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Peritoneal Dialysis Non-Infectious Complications.

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Presentation on theme: "Peritoneal Dialysis Non-Infectious Complications."— Presentation transcript:

1 Peritoneal Dialysis Non-Infectious Complications

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

3 Peritoneal Dialysis Increased Intra-Abdominal Pressure  Instillation of dialysate into the peritoneal cavity leads to increased intra-abdominal pressure  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)

4 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)

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

6 Peritoneal Dialysis 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 Dialysate Leaks

7 Peritoneal Dialysis Fluid Leak - CT Cannulogram

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

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

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

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

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

13 Peritoneal Dialysis Genital Oedema  Occurs in up to 10% of patients  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  Diagnosis: - can be difficult - CT scan with contrast ( mls Omnipaque)

14 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

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

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