CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva -...

CA S E:

DiagnosisM anagem entofDysfunctionalP D Catheter

BharatS achdevaM DL S U S hreveport

Case

• 36 yroldm alestartedP D 3 m onthsago.HasbeenhavingP D cycleralarm sw ithpoordrainforthepast1 w eek.Hehastriedm anualexchangesasw ell,fillsslow,reportsnopain,theoutflow ispoorandhetakes45 m intodrainthefluid.

• P hysical:VitalsW N L ,unrem arkablephysicalexam except1+ edem a.Catheternoinfection,nosignofdam agetothecatheter

Case

• W hatdow edonext?

Case

• 36 yroldm alestartedP D 3 m onthsago.HasbeenhavingP D cycleralarm sw ithpoordrainforthepast1 w eek.Hehastriedm anualexchangesasw ell,fillsslow,reportsnopain,theoutflow ispoorandhetakes45 m intodrainthefluid.

• P hysical:VitalsW N L ,unrem arkablephysicalexam except1+ edem a.Catheternoinfection,nosignofdam agetothecatheter

Constipation

www.medicine.cu.edu.eg5

BristolS toolChart

6 http://en.w ikipedia.org/w iki/Bristol_stool_chart

Case

• P atientreportedconstipationw ithaveragebow elm ovem ent1 in2-3 days.

• L axativesstarted,2-3 bow elsaday last3 days

• N ochangeinP D catheterfunction,m achinealarm sunchanged

• W hat’snext?

Case

1. L aparoscopicrevisionofP D catheter

2. Fluoroscopicrevisionofcatheter

3. CT S canabdom en

4. KU B

5. R em oveP D catheter

6. N oneoftheabove

P D M O DAL IT Y FAIL U R E

Mujais S, Story K. Peritoneal dialysis in the US: Evaluation of outcomes incontemporary cohorts. Kid ney Int2006;70 [Suppl 103]:S21-S26.

Flow P roblem sw ithP D Catheter

• O utflow :

– Constipation

– L eakage

– CatheterM igration

– CatheterW rap

– CatheterKink

– Fibrin

Fibrin

11

VageliP A,FreiseCE.Fibrinplug.Kidney Int2010;78:942.

Fibrin:U seofT issueP lasm inogenActivator

12

ZorzanelloM M ,Flem ingW J,P row antBF.U seoftissueplasm inogenactivatorinperitonealdialysiscatheters:aliteratuarereview andonecenter’sexperience.N ephrolN ursJ2004;31:534-537.

M anagem ent

• Constipation

– useoflaxativesand enem a’s

• S uspectedfibrinorbloodclot

– forcefulflushingofthecatheter

– anticoagulantintodialysate

– tissueplasm inogenactivator(T P A)packingofcatheterlum en

13

Case

M alpositionP D Catheter

Case

Case

Case

Flow P roblem sw ithP D Catheter

• O utflow :

– Constipation

– L eakage

– CatheterM igration

– CatheterW rap

– CatheterKink

– Fibrin

Case