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Post-operative Protocol and Maintenance of Function

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Surgical Aspects of Peritoneal Dialysis

Abstract

This chapter reviews optimum care of the peritoneal dialysis (PD) catheter from the immediate post-operative period to patient training and graduation to independent home PD. Early post-operative protocols for exit site care and flushing of the catheter are reviewed, and early use protocols are discussed. Common early catheter problems such as bleeding, obstruction, leakage and pain are reviewed in detail along with algorithmic approaches to these problems.

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References

  1. Gadahhah MF, Torres-Rivera C, Ramdeen G, et al. Relationship between intraperitoneal bleeding, adhesions, and peritoneal dialysis catheter failure: a method of prevention. Adv Perit Dial. 2001;17:127–9.

    Google Scholar 

  2. Piraino B, Bernardini J, Brown E, Figueiredo A, Johnson DW, Lye WC, Price V, Ramalakshmi S, Szeto CC. ISPD position statement on reducing the risks of peritoneal dialysis–related infections. Perit Dial Int. 2011;31(6):614–30.

    Article  CAS  PubMed  Google Scholar 

  3. Wallace E, Fissell RB, Golper TA, Blake PG, Lewin AM, Oliver MJ, Quinn RR. Catheter insertion and perioperative practices within the ISPD North American research consortium. Perit Dial Int. 2016;36(4):382–6. pdi-2015.

    Google Scholar 

  4. Dombros N, Dratwa M, Gokal R, Heimbürger O, Krediet R, Plum J, Rodrigues A, Selgas R, Struijk D, Verger C. European best practice guidelines for peritoneal dialysis. 3 Peritoneal access. Nephrol Dial Transplant. 2005;20:x8–ix12.

    Google Scholar 

  5. Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A, Chadha V, Yap HK, Schaefer F. Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int. 2012;32(Supplement 2):32–86.

    Article  Google Scholar 

  6. Twardowski ZJ, Prowant BF. Appearance and classification of healing peritoneal catheter exit sites. Perit Dial Int. 1996;16(3):S71.

    PubMed  Google Scholar 

  7. Twardowski ZJ, Prowant BF. Exit-site healing post catheter implantation. Perit Dial Int. 1996;16(Suppl 3):S51–70.

    PubMed  Google Scholar 

  8. Newman LN, Tessman M, Hanslik T, Schulak J, Mayes J, Friedlander M. A retrospective view of factors that affect catheter healing: four years of experience. Adv Perit Dial. 1993;9:217.

    CAS  PubMed  Google Scholar 

  9. Waite NM, Webster N, Laurel M, Johnson M, Fong IW. The efficacy of exit site povidone-iodine ointment in the prevention of early peritoneal dialysis-related infections. Am J Kidney Dis Off J National Kidney Foundation. 1997;29(5):763–8.

    CAS  Google Scholar 

  10. Luzar MA, Brown CB, Balf D, Hill L, Issad B, Monnier B, Moulart J, Sabatier JC, Wauquier JP, Peluso F. Exit-site care and exit-site infection in continuous ambulatory peritoneal dialysis (CAPD): results of a randomized multicenter trial. Perit Dial Int. 1990;10(1):25–9.

    CAS  PubMed  Google Scholar 

  11. Findlay A, Serrano C, Punzalan S, Fan SL. Increased peritoneal dialysis exit site infections using topical antiseptic polyhexamethylene biguanide compared to mupirocin: results of a safety interim analysis of an open-label prospective randomized study. Antimicrob Agents Chemother. 2013;57(5):2026–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Bernardini J, Bender F, Florio T, Sloand J, PalmMontalbano L, Fried L, Piraino B. Randomized, double-blind trial of antibiotic exit site cream for prevention of exit site infection in peritoneal dialysis patients. J Am Soc Nephrol. 2005;16(2):539–45.

    Article  CAS  PubMed  Google Scholar 

  13. Chu KH, Choy WY, Cheung CC, Fung KS, Tang HL, Lee W, Cheuk A, Yim KF, Chan WH, Tong KL. A prospective study of the efficacy of local application of gentamicin versus mupirocin in the prevention of peritoneal dialysis catheter-related infections. Perit Dial Int. 2008;28(5):505–8.

