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Dianeal PD-2 solutions are intended for intraperitoneal administration only. Not for intravenous administration.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.
The mode of therapy frequency of treatment, exchange volume, duration of dwell, and length of dialysis should be initiated and supervised by the prescribing physician.
To avoid the risk of severe dehydration and hypovolemia and to minimize the loss of protein, it is advisable to select the peritoneal dialysis solution with the lowest level of osmolarity consistent with the fluid removal requirements for that exchange.
As the patient's body weight becomes closer to the ideal weight, lowering the dextrose (glucose) concentration of DIANEAL is recommended.
Peritoneal dialysis solutions may be warmed in the overpouch to 37°C (98.6°F) to enhance patient comfort. However, only dry heat (for example heating pad, warming plate) should be used. Solutions should not be heated in water or in a microwave oven due to the potential for patient injury or discomfort.
Aseptic technique must be employed throughout the peritoneal dialysis procedure. It has been reported in the literature that, the addition of heparin to the dialysis solution may be indicated to aid in prevention of catheter blockage in patients with peritonitis, or when the solution drainage contains fibrinous or proteinaceous material. 500 to 1000 USP units of heparin per liter of solution has been recommended for adults. For children, 50 USP units per 100 mL of dialysis fluid has been recommended (Goel et al. 1998).
Additives may be incompatible. Complete information is not available. Those additives known to be incompatible should not be used. Consult with pharmacist, if available. If, in the informed judgement of the physician, it is deemed advisable to introduce additives, use aseptic technique. Mix thoroughly when additives have been introduced. Do not store solutions containing additives.
Do not administer if the solution is discolored, cloudy, contains particulate matter or shows evidence of leakage, or if seals are not intact. The drained fluid should be inspected for the presence of fibrin or cloudiness, which may indicate the presence of peritonitis.
Intermittent Peritoneal Dialysis (IPD): For maintenance dialysis of chronic renal failure patients.
The cycle of instillation, dwell and removal of dialysis fluid is repeated sequentially over a period of hours (8 to 36 hours) as many times per week as indicated by the condition of the patient. For chronic renal failure patients, maintenance dialysis is often accomplished by periodic dialysis (3 to 5 times weekly) for shorter time periods (8 to 14 hours per session) (Mattocks and El-Bassiouni 1971).
Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD): For maintenance of chronic renal failure patients: Patients on CAPD typically perform 4 cycles per day (24 hours). In CAPD, the solution remains in the cavity for dwell times of 4 to 6 hours during the day and approximately 8 hours overnight. At the conclusion of each dwell period, the access device is opened, the solution drained and fresh solution instilled (Ronco et al. 2000; Keshaviah et al. 1994).
Patients on APD typically perform 3-5 cycles at night and up to 2 cycles during the day. After the last outflow during the night, the equipment is then disconnected from the patient and the dialysate remains in the peritoneum until the next cycle. Additional exchanges can be infused by the cycler machine into the peritoneum during the daytime (Blake et al. 1996; Blake et al. 2011). It is recommended that adult patients being placed on peritoneal dialysis or, in the case of pediatric patients, the selected caretaker, (as well as the patient, when suitable), should be appropriately trained in a program which is under the supervision of a physician.
