Turn the patient to the side to improve drainage during peritoneal dialysis.

What is the correct approach if all fluid does not drain during peritoneal dialysis?

• A. Place the client in the supine position.
• B. Encourage the client to sit up straight.
• C. Turn the client side to side.
• D. Increase the height of the drainage bag.

Answer: (C)

The correct approach when all fluid does not drain during peritoneal dialysis is to turn the client side to side. This action can help facilitate the flow of fluid within the abdominal cavity, allowing for better drainage. The movement can help dislodge any fluid that may be trapped in pockets or adhere to structures within the peritoneum. Encouraging the client to change positions can also mobilize the dialysate, and turning from side to side is particularly effective in redistributing fluid and may help overcome gravitational or positional barriers to drainage. While placing the client in a supine position and encouraging them to sit up are options that might seem reasonable, they may not actively assist in resolving drainage issues as effectively as lateral movement. Increasing the height of the drainage bag might help with gravity drainage but can also lead to increased pressure that might not resolve the underlying issue of trapped fluid. Thus, turning the client optimally enhances the chances for complete drainage during the dialysis process.

Turn the patient to the side to improve PD drainage — a simple move that many nurses and caregivers learn can make a big difference. When the outflow starts to stall during peritoneal dialysis, this isn't a big mystery. It's a reminder that the body is a system and sometimes a gentle nudge—or a small change in position—can help the fluid flow where it needs to go. Let me walk you through why this works, what else to check, and how to keep PD sessions smooth and comfortable.

What’s happening during PD drainage

Peritoneal dialysis uses a catheter placed into the abdomen to fill the space with dialysate. The fluid sits for a prescribed dwell time, then drains out through a line into a collection bag. Drainage relies on gravity and the way the dialysate moves around the abdominal cavity. If the fluid isn’t draining well, it might be because the dialysate is trapped in pockets, or it’s not spreading evenly because of how the body is positioned or how the tubing sits.

Think of it like washing a pan. If water pools in little corners, you tilt the pan or jiggle it so the water runs toward the drain. In the same way, a change in body position can help the dialysate shift and drain more completely.

The move that often helps: turn the client side to side

Here’s the thing: turning the patient from one side to the other can redistribute the dialysate inside the abdomen, helping it reach the outflow tract and move toward the drainage bag. It’s a small maneuver with a meaningful payoff. It’s more effective than just keeping the patient flat or sitting upright, because side-to-side movement changes the angles at which the dialysate meets the catheter and the outflow line.

How to perform it safely

If you’re guiding someone through this in a clinical setting, or teaching a patient or caregiver, keep these points in mind:

• Check for safety first. Make sure the patient is comfortable, has support nearby, and that any lines aren’t kinked or pulled. Don’t yank or twist the catheter. Gentle, controlled movement works best.

• Pause drainage if needed. If the line or tubing feels resistant, pause briefly to check for obvious blocks (kinks, folds, or pinched tubing) before repositioning.

• Switch sides slowly. Help the patient roll toward one side, then the other, spacing each hold a few breaths apart to let the body adjust. You’re not trying to force a huge shift—just a gentle redistribution of the dialysate.

• Don’t forget the basics. Keep the drainage bag at an appropriate height to avoid pulling on the catheter, and maintain a steady, comfortable pace. If the bag is too high or too low, drainage may be affected in unhelpful ways.

• Observe the response. After you move the patient, give drainage a bit of time. Some patients drain quickly, others take a few minutes. If there’s no improvement after a couple of attempts, it’s time to check for other causes.

Why this approach is often more effective than other position changes

You might wonder why side-to-side movement is singled out. Supine positioning (lying flat) can sometimes help, but it doesn’t always address the gravity and flow issues that trap dialysate. Sitting upright may seem intuitive, yet it may create new angles that hinder outflow. Raising the drainage bag can aid gravity to some extent, but it can increase pressure in the abdomen and cause discomfort without solving the underlying drainage barrier.

Turning to the side changes the way the dialysate moves around the peritoneal cavity. It helps break up pockets of fluid, reduces the chance of a fluid collection forming around the omentum or other structures, and can counteract minor adhesions or positional blocks. It’s about restoring a more favorable flow pattern, not forcing the fluid to drain through a stubborn path.

