Peritoneal Dialysis NonInfectious Complications Peritoneal Dialysis Noninfectious Catheter

  • Slides: 15
Download presentation
Peritoneal Dialysis Non-Infectious Complications

Peritoneal Dialysis Non-Infectious Complications

Peritoneal Dialysis Non-infectious Catheter Complications v Inflow/outflow obstruction v Hernia v Leakage

Peritoneal Dialysis Non-infectious Catheter Complications v Inflow/outflow obstruction v Hernia v Leakage

Peritoneal Dialysis Increased Intra-Abdominal Pressure v Instillation of dialysate into the peritoneal cavity leads

Peritoneal Dialysis Increased Intra-Abdominal Pressure v Instillation of dialysate into the peritoneal cavity leads to increased intra-abdominal pressure v The magnitude of the increase depends upon: - Volume dialysate filled - Patient age, body mass index - Coughing, lifting straining at stool - Position of the patient (sitting>standing>supine)

Peritoneal Dialysis Inflow/Outflow Obstruction Causes: - Mechanical (e. g. tip migration, kink in tubing)

Peritoneal Dialysis Inflow/Outflow Obstruction Causes: - Mechanical (e. g. tip migration, kink in tubing) - Constipation - Catheter blockage Outflow obstruction is most frequent: - Intraluminal (clot, fibrin) - Extraluminal (constipation, occlusion, omental wrapping, tip migration, incorrect catheter placement)

Peritoneal Dialysis Inflow/Outflow Obstruction Recommendations v Establish type of obstruction v Conservative or non-invasive

Peritoneal Dialysis Inflow/Outflow Obstruction Recommendations v Establish type of obstruction v Conservative or non-invasive approaches - body position change - laxatives - heparinised saline - fibrinolytic agents v Aggressive therapies -a) blind - fluoroscopically guided wires, stylet, whiplash -b) direct - peritoneoscopy, surgical catheter revision or replacement

Peritoneal Dialysis Dialysate Leaks Early (within 30 days) - Manifest externally - Do not

Peritoneal Dialysis Dialysate Leaks Early (within 30 days) - Manifest externally - Do not require imaging - Managed by temporary discontinuation of PD (75%) or surgery Late (beyond 30 days) - Manifest by poor outflow, localised oedema, subcutaneous fluid - 30% require imaging - Hernia cause 40% of late leaks - Most late leaks require surgery (70%) - Frequently lead to change of treatment Tzamaloukas Adv PD 1990

Peritoneal Dialysis Fluid Leak - CT Cannulogram

Peritoneal Dialysis Fluid Leak - CT Cannulogram

Peritoneal Dialysis Abdominal Wall or Pericatheter Leak Presentation v Abdominal swelling or bogginess v

Peritoneal Dialysis Abdominal Wall or Pericatheter Leak Presentation v Abdominal swelling or bogginess v Reduced drain (effluent) output v Weight gain and abdominal wall oedema, without peripheral oedema v Pericatheter leak: wetness or swelling at exit-site

Peritoneal Dialysis Abdominal Wall or Pericatheter Leak Management v Reintroduce low pressure PD (APD)

Peritoneal Dialysis Abdominal Wall or Pericatheter Leak Management v Reintroduce low pressure PD (APD) or v Temporary transfer to HD to allow healing, or v Catheter replacement if pericatheter leak,

Peritoneal Dialysis Hernias and Genital Oedema v Caused by continuous elevation of intraabdominal pressure

Peritoneal Dialysis Hernias and Genital Oedema v Caused by continuous elevation of intraabdominal pressure and abdominal wall tension v Acquired or congenital defects in the abdominal wall Ø Inguinal > Catheter insertion site Ø Epigastric > Richters Ø Umbilical > Enterocoele Ø Incisional > Spigelion Ø Ventral > Obturator

Peritoneal Dialysis Hernias – risk factors v Raised intra-abdominal pressure v Female sex and

Peritoneal Dialysis Hernias – risk factors v Raised intra-abdominal pressure v Female sex and multiparity (no. of pregnancies) v Older age v Previous hernia v Polycystic kidney disease

Peritoneal Dialysis Hernias – clinical presentation v Painless or tender lump or swelling v

Peritoneal Dialysis Hernias – clinical presentation v Painless or tender lump or swelling v Bowel incarceration or strangulation v Peritonitis (transmural leakage of bacteria) Treatment: 1) Surgical repair 2) Reintroduce PD with low volumes, supine posture, increase volume over 2 weeks

Peritoneal Dialysis Genital Oedema v Occurs in up to 10% of patients v Mechanism:

Peritoneal Dialysis Genital Oedema v Occurs in up to 10% of patients v Mechanism: - fluid tracks through soft tissue plane in a hernia, catheter insertion site, peritoneal fascial defect, genital oedema associated with abdo wall oedema - patent processus vaginalis - males affected more than females v Diagnosis: - can be difficult - CT scan with contrast (100 -150 mls Omnipaque)

Peritoneal Dialysis continued…Genital Oedema Treatment: - bed rest - scrotal elevation if symptomatic -

Peritoneal Dialysis continued…Genital Oedema Treatment: - bed rest - scrotal elevation if symptomatic - low volume exchange/NIPD - stop PD temporarily - surgical repair if cause is hernia or patent processus vaginalis

Peritoneal Dialysis Infusion or Drainage Pain v CAUSES - constipation - jet effect -

Peritoneal Dialysis Infusion or Drainage Pain v CAUSES - constipation - jet effect - fluid p. H related v MANAGEMENT - laxatives - incomplete drainage - 1% lignocaine IP - slow infusion rate - Bicarbonate buffer - catheter replacement