peritoneal dialysis peritoneal dialysis kampol pattanasombatsakul

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  • Slide 1
  • Slide 2
  • Peritoneal Dialysis Peritoneal Dialysis Kampol Pattanasombatsakul
  • Slide 3
  • Peritoneum: 1-1.3 m 2 Visceral: 90% Visceral: 90% Parietal: 10% Parietal: 10% Peritoneal cavity Potential space Potential space 10-100 ml 10-100 ml Vascular supply
  • Slide 4
  • Slide 5
  • Peritoneal Dialysis Peritoneal Dialysis
  • Slide 6
  • Prepare unit for PD patients Personal (Team) Personal (Team) Nephrologist, Surgeon Nephrologist, Surgeon Nurse, on call nurse Nurse, on call nurse Other Other Equipment Equipment In unit : washing basin, dressing set, catheter, connector, dialysis set, In unit : washing basin, dressing set, catheter, connector, dialysis set, At home : washing basin, storage, clean towel, weight At home : washing basin, storage, clean towel, weight Management Management Education tools Education tools Data management, Statistic Data management, Statistic First visit, hospitalization, First visit, hospitalization,
  • Slide 7
  • Home Care therapy : benefit to Persons involved in dialysis care team Patient Family physician Nephrologist Nurse & colleges Technicians Social workers NutritionistRehabilitationCo-workerRelatives
  • Slide 8
  • Prepare unit for PD patients Personal Personal Nephrologist, Surgeon Nephrologist, Surgeon Nurse, on call nurse Nurse, on call nurse Other Other Equipment Equipment In unit : washing basin, dressing set, catheter, connector, dialysis set, In unit : washing basin, dressing set, catheter, connector, dialysis set, At home : washing basin, storage, clean towel, weight At home : washing basin, storage, clean towel, weight Management Management Education tools Education tools Data management, Statistic Data management, Statistic First visit, hospitalization, First visit, hospitalization,
  • Slide 9
  • Different PD catheters Straight 1 cuffStraight 2 cuffs Coiled Tenckhoff catheters Coiled 1 cuffCoiled 2 cuffs Swan Neck Tenckhoff catheters Straight Coiled Downwards directed exit site Permanent bend between 2 cuffs (180) Right or left Swan Neck Missouri Straight Coiled Bead placed IP, Flange extraP Straight Tenckhoff catheters
  • Slide 10
  • Prepare unit for PD patients Personal Personal Nephrologist, Surgeon Nephrologist, Surgeon Nurse, on call nurse Nurse, on call nurse Other Other Equipment Equipment In unit : washing basin, dressing set, catheter, connector, dialysis set, In unit : washing basin, dressing set, catheter, connector, dialysis set, At home : washing basin, storage, clean towel, weight At home : washing basin, storage, clean towel, weight Management Management Education tools Education tools Data management, Statistic Data management, Statistic First visit, hospitalization, First visit, hospitalization,
  • Slide 11
  • Education tool CKD, kidney function CKD, kidney function Catheter care and aseptic technique Catheter care and aseptic technique Dialysis exchange Dialysis exchange Fluid and nutritional balance Fluid and nutritional balance Record Record Complication Complication Medication Medication Follow up Follow up
  • Slide 12
  • Select the patients Not suitable for PD Not suitable for PD Skin disease over abdomen Skin disease over abdomen Serious abdominal surgery Serious abdominal surgery Malnourish : S. albumin Malnourish : S. albumin Large BSA > 2.0 Large BSA > 2.0 Very low GFR < 2 ml/min Very low GFR < 2 ml/min Abdominal anatomical defect Abdominal anatomical defect ? COPD ? COPD ? Diabetic ? Diabetic
  • Slide 13
  • Theoretically not to choose PD initially BUT PD may be feasible with added adjustments Large body size Large body size Diverticulosis / diverticulitis Diverticulosis / diverticulitis Severe backacheNIPD Severe backacheNIPD HerniasNIPD HerniasNIPD Multiple abdominal surgery Multiple abdominal surgery Poor manual dexterity Poor manual dexterity Blindness Blindness No compliance No compliance
  • Slide 14
  • PD preferred Bleeding diathesis (no need of heparinization) Bleeding diathesis (no need of heparinization) Diabetes (status of vessels, insulin i.p.) Diabetes (status of vessels, insulin i.p.) Chronic infections (prevention of the nosocomial spread hepatitis B, C, HIV) Chronic infections (prevention of the nosocomial spread hepatitis B, C, HIV) Future transplantation (improved initial graft function rate) Future transplantation (improved initial graft function rate) Multiple myeloma (improves the chances of renal recovery, removes some light-chains proteins) Multiple myeloma (improves the chances of renal recovery, removes some light-chains proteins)
  • Slide 15
  • PD and HD equally preferred Polycystic kidney disease Polycystic kidney disease Scleroderma, other conective tissue diseases (e.g. SLE) Scleroderma, other conective tissue diseases (e.g. SLE) Patients living in nursing homes Patients living in nursing homes
  • Slide 16
  • Psychosocial situations in which PD is more appropriate PD preferred Independent Life Independent Life Frequent travels Frequent travels Tendency towards PD Great need of independence by the patient Need to maintain work Distance to the HD center
  • Slide 17
  • Prepare the patients Who choose method of renal replacement therapy ? Who choose method of renal replacement therapy ? Who will take care the patients? Who will take care the patients? Uremic symptoms Uremic symptoms Volume balance Volume balance Compliance Compliance Socioeconomic and hygiene status Socioeconomic and hygiene status
  • Slide 18
  • CAPD for a new patient Patient education Patient education Patient training program Patient training program Catheter placement Catheter placement Break in period & training time Break in period & training time Peritoneal testing Peritoneal testing Mode of Dialysis Mode of Dialysis
  • Slide 19
  • Patient Education . . . . .