Beyond the move: what else to check when drainage is slow

If drainage remains slow after side-to-side repositioning, there are a few practical checks worth making. Think of this as a short diagnostic routine you can run in the moment:

• Check for kinks and twists. The outflow line should be free of kinks and not compressed by the patient’s body or bedding.

• Inspect the catheter site. Look for redness, warmth, or discharge around the catheter—these can signal infection or irritation, which might affect drainage.

• Assess constipation and abdominal pressure. If the bowel is distended or there’s stool impaction, it can impede drainage.

• Consider omentum wrap. In some cases, the omentum (a fatty apron inside the abdomen) can drape over the catheter and hamper drainage. If this is suspected, talk with the medical team about the best course of action.

• Check the dialysate and bag system. Ensure the dialysate is clear, not clumped, and that the drainage bag is functioning properly. A clogged filter or a bag with air bubbles can masquerade as drainage problems.

• Reassess dwell time and flow rate. Sometimes, a frame of reference helps: a longer dwell might be needed or a momentary pause after repositioning to allow flow to resume.

When to escalate

Most drainage issues resolve with a simple repositioning and a quick check. If there’s persistent resistance after trying side-to-side movement, or if the patient experiences increasing pain, fever, or signs of infection, escalate promptly. In those cases, it’s wise to involve nursing leadership or a physician. You’re not letting go of the concern; you’re ensuring that what’s happening is understood and addressed safely.

Practical tips for patients and caregivers

A lot of successful PD care comes down to routine and communication. Here are some practical nuggets that make a real difference over time:

• Create a simple “drain check” routine. After each fill, note how long drainage takes and whether repositioning helped. A quick log helps spot patterns.

• Use comfortable positioning. If your patient has shoulder, hip, or back issues, tailor the side-lying position to what feels stable and safe.

• Keep the environment calm. A quiet room, gentle lighting, and a familiar routine reduce stress, which can influence how the body responds to drainage.

• Stay hydrated and mindful of diet. Adequate hydration and a fiber-rich diet can help digestion and overall comfort, which in turn supports smoother PD sessions.

• Engage in a short education moment. When you explain the “why” behind the side-to-side move, patients and families gain confidence. A little knowledge goes a long way toward reducing anxiety during a PD cycle.

A quick, practical checklist you can keep handy

• Confirm the patient is in a comfortable, supported position.

• Check tubing for kinks or pinches; straighten as needed.

• If drainage is slow, roll the patient from side to side a few times, pausing between attempts.

• Reassess bag height and ensure no tension on the line.

• Look for signs of infection at the catheter site and assess abdominal tenderness.

• If drainage remains poor after a couple of repositioning attempts, contact a clinician for guidance.

A few words on the bigger picture

Peritoneal dialysis is a flexible, patient-centered way to manage kidney function. The drainage step, which might seem small, is a good reminder that successful therapy often hinges on simple, repeatable techniques. The side-to-side maneuver is a practical example of how attentive care and thoughtful positioning can reduce risk, reduce discomfort, and keep the treatment on track.

As you work with PD patients, you’ll notice there are countless little decisions that shape outcomes. Skillful positioning is one that—when done calmly and correctly—supports better flow, reduces stress for the patient, and keeps the day moving forward. It’s part craft, part science, and a lot of listening to what the body is telling you in real time.

Bringing it all together

When drainage isn’t moving as it should, remember the core idea: a gentle turn to the side can help rediscover the path of least resistance for the dialysate. It’s a straightforward move with a meaningful impact. Pair it with careful checks for line integrity, catheter status, and patient comfort, and you’re laying a solid foundation for a smooth PD cycle.

If you want to carry this forward in your clinical practice, keep the emphasis on clarity, safety, and empathy. Speak to patients in plain language, invite questions, and acknowledge the practical realities of daily PD routines. A patient who feels heard—and who understands the why behind each step—is already on the road to better outcomes.

In the end, peritoneal dialysis isn’t just about a machine and a bag; it’s about keeping a person’s life steady and predictable, even on the days when the flow feels a little stubborn. And sometimes, the simplest adjustment—turning to the side—can be the move that makes all the difference.