent is transparent/clear and may be normally yellow. Anything not crystal clear or normal yellow should be reported and evaluated.Play from here
• Bloody/red: hemoperitoneum; ovulation or menstruation can be benign causes, but cyst rupture, trauma, procedures, uremia, EPS, cancer, or organ injury require assessment. After complicated catheter surgery, small-volume cool-fluid irrigation and ordered heparin may be used.Play from here
• Cloudy: treat as peritonitis until proven otherwise. Also consider blood, cells, or other causes; report immediately.Play from here
• Milky/opaque: high triglycerides, chyle obstruction, intestinal drainage, high-fat intake, trauma, lymphoma, or heart failure.Play from here
• Peach: mixture of blood and chyle; identify both sources.Play from here
• Yellow-green: bile leak into the peritoneum; risk of GI infection and perforated/inflamed gallbladder.Play from here
• Fluorescent yellow: fluorescein used for eye examination; it glows in the dark and is not harmful.Play from here
• Brown-black/cola: hemolysis, including pancreatitis-related enzyme activity.Play from here
• Orange may follow rifampin; rust-colored fluid can follow IV iron.Play from here

Exam cue

• Cloudy is an emergency report; never reassure yourself based on color alone.Play from here

Catheter damage and exit/tunnel infection

• Any torn, crushed, cut, punctured, chemically damaged, or broken catheter/transfer set is a major infection risk. Report immediately; a damaged transfer set may be replaced, while the PD nurse may repair/splice internal catheter damage. Go to the ER when instructed.Play from here
• Excessive tape tension, tugging, friction, or tight clothing can cause erosion, bleeding, pain, and inflammation. Teach approved taping and report trauma, bleeding, or discomfort immediately.Play from here
• An extruded cuff exposes fibrous material where bacteria can grow, often after weight loss or traction. Partial extrusion traps bacteria near the exit; specialized cleaning, cuff/fiber removal, surgery, or catheter removal may be required.Play from here
• Exit-site infection (ESI) signs include redness, swelling, pain, purulent drainage, and exuberant/granulation tissue. Acute ESI resolves in weeks; chronic infection persists or relapses and can spread down the tunnel.Play from here
• Treatment may include 2–3 weeks of oral antibiotics, hypertonic salt/vinegar soaks, dressing changes, cultures of pus, topical prophylactic antibiotic, cuff surgery, or catheter removal. Fluid around the superficial cuff on ultrasound may require surgery before the infection spreads.Play from here
• Tunnel infection is deeper and more serious. Redness extending about 2 cm or more, blood/pus from the tunnel, pain, swelling with induration, or dialysate leaking through an eroded tunnel warrants urgent escalation, antibiotics/wound care, possible catheter removal, and temporary HD.Play from here
• A simple exit-site score uses swelling, crust, redness, pain, drainage, and granulation tissue. A score of 4 or more, purulent drainage, exuberant tissue, or proud flesh supports ESI; follow clinic scoring rules.Play from here

Peritonitis

• Peritonitis occurs when microorganisms enter the sterile peritoneum, usually through the catheter system. It is the most serious common PD complication and can cause hospitalization, catheter loss, stopping PD, fibrosis, or death. Symptoms can appear over hours to days.Play from here
• Report severe abdominal pain, cloudy effluent, nausea/vomiting/diarrhea, weakness or malaise, or fever immediately. Treatment should start as soon as samples are obtained to preserve membrane function.Play from here
• Risk is higher with older age, obesity, diabetes/comorbidity, weak immunity, constipation, or difficulty maintaining sterile technique. Patients may need extra protein while healing.Play from here
• Touch contamination breaks sterility. Wet contamination after fluid exchange and dry contamination before exchange (such as touching a transfer set) both matter; wet contamination is especially likely to lead to peritonitis.Play from here
• Internal sources include gut bacteria crossing with constipation, recent antibiotics, appendicitis, gallbladder or other GI disease, tuberculosis, and cirrhosis. Dental, GI, and gynecologic procedures can seed infection; prophylaxis may be ordered.Play from here
• Common organisms include skin flora such as S. epidermidis and S. aureus. Biofilm can cause relapse with the same organism and require catheter removal. More than one organism (polymicrobial peritonitis) increases the likelihood of catheter removal and HD.Play from here
• After the nurse obtains dialysate samples, intraperitoneal antibiotics are mixed into dialysate for a long dwell; home treatment may be taught. Courses often last 2–3 weeks. Add medication only through the designated port with sterile technique; never puncture the bag.Play from here
• Fungal peritonitis, often Candida, is more likely after antibiotics or with low albumin. It can cause flow problems, abscesses, EPS, and death; early treatment generally includes catheter removal and usually temporary/permanent HD. Antifungal prophylaxis may accompany antibacterial treatment.Play from here

