What is tidal APD?
Tidal APD is a technique whereby a constant residual volume of PD fluid (e.g., 200 mL) is left in the peritoneal cavity following the first APD cycle and dwell.
Partial fill volumes delivered for subsequent cycles (e.g., 1800 mL) are reduced proportionate to this prescribed residual volume, so that the total peritoneal volume does not exceed the prescribed dwell volume (e.g., 2000 mL).
Accommodation in cycler prescription must be made for the anticipated UF. Failure to do so will result in progressive increases in peritoneal volume and intraperitoneal pressure, an effect that could result in adverse abdominal wall or cardiopulmonary events. Intermediate full drains are possible and programmable in the cycler.
Tidal PD is usually prescribed for reasons of drain pain, to provide a “cushion” of PD fluid between the PD catheter and pelvic organs.
A constant residual volume provided through tidal PD can also help manage slow PD catheter drainage occurring toward the end of drain attributable to pelvic structures impeding flow at low peritoneal fluid volumes.