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

21
CA S E: DiagnosisM anagementof DysfunctionalP DCatheter BharatSachdevaM D LSU Shreveport

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

Page 1: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

CA S E:

DiagnosisM anagem entofDysfunctionalP D Catheter

BharatS achdevaM DL S U S hreveport

Page 2: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

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

Page 3: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

Case

• W hatdow edonext?

Page 4: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

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

Page 5: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

Constipation

www.medicine.cu.edu.eg5

Page 6: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

BristolS toolChart

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

Page 7: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

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?

Page 8: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

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

Page 9: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

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.

Page 10: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

Flow P roblem sw ithP D Catheter

• O utflow :

– Constipation

– L eakage

– CatheterM igration

– CatheterW rap

– CatheterKink

– Fibrin

Page 11: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

Fibrin

11

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

Page 12: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

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.

Page 13: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

M anagem ent

• Constipation

– useoflaxativesand enem a’s

• S uspectedfibrinorbloodclot

– forcefulflushingofthecatheter

– anticoagulantintodialysate

– tissueplasm inogenactivator(T P A)packingofcatheterlum en

13

Page 14: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017
Page 15: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

Case

Page 16: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

M alpositionP D Catheter

Page 17: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

Case

Page 18: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

Case

Page 19: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

Case

Page 20: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

Flow P roblem sw ithP D Catheter

• O utflow :

– Constipation

– L eakage

– CatheterM igration

– CatheterW rap

– CatheterKink

– Fibrin

Page 21: CAS E: DiagnosisM anagementof DysfunctionalP D …...Microsoft PowerPoint - 7 - PPC - Sachdeva - Diagnosis Management of Dysfunctional PD Catheter.pptx Author lfox Created Date 2/23/2017

Case