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peritoneal access and exit site care

Susan Bridger
Providing care and education for a patient on peritoneal dialysis (PD) requires that the nephrology nurse have knowledge and expertise in the PD access. This article provides information on types and placement of PD catheters, pre-placement and post-placement education and care, how to assess PD catheter exit site healing, and initial use of the PD catheter for access.
September 2017: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
John H Crabtree, Kai-Ming Chow
The success of peritoneal dialysis as renal-replacement therapy depends on a well-functioning peritoneal catheter. Knowledge of best practices in catheter insertion can minimize the risk of catheter complications that lead to peritoneal dialysis failure. The catheter placement procedure begins with preoperative assessment of the patient to determine the most appropriate catheter type, insertion site, and exit site location. Preoperative preparation of the patient is an instrumental step in facilitating the performance of the procedure, avoiding untoward events, and promoting the desired outcome...
January 2017: Seminars in Nephrology
Thomas A Forbes, Loren Shaw, Catherine Quinlan
International guidelines in peritoneal dialysis (PD) advocate for regular application of topical mupirocin in chronic PD exit-site care. A strong evidence base links this treatment to reduced rates of exit-site infections and peritonitis. However, emerging reports of increasing mupirocin resistance and gram-negative infections are threatening the long-term viability of topical antibiotic ointments as a prophylactic treatment. Medical grade honey has multiple proven antibacterial and wound healing properties...
November 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Maria Altieri, Tarun R Jindal, Mayur Patel, David K Oliver, Edward M Falta, Eric A Elster, Alden Doyle, Stephen R Guy, Arthur L Womble, Rahul M Jindal
INTRODUCTION: In 2008, we initiated the first Guyanese comprehensive kidney replacement program, comprising hemodialysis (HD), peritoneal dialysis (PD), vascular access procedures, and living-donor kidney transplantation. The government of Guyana, US-based philanthropists, US-based physicians, and Guyanese caregivers teamed up to form a public-private partnership. This pilot program was free of cost to the patients. METHODS: From July 2010 to the time of writing, we placed 17 patients with end-stage kidney disease on PD, which was used as a bridge to living-donor kidney transplantation...
March 2013: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Jodie H Frost, Atul Bagul
Background. Peritoneal dialysis (PD) is an effective option of renal replacement therapy for ESRF, offering advantages over haemodialysis. Peritoneal dialysis catheter (PDC) placement is thought to be the key to successful PD and the economic advantages are lost if a patient switches to HD in the 1st year. This paper is a brief document elaborating a recap of published literature, looking at various surgical tips and manoeuvres to enhance optimal outcome of PDC placement. Methods. A search strategy assessing for access team, preoperative antibiotic prophylaxis, type of catheter, catheter exit site, intraoperative catheter trial, optimal time to commence PD, hernia repairs, number of cuffs, catheter-embedding procedures, rectus sheath tunnelling, laparoscopic fixing, omentopexy, omentectomy, the "Y"-Tec system, resection of epiploic appendages, adhesiolysis, a trained surgeon, and perioperative catheter care protocol was used looking at various databases...
2012: International Journal of Nephrology
Yener Koc, Abdulkadir Unsal, Taner Basturk, Tamer Sakaci, Elbis Ahbap-Dal, Ayse Sinangil-Arar, Sennur Kose-Budak, Hasan Kayabasi
AIM: The aim of this study is to investigate the mortality and the factors which may affect it in patients who were transferred to peritoneal dialysis (PD) from hemodialysis (HD), compared to patients assigned to PD as first-line therapy. MATERIAL AND METHODS: A total of 322 patients treated with PD between 2001 and 2010 were evaluated retrospectively. Twenty three patients were excluded and the data of remaining 299 patients (167F, mean follow up time 38.5±26...
