Peritoneal Dialysis Nursing and Home Support
Hong Kong has the highest use of peritoneal dialysis in the world, and dialysis at home is the main approach. Support at home decides how well it goes. Peritonitis is the biggest threat in PD: correct aseptic technique, exit-site care and recognising the signs can lower the risk a great deal, although it cannot be brought to zero. Our team of registered nurses in Hong Kong visits the home and helps carry out what was taught in hospital as real daily practice.
- Team of registered nurses in Hong Kong
- Home visits across Hong Kong
- Nurse $920 per hour · no minimum charge
- Based on ISPD international guidelines
Fees, service areas and how to book
The questions below are the ones that families and patients ask most, answered together. For full fees, see the pricing page.
| Fees | Registered nurse HK$920 per hour (4 hours $400 / 8 hours $340 / 12 hours $300), no minimum charge, and single visits can be booked as needed. |
| Service areas | The service covers Hong Kong Island, Kowloon and the New Territories, including private homes and residential care homes. |
| Who visits | The service is provided by registered nurses in Hong Kong who are registered with the Nursing Council of Hong Kong. They visit to assess the patient, give technique training and provide daily nursing care. |
| Modes supported | We support both manual exchanges (CAPD) and overnight machine exchanges (APD). The care priorities are the same for both, and the nurse adjusts the training to the mode the patient uses. |
| How to book | WhatsApp for enquiries and bookings. |
How common peritoneal dialysis is in Hong Kong, and home nursing support
Peritoneal dialysis (PD, commonly called dialysis through the abdomen) is a home treatment alternative for end-stage kidney disease. It has two main forms: continuous ambulatory peritoneal dialysis (CAPD, fluid exchanged by hand during the day) and automated peritoneal dialysis (APD, fluid exchanged by a machine at night). Hong Kong has had a PD-First policy since 1985, and is one of the earliest and largest places to adopt it. In 2021 about 73.6% of dialysis patients used peritoneal dialysis, the highest proportion in the world. In other words, dialysis at home is the usual approach in Hong Kong and not an isolated case.
However, when the skills taught at a hospital PD centre are carried out at home by the patient, family or domestic helper, contamination can easily occur through small lapses in detail. A visiting registered nurse acts as the bridge between teaching in hospital and actual practice at home. Through direct observation, correcting technique, checking the exit site and giving care guidance, the nurse helps the family carry out every step reliably. This is part of our home nursing service.
Peritonitis is the main threat in PD, and the risk can be lowered but not brought to zero
Peritonitis (infection and inflammation of the peritoneum) is the main complication of peritoneal dialysis, and the leading reason for admission to hospital and for switching to haemodialysis (technique failure). The International Society for Peritoneal Dialysis (ISPD) updated its guideline in 2022 and put prevention at the centre. Key points include: handling contamination properly, giving antibiotic prophylaxis before invasive procedures, regular reassessment and retraining, and managing risk factors that can be changed (for example keeping pets at home, low potassium and constipation).
One point should be made first: good daily care can greatly lower the risk of peritonitis, but cannot bring the risk to zero. Clinical research shows that nurse teaching alone did not statistically reduce peritonitis significantly (Nopsopon 2022 meta-analysis). The certainty of the evidence for applying topical antibiotics routinely to prevent peritonitis is also low, and it did not reach statistical significance (Campbell 2017 Cochrane). Our service therefore does not promise by what percentage the infection rate will fall. It focuses on carrying out the care steps according to international guidelines and teaching family members to recognise the signs of infection early.
Spotting the early signs of peritonitis is the key to treating it in time. If any of the following appear (especially cloudy dialysis fluid), contact the kidney team as soon as possible:
- The drained dialysis fluid becomes cloudy. This is the most typical warning sign and needs special attention.
- Abdominal pain, especially during exchange or drainage.
- Fever or chills
- Nausea and vomiting
- Poor drainage, or clearly less fluid coming out.
Daily care of the catheter exit site
The catheter exit site is one of the main routes by which bacteria enter the body, and good daily care is the basic way to prevent exit-site and tunnel infection. The ISPD 2023 guideline sets the exit-site infection rate target at no more than 0.40 episodes per patient-year. It also points to the latest clinical direction: a lower recommendation for routine application of topical antibiotics, and more emphasis on early clinical observation and suitable dressing cover.
Key points of daily exit-site care
- Keep the catheter exit site clean and dry at all times
- Change the dressing regularly as instructed by the kidney team
- Secure the catheter and take care not to pull on it
- Check the exit site every day for redness, swelling, discharge, crusting or pain when pressed
Exit-site problems to report early
- The exit site stays red, or becomes more and more painful
- Pus or unusual discharge comes out
- The wound keeps forming crusts and has not healed for a long time
- Redness and pain along the line of the catheter (a tunnel infection is suspected)
Home aseptic exchange training and retraining process
The aseptic exchange procedure is the core skill of dialysis at home. The teaching syllabus prepared by the ISPD nursing committee (Figueiredo 2016) is based on adult education theory. It defines the scope of teaching clearly, covering aseptic technique, exit-site care and recognition of complications, and recommends structured one-to-one training for patients, family members or domestic helpers. One study also suggests that repeated retraining at home may help older patients to prevent infection (Chang 2018; a small trial that gives directional support). The value of a visiting nurse is in guiding the technique in the real home environment and regularly reassessing whether the technique is accurate.
- 1WhatsApp or phone consultationWe first learn about the patient's condition, the dialysis mode in use (CAPD or APD), the home environment and who usually does the exchanges, and then give initial advice and a quote.
- 2First home assessmentThe nurse visits to check the catheter exit site, looks at whether the usual exchange technique and home environment are suitable, and learns how confident the patient and carer feel when doing it themselves.