    PubMed  Google Scholar 

  14. Mahaldar A, Weisz M, Kathuria P. Comparison of gentamicin and mupirocin in the prevention of exit-site infection and peritonitis in peritoneal dialysis. Adv Perit Dial. 2009;25:56–9.

    PubMed  Google Scholar 

  15. Brown PA, McCormick BB, Knoll G, Su Y, Doucette S, Fergusson D, Lavoie S. Complications and catheter survival with prolonged embedding of peritoneal dialysis catheters. Nephrol Dial Transplant. 2008;23(7):2299–303.

    Article  PubMed  Google Scholar 

  16. Elhassan E, McNair B, Quinn M, Teitelbaum I. Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate. Perit Dial Int. 2011;31(5):558–64.

    Article  PubMed  Google Scholar 

  17. McCormick BB, Brown PA, Knoll G, Yelle JD, Page D, Biyani M, Lavoie S. Use of the embedded peritoneal dialysis catheter: experience and results from a North American center. Kidney Int. 2006;70:S38–43.

    Article  Google Scholar 

  18. Figueiredo A, Goh BL, Jenkins S, Johnson DW, Mactier R, Ramalakshmi S, Shrestha B, Struijk D, Wilkie M. Clinical practice guidelines for peritoneal access. Perit Dial Int. 2010;30(4):424–9.

    Article  PubMed  Google Scholar 

  19. Rodríguez-Palomares JR, Ruiz C, Granado A, Montenegro J. El acceso peritoneal. Guías de práctica clínica en diálisis peritoneal. Nefrologia. 2006;26(Suppl 4):1–184.

    PubMed  Google Scholar 

  20. Setyapranata S, Holt SG. The gut in older patients on peritoneal dialysis. Perit Dial Int. 2015;35(6):650–4.

    Article  CAS  PubMed  Google Scholar 

  21. Afsar B, Elsurer R, Bilgic A, Sezer S, Ozdemir F. Regular lactulose use is associated with lower peritonitis rates: an observational study. Perit Dial Int. 2010;30(2):243–6.

    Article  CAS  PubMed  Google Scholar 

  22. Mimidis K, Mourvati E, Kaliontzidou M, Papadopoulos V, Thodis E, Kartalis G, Vargemezis V. Efficacy of polyethylene glycol in constipated CAPD patients. Perit Dial Int. 2005;25(6):601–3.

    PubMed  Google Scholar 

  23. Jung GJ, Gil HW, Yang JO, Lee EY, Hong SY. Severe hypermagnesemia causing quadriparesis in a CAPD patient. Perit Dial Int. 2008;28(2):206.

    CAS  PubMed  Google Scholar 

  24. Weir MA, Fleet JL, Vinden C, Shariff SZ, Liu K, Song H, Jain AK, Gandhi S, Clark WF, Garg AX. Hyponatremia and sodium picosulfate bowel preparations in older adults. Am J Gastroenterol. 2014;109(5):686.

    Article  CAS  PubMed  Google Scholar 

  25. Harman G, McCormick BB. Hemorrhage because of amyloid-related factor X deficiency after insertion of tenckhoff catheter. Perit Dial Int. 2012;32(5):567–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Mital S, Fried LF, Piraino B. Bleeding complications associated with peritoneal dialysis catheter insertion. Perit Dial Int. 2004;24(5):478–80.

    PubMed  Google Scholar 

  27. Li JR, Chen CH, Chiu KY, Yang CR, Cheng CL, Ou YC, Ko JL, Ho HC. Management of pericannular bleeding after peritoneal dialysis catheter placement. Perit Dial Int. 2012;32(3):361–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Tzamaloukas AH, Gibel LJ, Eisenberg B, et al. Early and late peritoneal dialysate leaks in patients on CAPD. Adv Perit Dial. 1990;6:64–71.

    CAS  PubMed  Google Scholar 

  29. Rahim KA, Seidel K, McDonald RA. Risk factors for catheter-related complications in pediatric peritoneal dialysis. Pediatr Nephrol. 2004;19:1021–8.