May 14, 2012: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
C Reddy, P E Dybbro, S Guest
Experiences with minimally invasive techniques for peritoneal dialysis (PD) catheter placement are being increasingly described. Percutaneous placement of catheters using ultrasound and fluoroscopic guidance has reduced the risk of complications and has led to successful long-term catheter function. An interventional radiology catheter placement capability was established at our facility and it serves as the basis for this report. We performed a retrospective analysis of patients in a tertiary care center in Northern California who required PD between July 2005 and October 2008...
January 2010: Renal Failure
Loay Salman, Arif Asif
Antibiotic prophylaxis has been employed to reduce the risk of infection. Many reports have documented the role of prophylactic antibiotics on the subsequent development of infection in patients undergoing surgical as well as a variety of percutaneous interventions including cardiac, vascular, biliary, genitourinary, and drainage of fluid collections. While prophylactic antibiotics can be critically important for certain procedures, their use can be associated with allergic reactions (including anaphylaxis), development of bacterial resistance, and increased costs of medical care...
May 2009: Seminars in Dialysis
C R Rodríguez, E Bardón Otero, M L Vila Paz
UNLABELLED: PATIENT EVALUATION AND PREPARATION PRIOR TO VASCULAR ACCESS (VA) PLACEMENT: 1. Early referral of patients with advanced chronic kidney disease (ACKD: GFR <or= 30 ml/min: CKD stage 4) is necessary so that they are educated about the different modalities of kidney replacement therapy (KRT) and there is sufficient time to perform a permanent functioning VA before the initiation of HD (Strength of Recommendation C). 2. Preservation of the venous network of the upper extremities (UE): - Venipuntures and catheterizations in the UE should be avoided to reduce the incidence of venous occlusions and stenosis (Strength of Recommendation B)...
2008: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Rui Maio, Nuno Figueiredo, Paulo Costa
BACKGROUND/AIMS: Currently there are several techniques for laparoscopic placement of peritoneal dialysis catheters. The aim of this paper is to describe our technique and outcomes. PATIENTS AND METHODS: Laparoscopic implantation of peritoneal catheters was performed in 100 consecutive patients. The technique employed laparoscopically guided musculofascial tunneling to maintain catheter orientation toward the deep pelvis, and adhesiolysis to eliminate compartmentalization that could affect completeness of dialysate drainage...
March 2008: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Andrea E Stinghen, Pasqual Barretti, Roberto Pecoits-Filho
Despite improvements in connectology, peritoneal dialysis (PD)-associated peritonitis contributes significantly to morbidity and modality failure in patients maintained on PD therapy. A broad spectrum of organisms-gram-positive, gram-negative, fungal, anaerobic-are involved in this complication. In addition, a significant percentage of episodes involve polymicrobial and culture-negative infection. Technological advances are being developed to minimize the incidence of access-related complications such as peritonitis...
June 2007: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Adam Whaley-Connell, Brian S Pavey, Roberta Satalowich, Barbara F Prowant, Madhukar Misra, Zbylut J Twardowski, Karl D Nolph, Ramesh Khanna
Peritoneal dialysis (PD)-associated peritonitis contributes significantly to morbidity and modalityfailure. The number of patients on PD is declining in Western countries, and peritonitis is a potential deterrent to the therapy. Here, we present a clinically significant decline in the rate of peritonitis at a single center over a 28-year period, with current rates significantly lower than the national average, and we review several factors that have contributed to those outcomes. Peritonitis and duration of follow-up have been recorded for all patients followed in our program since 1977...
2005: Advances in Peritoneal Dialysis
R Scanziani, M Pozzi, L Pisano, G Santagostino Barbone, B Dozio, G Rovere, P Gabella, F Magrì
Peritoneal dialysis (PD) represents a treatment opportunity for patients with end-stage renal failure, but it has particular complications that sometimes force cessation of this procedure (1- 9). These complications are due to the presence of the peritoneal catheter and of dialysis solution within the peritoneal cavity. Infections are the most common complications of PD, followed by mechanical complications. Diagnostic imaging of the complications of PD is important because such an evaluation can aid in the diagnosis and in the decision making process about the treatment...
