When Conventional Thinking Isn’t Enough: A Story of Nursing Resilience and Tenacity

Mrs Lily Jin¹, Mrs Catherine Blackamore

¹CCLHD, Long Jetty, Australia

Biography:

Lily is a Registered Nurse with 22 years of experience, including the past two decades devoted to renal nursing and education. She is deeply passionate about supporting and empowering patients to make informed, confident decisions about their renal replacement therapy through a shared decision-making approach. Lily is committed to improving patient outcomes and is known for her approachable style, innovative thinking, and determination to find solutions — she rarely accepts “no” when advocating for patients and better care.

Abstract:

Introduction

Early technique failure in continuous ambulatory peritoneal dialysis (CAPD) can compromise dialysis adequacy and patient wellbeing, often leading to premature modality change. Comprehensive nursing assessment and creative problem-solving are essential to identify reversible causes and support safe transitions between dialysis modalities. This case demonstrates how persistent nursing intervention enabled successful continuation of peritoneal dialysis through transition to automated peritoneal dialysis (APD).

Case Description

A patient newly commenced on home CAPD demonstrated poor dialysis adequacy after one month, accompanied by worsening uraemic symptoms. Biochemical markers showed significantly elevated serum urea (41 mmol/L) and creatinine (900 µmol/L). The patient was transferred to an in-centre dialysis unit for urgent haemodialysis, with an initial plan for peritoneal dialysis catheter removal.

A detailed nursing review prompted a Standard Peritoneal Assessment using 4.25% Dianeal with a 2 L, 4-hour dwell. Ultrafiltration of 1000 mL was achieved, indicating preserved ultrafiltration capacity. To further assess membrane function, a supervised 6-hour APD trial was conducted in the clinic, during which no ultrafiltration failure occurred. Based on these findings, the patient transitioned back to home APD. Follow-up demonstrated improved dialysis adequacy, stabilised biochemical parameters, and resolution of uraemic symptoms.

Conclusion

Persistent and adaptable nursing practice enabled early identification of CAPD failure and facilitated a successful transition to APD, restoring dialysis adequacy and improving clinical stability. This case highlights the critical role of nursing resilience in optimising peritoneal dialysis outcomes.