- 3Aseptic technique trainingFollowing the ISPD teaching framework, the nurse teaches the patient, family member or domestic helper step by step how to wash hands correctly, wear a mask, make the aseptic connection and drain.
- 4Exit-site care and symptom educationThe nurse demonstrates on the spot how to clean the exit site and change the dressing, and teaches everyone how to recognise the warning signs of peritonitis and exit-site infection early, and how to report if something goes wrong.
- 5Regular retraining and monitoringThe nurse visits regularly to measure the patient's vital signs, record fluid balance and check the condition of the exit site. The nurse also checks whether the exchange technique has drifted, and corrects it when needed.
Who should book home dialysis nursing
People who have just started dialysis or just left hospital
- Just home from hospital, not yet familiar with the exchange steps and feeling nervous doing them
- Want a nurse present first to confirm the technique is correct before doing it alone
Families where a carer helps with dialysis
- A domestic helper or family member usually helps with exchanges, and would like a healthcare professional to check and keep an eye on the quality of the technique
- The carer feels very nervous doing aseptic technique and lacks confidence
Higher-risk groups
- Patients who have had peritonitis several times
- People with poor eyesight, hands that are not nimble enough, or cognitive impairment
Families who need short-term support
- The family member or domestic helper who usually cares is on leave and a professional nurse is needed to cover for a while
- There is a problem with the catheter exit site and someone needs to watch it more closely during this period
Case example: APD with retraining of a domestic helper
(The following is an illustration using a pseudonym.) Mr Chan, aged 75, has mild cognitive impairment and kidney disease. He is looked after day to day by a domestic helper and has just started automated peritoneal dialysis (APD) at home. The helper felt quite anxious about aseptic technique, and the catheter exit site had mild redness.
What nursing did
- A registered nurse visited on several days in a row to guide and observe the helper on the spot
- The steps were rewritten as a clear illustrated guide, and posted in the dialysis room for easy reference at any time
- The nurse corrected on the spot the helper's hand technique and steps when connecting the catheter
- The nurse helped to clean the catheter exit site and change the dressing
Improvements observed
- The redness at the exit site slowly settled
- The helper was clearly more confident doing the exchanges than before
- The household could carry out the exchange procedure more steadily and accurately every day
- There was no longer a need to keep seeing the doctor because of panic during the procedure
This example fits the clinical direction of structured carer training (Figueiredo 2016) and repeated retraining at home (Chang 2018). It must be stressed that individual situations and results differ from person to person, and that correct care helps lower the risk of infection but cannot guarantee that complications are avoided completely.
Choosing peritoneal dialysis or haemodialysis
Many families ask whether peritoneal dialysis is always better than haemodialysis. In fact neither is better in every respect. One study found that in older patients the mortality with peritoneal dialysis was slightly higher than with haemodialysis (Cheng 2024). The real advantages of peritoneal dialysis are a high degree of independence, being able to do it at home, a more flexible lifestyle, help in preserving residual kidney function and fewer trips to and from hospital. A longer life is not one of the advantages. It is also the default mode in Hong Kong's public healthcare system. The final choice of dialysis type should be made by the doctor together with the patient according to the individual's body and family situation.
Frequently asked questions
Would you like to arrange a home nursing assessment, aseptic technique training or an exit-site check for an older person on home dialysis? Message us on WhatsApp for a quick reply, followed up by a registered nurse in Hong Kong.
WhatsApp for a free enquiry and quoteDisclaimer: This article is general health information and is not professional medical advice. If you have any health concerns, please consult a qualified healthcare professional.
References
- Li, P. K. T., Chow, K. M., Cho, Y., et al. (2022). ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Peritoneal Dialysis International, 42(2), 110–153. PubMed
- Chow, K. M., Li, P. K. T., Cho, Y., et al. (2023). ISPD Catheter-related Infection Recommendations: 2023 Update. Peritoneal Dialysis International, 43(3), 201–219. PubMed
- Figueiredo, A. E., Bernardini, J., Bowes, E., et al. (2016). A syllabus for teaching peritoneal dialysis to patients and caregivers. Peritoneal Dialysis International, 36(6), 592–605. PubMed
- Campbell, D., Mudge, D. W., Craig, J. C., Johnson, D. W., Tong, A., & Strippoli, G. F. M. (2017). Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients. Cochrane Database of Systematic Reviews, 4(4), CD004679. PubMed
- Nopsopon, T., Kantagowit, P., Chumsri, C., et al. (2022). Nurse-based educational interventions in patients with peritoneal dialysis: a systematic review and meta-analysis. International Journal of Nursing Studies Advances, 4, 100102. PubMed
- Chang, J. H., Oh, J., Park, S. K., et al. (2018). Frequent patient retraining at home reduces the risks of peritoneal dialysis-related infections: a randomised study. Scientific Reports, 8, 12919. PubMed
- Li, P. K. T., Lu, W., Mak, S. K., et al. (2022). Peritoneal dialysis first policy in Hong Kong for 35 years: global impact. Nephrology (Carlton), 27(10), 787–794. PubMed
- Szeto, C. C., Lo, W. K., & Li, P. K. T. (2019). Clinical practice guidelines for the provision of renal service in Hong Kong: Peritoneal Dialysis. Nephrology (Carlton), 24 (Suppl 1). PubMed
- Cheng, L., Hu, N., Song, D., & Chen, Y. (2024). Mortality of peritoneal dialysis versus hemodialysis in older adults: an updated systematic review and meta-analysis. Gerontology, 70(5), 461–478. PubMed
- Nursing Council of Hong Kong. Code of Professional Conduct and Code of Ethics for Registered Nurses and Enrolled Nurses. nchk.org.hk