January 2006: International Journal of Artificial Organs
Alicia M Neu, P L Martin Ho, Ruth A McDonald, Bradley A Warady
The 2001 annual report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) registry includes data on 4,546 dialysis patients. Important trends in dialysis care include a significant increase in the use of peritoneal dialysis catheters with two cuffs (51.6% vs. 36.2%, P<0.001), a Swan neck tunnel (34.1% vs. 20.9%, P<0.001), and a downward pointing exit site (34.9% vs. 29.5%, P<0.001) in patients who initiated dialysis between 1997 and 2000 compared with 1992-1996. Most hemodialysis patients continued to have an external percutaneous catheter as their access at the time of initiation of dialysis (1,550/1,971 patients, 78...
August 2002: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Narayan Prasad, Amit Gupta, Milly Mathew, Georgi Abraham
Access-related complications differ considerably between acute and chronic peritoneal dialysis as a result of differences in catheter design, catheter material, number of cuffs, break in period, and the duration of peritoneal dialysis. Pain, which is the commonest complication of acute peritoneal dialysis, is seen in 56% to 75% followed by blood tinged dialysate effluent in 30%, pericatheter leak in 14% to 36%, catheter malfunction in 12% to 28%, bowel injury in 0.1% to 1.3%, rarely bladder injury and peritonitis in 2...
April 2002: Advances in Renal Replacement Therapy
Nada Dimkovic, Dimitrios G Oreopoulos
Available data indicate that peritoneal dialysis (PD) offers some advantages for the increasing number of elderly patients with ESRD, such as hemodynamic stability, steady-state metabolic control, good control of hypertension, independence from hospital visits, and avoidance of repeated vascular access. Early referral promotes the establishment of peritoneal access and minimizes the consequences of uremia and subsequent morbidity and frequent hospitalization. Elderly patients have similar modality-related complications such as peritonitis, catheter-related complications, exit-site and tunnel infection, and hernias as younger patients...
March 2002: Seminars in Dialysis
B Piraino
Staphylococcus aureus infections are a major cause of morbidity and hospitalization in dialysis patients. The risk of infection relates to the type of access. Patients with acute hemodialysis (HD) catheters are at the greatest risk of S. aureus bacteremia, followed by tunneled HD catheters, and grafts. Patients with a fistula have a rate similar to that of peritoneal (PD) patients. In PD patients, however, S. aureus is the second most common cause of peritonitis, is often associated with a catheter infection, and frequently requires catheter removal for resolution...
November 2000: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
R Gokal, S Alexander, S Ash, T W Chen, A Danielson, C Holmes, P Joffe, J Moncrief, K Nichols, B Piraino, B Prowant, A Slingeneyer, B Stegmayr, Z Twardowski, S Vas
No abstract text is available yet for this article.
January 1998: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
A M Neu, E C Kohaut, B A Warady
To determine standard peritoneal access practices in North American children, a questionnaire was distributed to the 18 participating centers of the Pediatric Peritoneal Dialysis Study Consortium. The survey covered areas including catheter placement, postoperative catheter break-in, chronic catheter care, and treatment of exit-site and tunnel infection.
1995: Advances in Peritoneal Dialysis
R Gokal, S R Ash, G B Helfrich, C J Holmes, P Joffe, W K Nichols, D G Oreopoulos, M C Riella, A Slingeneyer, Z J Twardowski
The peritoneal catheter is the CAPD patient's lifeline. Advances in catheter knowledge have made it possible to access the peritoneal cavity safely and maintain access over an extended period of time. Infection at the exit site remains a major problem, a solution for which is being extensively researched. The successful outcome of a catheter in an individual depends on meticulous care and adherence to sound principles of catheter insertion and management. The guidelines provided in this publication represent the consensus based on the extensive experience of several major centers worldwide...
1993: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
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