    Article  PubMed  Google Scholar 

  30. Patel UD, Mottes TA, Flynn JT. Delayed compared with immediate use of peritoneal catheter in pediatric peritoneal dialysis. Adv Perit Dial. 2001;17:253–9.

    CAS  PubMed  Google Scholar 

  31. Liu Y, Zhang L, Lin A, Ni Z, Qian J, Fang W. Impact of break-in period on the short-term outcomes of patients started on peritoneal dialysis. Perit Dial Int. 2014;34(1):49–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Ghaffari A. Urgent-start peritoneal dialysis: a quality improvement report. Am J Kidney Dis. 2012;59(3):400–8.

    Article  PubMed  Google Scholar 

  33. Casaretto A, Rosario R, Kotzker WR, Pagan-Rosario Y, Groenhoff C, Guest S. Urgent-start peritoneal dialysis: report from a US private nephrology practice. Adv Perit Dial. 2011;28:102–5. Conference on Peritoneal Dialysis.

    Google Scholar 

  34. Povlsen JV, Ivarsen P. How to start the late referred ESRD patient urgently on chronic APD. Nephrology Dialysis Transplantation. 2006;21(Suppl 2):ii56–9.

    Google Scholar 

  35. Arramreddy R, Zheng S, Saxena AB, Liebman SE, Wong L. Urgent-start peritoneal dialysis: a chance for a new beginning. Am J Kidney Dis. 2014;63(3):390–5.

    Article  PubMed  Google Scholar 

  36. Voss D, Hawkins S, Poole G, Marshall M. Radiological versus surgical implantation of first catheter for peritoneal dialysis: a randomized non-inferiority trial. Nephrol Dial Transplant. 2012;27(11):4196–204.

    Article  PubMed  Google Scholar 

  37. Gadallah MF, Pervez A, El-Shahawy MA, Sorrells D, Zibari G, McDonald J, Work J. Peritoneoscopic versus surgical placement of peritoneal dialysis catheters: a prospective randomized study on outcome. Am J Kidney Dis. 1999;33(1):118–22.

    Article  CAS  PubMed  Google Scholar 

  38. Sharma AP, Mandhani A, Daniel SP, Filler G. Shorter break-in period is a viable option with tighter PD catheter securing during the insertion. Nephrology. 2008;13(8):672–6.

    Article  PubMed  Google Scholar 

  39. Sojo ET, Grosman MD, Monteverde ML, Bailez MM, Delgado N. Fibrin glue is useful in preventing early dialysate leakage in children on chronic peritoneal dialysis. Perit Dial Int. 2004;24(2):186–90.

    CAS  PubMed  Google Scholar 

  40. Alkatheeri AM, Blake PG, Gray D, Jain AK. Success of urgent-start peritoneal dialysis in a large Canadian renal program. Perit Dial Int. 2016;36(2):171–6.

    Article  PubMed  Google Scholar 

  41. Liu FX, Ghaffari A, Dhatt H, Kumar V, Balsera C, Wallace E, Khairullah Q, Lesher B, Gao X, Henderson H, LaFleur P. Economic evaluation of urgent-start peritoneal dialysis versus urgent-start hemodialysis in the United States. Medicine. 2014;93(28):e293.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Ghaffari A, Kumar V, Guest S. Infrastructure requirements for an urgent-start peritoneal dialysis program. Perit Dial Int. 2013;33(6):611–7.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Balaskas EV, Ikonomopoulos D, Sioulis A, et al. Survival and complications of 225 catheters used in continuous ambulatory peritoneal dialysis: one-center experience in Northern Greece. Perit Dial Int. 1999;19(Suppl 2):S167–71.

    PubMed  Google Scholar 

  44. Leblanc M, Ouimet D, Pichette V. Dialysate leaks in peritoneal dialysis. Semin Dial. 2001;14(1):50–4. Blackwell Science Inc.

    Google Scholar 

  45. Del Peso G, Bajo MA, Costero O, et al. Risk factors for abdominal wall complications in peritoneal dialysis patients. Perit Dial Int. 2003;23:249–54.

    PubMed  Google Scholar 

  46. Holley JL, Bernardini J, Piraino B. Characteristics and outcome of peritoneal dialysate leaks and associated infections. Adv Perit Dial. 1993;9:240–3.

