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
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
Case
• W hatdow edonext?
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
Constipation
www.medicine.cu.edu.eg5
BristolS toolChart
6 http://en.w ikipedia.org/w iki/Bristol_stool_chart
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?
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
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.
Flow P roblem sw ithP D Catheter
• O utflow :
– Constipation
– L eakage
– CatheterM igration
– CatheterW rap
– CatheterKink
– Fibrin
Fibrin
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VageliP A,FreiseCE.Fibrinplug.Kidney Int2010;78:942.
Fibrin:U seofT issueP lasm inogenActivator
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ZorzanelloM M ,Flem ingW J,P row antBF.U seoftissueplasm inogenactivatorinperitonealdialysiscatheters:aliteratuarereview andonecenter’sexperience.N ephrolN ursJ2004;31:534-537.
M anagem ent
• Constipation
– useoflaxativesand enem a’s
• S uspectedfibrinorbloodclot
– forcefulflushingofthecatheter
– anticoagulantintodialysate
– tissueplasm inogenactivator(T P A)packingofcatheterlum en
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Case
M alpositionP D Catheter
Case
Case
Case
Flow P roblem sw ithP D Catheter
• O utflow :
– Constipation
– L eakage
– CatheterM igration
– CatheterW rap
– CatheterKink
– Fibrin
Case