CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva -...
Transcript of CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva -...
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CA S E:
DiagnosisM anagem entofDysfunctionalP D Catheter
BharatS achdevaM DL S U S hreveport
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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
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Case
• W hatdow edonext?
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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
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Constipation
www.medicine.cu.edu.eg5
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BristolS toolChart
6 http://en.w ikipedia.org/w iki/Bristol_stool_chart
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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?
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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
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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.
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Flow P roblem sw ithP D Catheter
• O utflow :
– Constipation
– L eakage
– CatheterM igration
– CatheterW rap
– CatheterKink
– Fibrin
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Fibrin
11
VageliP A,FreiseCE.Fibrinplug.Kidney Int2010;78:942.
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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.
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M anagem ent
• Constipation
– useoflaxativesand enem a’s
• S uspectedfibrinorbloodclot
– forcefulflushingofthecatheter
– anticoagulantintodialysate
– tissueplasm inogenactivator(T P A)packingofcatheterlum en
13
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Case
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M alpositionP D Catheter
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Case
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Case
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Case
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Flow P roblem sw ithP D Catheter
• O utflow :
– Constipation
– L eakage
– CatheterM igration
– CatheterW rap
– CatheterKink
– Fibrin
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Case