    CAS  PubMed  Google Scholar 

  47. Gokal R, Alexander S, Ash S, et al. Peritoneal catheters and exit-site practices toward optimum peritoneal access: 1998 update. (Official report from the International Society for Peritoneal Dialysis). Perit Dial Int. 1998;18:11–33.

    CAS  PubMed  Google Scholar 

  48. Crabtree JH. Selected best demonstrated practices in peritoneal dialysis access. Kidney Int. 2006;70:S27–37.

    Article  Google Scholar 

  49. Kolesnyk I, Dekker FW, Boeschoten EW, Krediet RT. Time-dependent reasons for peritoneal dialysis technique failure and mortality. Perit Dial Int. 2010;30(2):170–7.

    Article  PubMed  Google Scholar 

  50. Ponce SP, Pierratos A, Izatt S, et al. Comparison of the survival and complications of three permanent peritoneal dialysis catheters. Perit Dial Bull. 1982;2:82–6.

    Google Scholar 

  51. Diaz-Buxo JA, Geissinger WT. Single cuff versus double cuff Tenckhoff catheter. Perit Dial Bull. 1984;4:S100–2.

    Google Scholar 

  52. Moss JS, Minda SA, Newman GE, Dunnick NR, Vernon WB, Schwab SJ. Malpositioned peritoneal dialysis catheters: a critical reappraisal of correction by stiff-wire manipulation. Am J Kidney Dis. 1990;15(4):305–8.

    Article  CAS  PubMed  Google Scholar 

  53. Swartz R, Messana J, Rocher L, et al. The curled catheter: dependable device for percutaneous peritoneal access. Perit Dial Int. 1990;10:231–5.

    CAS  PubMed  Google Scholar 

  54. Kappel JE, Ferguson GMC, Kudel RM, et al. Stiff wire manipulation of peritoneal dialysis catheters. In: Khanna R, editor. Advances in peritoneal dialysis, vol. 12. Toronto: Peritoneal Dialysis Publications; 1996. p. 223–6.

    Google Scholar 

  55. Diaz-Buxo JA. Peritoneal dialysis catheter malfunction due to compartmentalization. Perit Dial Int. 1997;17:209–10.

    CAS  PubMed  Google Scholar 

  56. Hills BA, Birch S, LaMont AC. Spatial distribution of dialysate in patients and its implications to intradialysate diffusion. Perit Dial Int. 2002;22(6):698–704.

    PubMed  Google Scholar 

  57. Ersoy FF, Twardowski ZJ, Satalowich RJ, Ketchersid T. A retrospective analysis of catheter position and function in 91 CAPD patients. Perit Dial Int. 1994;14:409–10.

    CAS  PubMed  Google Scholar 

  58. Zorzanello MM, Fleming WJ, Prowant BE. Use of tissue plasminogen activator in peritoneal dialysis catheters: a literature review and one center’s experience. Nephrol Nurs J. 2004;31:534–7.

    PubMed  Google Scholar 

  59. Shea M, Hmiel SP, Beck AM. Use of tissue plasminogen activator for thrombolysis in occluded peritoneal dialysis catheters in children. Adv Perit Dial. 2001;17:249–52.

    CAS  PubMed  Google Scholar 

  60. Scanziani R, Dozio B, Baragetti I, Maroni S. Intraperitoneal hydrostatic pressure and flow characteristics of peritoneal catheters in automated peritoneal dialysis. Nephrol Dial Transplant. 2003;18(11):2391–8.

    Article  PubMed  Google Scholar 

  61. Kappel JE, Ferguson GM, Kudel RM, Kudel TA, Lawlor BJ, Pylypchuk GB. Stiff wire manipulation of peritoneal dialysis catheters. Adv Perit Dial. 1995;11:202–7.

    CAS  PubMed  Google Scholar 

  62. Simons ME, Pron G, Voros M, Vanderburgh LC, Rao PS, Oreopoulos DG. Fluoroscopically-guided manipulation of malfunctioning peritoneal dialysis catheters. Perit Dial Int. 1999;19(6):544–9.

