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Non-Infectious Complications

Non-Infectious Complications. Non-infectious Catheter Complications. Inflow/outflow obstruction Hernia Leakage. Increased Intra-Abdominal Pressure. Instillation of dialysate into the peritoneal cavity leads to increased intra-abdominal pressure The magnitude of the increase depends upon:

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Non-Infectious Complications

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  1. Non-Infectious Complications

  2. Non-infectious Catheter Complications • Inflow/outflow obstruction • Hernia • Leakage

  3. 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. 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. 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. 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

  7. Fluid Leak - CT Cannulogram

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

  12. 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. 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 (100-150mls Omnipaque)

  14. 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. 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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