Clinical pearl / safety

• Cloudy effluent, new abdominal pain, fever, or a contaminated connection is a same-day/urgent PD-nurse call—not a wait-and-see problem.Play from here

Study guide

• Infection, catheter dysfunction, membrane failure, UF failure, recurrent complications, or loss of adequate clearance can require HD. Patients may need emotional support and orientation, especially if they expected PD to continue indefinitely.Play from here
• Some prior PD patients may be candidates for home HD. Encourage the patient to stay involved with the care team and discuss modality choices rather than presenting transition as personal failure.Play from here
• Catheter removal is often open surgery with the entire catheter removed intact; sometimes it is pulled in an office. Removal methods differ when infection is known or suspected because retained cuff material can remain embedded and infection may spread.Play from here

Study guide

• PD offers home independence, no routine needles, flexible work/travel, and preservation of RKF for many patients, but success depends on asepsis, correct supplies, complete exchanges, nutrition, and early recognition of complications.Play from here
• A dialysis technician can reinforce taught hand hygiene and connection steps, help organize supplies and the treatment area, observe exchanges, document findings, and alert the PD nurse to abnormal effluent, pain, flow, weight, blood pressure, exit-site changes, contamination, or equipment damage.Play from here

Exam cue

• Teach what is authorized, observe what is changing, protect the sterile system, and escalate early.Play from here

Uncommon words from this chapter. Plain definitions + a short dialysis-related example.Play from here

peritoneum

The living lining of the belly used as PD's exchange membrane.

Example. PD uses the peritoneum and its capillaries instead of an external dialyzer.

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dwell

The time dialysate stays in the abdomen between fill and drain.

Example. A longer dwell can change how much waste and water move into the fluid.

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ultrafiltration

Water removal into PD fluid, usually pulled by the osmotic agent.

Example. Yellow 1.5% dextrose usually gives the least ultrafiltration; red 4.25% gives the most.

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aseptic

Keeping every connection and cap free of germs.

Example. A contaminated transfer-set end can seed peritonitis, so aseptic steps are not optional.

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residual kidney function

The urine and filtration the patient's own kidneys still provide.

Example. Even small residual kidney function adds clearance and may slow the need for a full PD dose.

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incremental PD

Starting with less than a full standard PD dose while native function remains.

Example. Incremental PD can increase fills or exchanges as residual function falls.

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euvolemic

Having a normal, not overloaded or dehydrated, fluid status.

Example. A yellow bag is often used when the patient is euvolemic to avoid extra water removal.

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icodextrin

A non-sugar polymer used for some long PD dwells.

Example. Purple icodextrin bags need a compatible glucose meter because some meters read falsely high.

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adequacy

Whether PD is clearing enough waste and water for that person.

Example. Adequacy includes Kt/V, symptoms, weight, blood pressure, and leftover kidney function.

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PET

Peritoneal equilibration test: a timed study of how fast the membrane transfers solute and water.

Example. A PET after about the first month helps classify slow versus fast transporters.

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omentum

A fatty apron of tissue in the abdomen that can wrap around a catheter.

Example. Omental wrapping can block PD flow and may need surgery.

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adhesion

An abnormal tissue bridge after surgery, bleeding, or inflammation.

Example. Adhesions can wall off the catheter and shrink the usable membrane area.

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overfill

Too much fluid left in the abdomen, often from filling without a complete drain.

Example. Overfill can cause severe pressure and is more common with cycler PD.

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fibrosis

Thickening and scarring of the peritoneum after injury, infection, or long glucose exposure.

Example. Fibrosis can speed transfer, reduce water removal, and end PD.

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EPS

Encapsulating peritoneal sclerosis: rare, severe scarring that encases bowel.

Example. EPS can cause obstruction, malnutrition, and sepsis and is a reason PD may stop.

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hemoperitoneum

Blood in the drained PD fluid.

Example. Bloody effluent is hemoperitoneum and needs evaluation even if menstruation is a possible cause.

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peritonitis

Infection of the sterile peritoneal space.

Example. Treat cloudy effluent as peritonitis until the team proves otherwise.

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biofilm

A sticky layer of germs on a catheter that is hard to clear with medicine alone.

Example. Biofilm can cause repeated peritonitis with the same organism.

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extrusion

A catheter cuff working its way out through the skin.

Example. An extruded cuff exposes material where bacteria can grow.

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induration

Hard, thickened tissue under the skin.

Example. Tunnel infection may show pain, swelling, and induration along the catheter path.

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effluent

The used PD fluid that drains out.

Example. Expected effluent is clear and may be normally yellow; anything else is reportable.

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osmotic

Related to the pull created by dissolved agents that draw water.

Example. Dextrose is the usual osmotic agent that pulls water into PD fluid.

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