peritoneal dialysis complications management

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Peritoneal dialysis complications management. PD complications. Infection Mechanical Volume overload. Infection. Flush before fill. 1. 2. 3. Infectious complications. Peritonitis. Exit site infection. การติดเชื้อในช่องท้อง. - PowerPoint PPT Presentation

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Peritoneal dialysis

Peritoneal dialysis complications managementPD complicationsInfectionMechanicalVolume overloadInfection

Flush before fill

1

2

3Infectious complications

Exit site infectionPeritonitis

9 International Society For Peritoneal Dialysis (ISPD) .. 2553 - 0.67 1 18 .. 2554 - 0.47 1 25.5

Intraluminal route (Touch contamination)Periluminal routeEnteric route (transmural migration) Hematogenous spread Gynecological route

Intraluminal route (Touch contamination) transfer - Coagulase negative Staphylococcus - Diptheroid spp. - Corynebacterium spp. - Bacillus spp. 2. Periluminal route Tenckhoff biofilm Tenckhoff - Staphylococcus aureus - Pseudomonas spp. 3. Enteric route (transmural migration) diverticulitis Klebsiella spp., Enterobacter spp. Proteus spp. Enterococcus spp. Bacteroides fragilis

4. Hematogenous spread - - Streptococcus spp. 5. Gynecological route Lactobaciilus Neisseria spp.

2 3 rebound tenderness (cloudy effluent) 100 /. neutrophil 50 dialysate cell count 10% providone iodine

1. (large volume) 50 3000 15 solid media hemoculture

2. (bedside) (connecting part) 30 hemoculture 10 2

Streptococcus spp. Enterococcus ampicillin 125 ./. aminoglycoside combination therapy 5 Streptococcus 14 Enterococcus 21

penicillin vancomycin vancomycin quinupristin/daflopristin), linezolid, daptomycin

Staphylococcus aureus Cefazolin MSSA 5 21

methicillin (MRSA) 2 vancomycin, teicoplanin clindamycin rifampicin 600 . 5-7 Pseudomonas spp.Strenotrophomonas spp. E. Coli, Proteus spp., Klebsiella spp. eftazidime, sulperazon, cefpirome, cefepime, aztreonam, piperacillin, meropenam, imipenem/cilastin, netilmicin amikacin quinolone trimethoprim/ sulfamethoxazole 21 21-28 14-21 cephalosporin ceftazidime, cefepime 5

3 14 , Legionella, Mycoplasma, Mycobacteria 14 5 14

Tenckhoff 1. 5 (Refractory peritonitis)2. 4 (Relapsing or recurrent peritonitis)3. Chronic Exit site infection tunnel infection peritonitis (Refractory catheter related peritonitis)4. Fungal peritonitis

2. (work instruction: WI) . . peritonitis catheter-related infection . . 3

3. 4. Flush before fill5. PD

6. 7. PD WI Mechanical complicationsMechanical complicationsCatheterHerniasDialysate leaksCatheter1. (Malposition)2. (Kinking) 3. Entrapment1. Catheter Malposition rectovesical pouch () rectouterine pouch ()

2. (Kinking)

3. Catheter Entrapment

HerniaUmbilicus herniaInguinal hernia 1 CAPD

Dialysate leaks Volume overload (volume overload)Pleural effusionAscites

volume overloadIntake (salt,water) , urine output Non-complianceMechanical problems (malposition, entrapment, leak)Membrane Intake 2

Non-compliance

adequate dialysis dose

volume overloadPlain film abdomen- AP, lateral Peritoneal Equilibration Test :PETObtaining patient samples 1. PET 8-12

2. 25

2.5%Dextrose 200 ml/min 2 400 ml 2 10

200 ml 2-3 - 10 ml (zero sample) (190 ml) Peritoneal Equilibration Test :PET 2 200 ml 2-3 10 ml (190 ml) (2 hr.dwell sample) (clot blood) 5 ml

6. 4 2-3 10 ml (4 hr.sample)

Peritoneal Equilibration Test :PET glucose creatinine

Peritoneal Equilibration Test :PET

Peritoneal Equilibrium TestTwardowski et al PDI 1987D/Do glucoseD/P creatinineUltrafiltration

UF failure PD 4.25% 4 400 . PD 2.5% 4 100 .

UF failure classificationType I-high PET statusRapid loss of osmotic gradientType II-low PET statusInadequate peritoneal surface area or membrane sclerosisType III-any PET status -Excessive lymphatic absorptionType IV-any PET statusAQP deficiency, no Na sieving

Type 1 UF failureType 2 UF failureType 3 UF failureType 4 UF failureEncapsulated peritoneal sclerosis (EPS)Bowel enveloped by thick fibrous tissue causing obstructionRare (about 2-3%) but severeCause: unknownRisk: time of PD(> 8 ) , peritonitis Treatment: surgery, dialysis

High transporter - dwell time, cycle - glucose concentration dialysate : 2.5%, 4.25% - NIPD, DAPD, CIPD - 7.5% Icodextrin - Hybrid RRT: Combined HD+PDHigh average transporter - NIPD, CIPD, TPD - 7.5% IcodextrinLow average transporter - High dose CAPD, long dwell timeLow transporter -

volume, dwell time UF fialure PET PD 5. NSAIDS, aminoglycoside radiocontrast ACEI/ARB 6. PD UF failure Encapsulated peritoneal sclerosis (EPS)7. 8. 9.

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