1 / 20

PD Access

PD Access. Peritoneal Catheters. PD catheter is patients lifeline Several advances have made access safer and longer lasting Successful outcome is dependent on meticulous care and attention to detail

colette-garner
Download Presentation

PD Access

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PD Access

  2. Peritoneal Catheters • PD catheter is patients lifeline • Several advances have made access safer and longer lasting • Successful outcome is dependent on meticulous care and attention to detail • Adherence to principles of catheter insertion and subsequent management and care remain the cornerstone of successful PD access

  3. The ideal PD Catheter • Rapid rate of dialysate flow • Minimal or no - leaks - migration - exit and tunnel infections - peritonitis • Ease of insertion by all techniques • Long lasting • Inert material - durability - resistant ot infection/biofilm - antimicrobial properties

  4. Peritoneal Catheters and Exit Site Practices - Towards Optimum Peritoneal Access - 1998 Update Gokal R et al Perit Dial Int 1998;18:11-33

  5. Peritoneal Catheters and Exit Site Practices Areas Covered • Peritoneal Catheters • Catheter Choice and Catheter Outcomes • Catheter Insertion • Immediate post - operative care • Chronic care of healed exit-site

  6. Peritoneal Catheters Intraperitoneal Segment Straight Coiled Silicone discs T-fluted Subcutaneous Tract straight permanent bend - Swan-neck/Missouri Swan-neck presternal Anchorage Dacron cuffs Bead-and-flange - Swan-neck

  7. P Currently available chronic peritoneal catheters Gokal et al PDI 1998;18:11-33

  8. Catheter Insertion • Prevention of complications begins with the decision to place a patient on peritoneal dialysis

  9. Appropriate candidates • Motivated ESRD patient • Patient support – family, carer, etc • Ability to understand and use sterile technique • Physical capability • Ideal candidate would have no prior abdominal procedures

  10. EARLY Leak Obstruction to flow Bleeding Infection Intestinal perforation Inability to insert catheter LATE Obstruction to flow Hernia Hydrothorax Peritonitis Exit-site erosion / infection Other surgical problems * diverticulitis * cholecystitis Insertion Complications

  11. Catheter Insertion • Who should place the PD catheter? The Surgeon!

  12. Communication is Essential Surgeon Nephrologist Nurse

  13. Peritoneal Catheters Outcome in relation to exit direction • Downward directed exit site recommended • Golper T et al AJKD 1996;38:428-36 - 38% decreased risk of peritonitis associated with ESI • USRDS 1996 Report - peritonitis less with permanent bent catheter

  14. Peritoneal Catheters Outcome in relation to number of cuffs RECOMMENDATIONS • Double cuffed catheters should be used for chronic peritoneal dialysis • USRDS 1992 , Warady 1996, Honda 1996 - single cuff associated with shorter time to first peritonitis • Linblad et al PDI 1988;8:129-33 and Favazza et al PDI 1995;15:357-62 - more frequent exit site complications and shorter survival times for single cuff • Eklund et al NDT 1997;12:2664-6 - no difference between single or double cuffs (RCT)

  15. Catheter Choice and Outcomes RECOMMENDATIONS • Catheter survival of >80% at one year desirable • Double cuffed catheter preferred to single cuff • Downward directed exit-site decreases the risk of catheter related infections (advantage being its- preformed arcuate bend) • No catheter appears to be superior to the 2 cuff standard Tenckhoff catheter - experience with swan-neck catheters is promising.

  16. Catheter Insertion PRE-IMPLANTATION PREPARATION • Fully inform patient of details of procedure • Pre-surgical assessment (e.g. hernias) • Determination of exit-site • Skin preparation • Bowel preparation • Prophylactic antibiotics - Evidence suggests that peri-op antibiotics diminishes wound infection

  17. Catheter Implantation Techniques RECOMMENDATIONS • Implantation to be performed by competent, experienced operator, in a planned manner. Care and attention to detail is important • Peritoneal entry - lateral or paramedian • Deep cuff - placed in musculature of anterior abdominal wall or within posterior rectus fascia. • Subcutaneous cuff - 2cm from exit site • Catheter patency needs checking • Exit-site facing downward or laterally

  18. A Healthy Exit Site

  19. Immediate Post Operative Care AIMS • Minimise bacterial colonisation • Prevent trauma to exit-site and traction on cuffs • Minimise intra-abdominal pressure to prevent leakage • Several approaches to post operative care • No evidence to support superiority of any one RECOMMENDATIONS • Minimise catheter movement • Minimise catheter handling until healing of wound and tract - 3-4 weeks

  20. Post implantation Dialysis RECOMMENDATIONS • Flush catheter with small volumes (e.g. 500ml) until effluent is clear • Starting CAPD depends on type of implantation technique - generally catheter should be capped for 2 weeks before starting PD • PD in the interim should be - intermittent - small volumes - gradual increase in volume - patient in a supine position

More Related