  • Slide 20
  • Patient training program Hand wash Hand wash Basic sterile technique Basic sterile technique Exchange procedure Exchange procedure ( exit site care ) ( exit site care )
  • Slide 21
  • Catheter placement Pre operative preparation Pre operative preparation Ideal location should be mark by team Ideal location should be mark by team Free of constipation Free of constipation Controversy : nose culture for S. aureus nasal carrier, if positive, 5-day course intranasal mupirocin will be used. Controversy : nose culture for S. aureus nasal carrier, if positive, 5-day course intranasal mupirocin will be used. Operative Operative Prophylaxis ABO (evidence): 1 st generation cephalosporin ( randomized control : vancomycin 1 gm iv, single dose is superior than cephalosporin ) ( odd ratio 11.5 : 6.45 : 1) Prophylaxis ABO (evidence): 1 st generation cephalosporin ( randomized control : vancomycin 1 gm iv, single dose is superior than cephalosporin ) ( odd ratio 11.5 : 6.45 : 1) Using Double cuff with superficial cuff should be 2-3 cm. from the exit site Using Double cuff with superficial cuff should be 2-3 cm. from the exit site Downward direct tunnel Downward direct tunnel Swan neck catheter ( not confirm ) Swan neck catheter ( not confirm ) Avoid trauma and hematoma during catheter placement Avoid trauma and hematoma during catheter placement Suture increase risk of infection and are contraindicate Suture increase risk of infection and are contraindicate Peritoneal Dialysis-Related Infections Recommendations : 2005 update PDI 2005: 25(2) ; 107-131
  • Slide 22
  • Peritoneal catheter Exit site Cuffs
  • Slide 23
  • Slide 24
  • Post operative care Pain management Pain management Antibiotic Antibiotic Break in period : rinse peritoneum Break in period : rinse peritoneum ? Dialysis need ? Dialysis need Consider HD first Consider HD first Hospitalization Hospitalization Training review, catheter exchange system Training review, catheter exchange system
  • Slide 25
  • Immediate post operative state Perioperative pain Perioperative pain Bloody effluent Bloody effluent Dialysate leakage Dialysate leakage Displacement Displacement Perioperative peritonitis Perioperative peritonitis Temporary obstruction Temporary obstruction Cuff extrusion Cuff extrusion
  • Slide 26
  • Perioperative pain Wound pain Wound pain Catheter related pain reaction, location Catheter related pain reaction, location In flow pain dialysate related In flow pain dialysate related Management Management Adequate analgesic during operation and post operative period Adequate analgesic during operation and post operative period Pseudo ascites during catheter insertion Pseudo ascites during catheter insertion No guide-wire / smooth catheter insertion No guide-wire / smooth catheter insertion Slow infusion / low volume Slow infusion / low volume Non osmotic dialysate solution Non osmotic dialysate solution Warm dialysate Warm dialysate Immediate post operative state
  • Slide 27
  • Bloody Effluent Bleeding complication during surgical procedure Bleeding complication during surgical procedure Bleeding tendency in end stage renal disease Bleeding tendency in end stage renal disease Thrombocytopenia Thrombocytopenia Management Management Rinse peritoneal cavity until clear Rinse peritoneal cavity until clear Add heparin 500-1000 unit / L in last bag dialysate Add heparin 500-1000 unit / L in last bag dialysate Correction of bleeding

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