    CAS  PubMed  Google Scholar 

  63. Diaz-Buxo JA, Turner MW, Nelms M. Fluoroscopic manipulation of Tenckhoff catheters: outcome analysis. Clin Nephrol. 1997;47(6):384–8.

    CAS  PubMed  Google Scholar 

  64. Savader SJ, Lund G, Scheel PJ, et al. Guide wire directed manipulation of malfunctioning peritoneal dialysis catheters: a critical analysis. J Vasc Interv Radiol. 1997;8:957–63.

    Article  CAS  PubMed  Google Scholar 

  65. Plaza MM, Rivas MC, Domínguez–Viguera L. Swan-neck S. Fluoroscopic manipulation is also useful for malfunctioning swan-neck peritoneal catheters. Perit Dial Int. 2001;21:193–7.

    Google Scholar 

  66. Miller M, McCormick B, Lavoie S, Biyani M, Zimmerman D. Fluoroscopic manipulation of peritoneal dialysis catheters: outcomes and factors associated with successful manipulation. Clin J Am Soc Nephrol. 2012;7(5):795–800.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Kwon YH, Kwon SH, Oh JH, Jeong KH, Lee TW. Fluoroscopic guide wire manipulation of malfunctioning peritoneal dialysis catheters initially placed by Interventional Radiologists. J Vasc Interv Radiol. 2014;25(6):904–10.

    Article  PubMed  Google Scholar 

  68. Santarelli S, Zeiler M, Marinelli R, Monteburini T, Federico A, Ceraudo E. Videolaparoscopy as rescue therapy and placement of peritoneal dialysis catheters: a thirty-two case single centre experience. Nephrol Dial Transplant. 2006;21(5):1348–54.

    Article  PubMed  Google Scholar 

  69. Yilmazlar T, Kirdak T, Bilgin S, Yavuz M, Yurtkuran M. Laparoscopic findings of peritoneal dialysis catheter malfunction and management outcomes. Perit Dial Int. 2006;26(3):374–9.

    PubMed  Google Scholar 

  70. Skipper K, Dickerman R, Dunn E. Laparoscopic placement and revision of peritoneal dialysis catheters. JSLS. 1999;3(1):63–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  71. Brandt CP, Ricanati ES. Use of laparoscopy in the management of malfunctioning peritoneal dialysis catheters. Adv Perit Dial. 1996;12:223–6.

    CAS  PubMed  Google Scholar 

  72. Gudsoorkar PS, Penner T, Jassal SV, Bargman JM. The enigmatic fallopian tube: a more common cause of catheter malfunction than previously recognized. Perit Dial Int. 2016;36(4):459–61.

    Article  PubMed  Google Scholar 

  73. Twardowski ZJ, Prowant BF, Nichols WK, et al. Six-year experience with swan neck catheters. Perit Dial Int. 1992;12:384–9.

    CAS  PubMed  Google Scholar 

  74. Twardowski ZJ, Nichols WK. Peritoneal dialysis access and exit-site care including surgical aspects. In: Gokal R, Khanna R, Krediet R, Nolph KD, editors. Textbook of peritoneal dialysis. 2nd ed. Dordrecht: Kluwer Academic Publishers; 2000. p. 307–61.

    Chapter  Google Scholar 

  75. Rippe B, Simonsen O, Wieslander A, et al. Clinical and physiological effects of a new, less toxic and less acidic fluid for peritoneal dialysis. Perit Dial Int. 1997;17:27–34.

    CAS  PubMed  Google Scholar 

  76. Blake P. Drain pain, overfill, and how they are connected. Perit Dial Int. 2014;34(4):342–4.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Juergensen PH, Murphy AL, Pherson KA, et al. Tidal peritoneal dialysis to achieve comfort in chronic peritoneal dialysis patients. Adv Perit Dial. 1999;15:125–6.

    CAS  PubMed  Google Scholar 

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Correspondence to Brendan McCormick MD, FRCPC .

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McCormick, B. (2017). Post-operative Protocol and Maintenance of Function. In: Haggerty, S. (eds) Surgical Aspects of Peritoneal Dialysis. Springer, Cham. https://doi.org/10.1007/978-3-319-52821-2_11

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  • DOI: https://doi.org/10.1007/978-3-319-52821-2_11

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