Increased Drainage Volume in Intermittent Peritoneal Dialysis Using a Two-Bag, Low Hydrostatic Pressure Drainage System

2008 ◽  
Vol 11 (5) ◽  
pp. 413-415
Author(s):  
Avishalom Pomeranz ◽  
Zeev Korzets ◽  
Jacques Bernheimfrom
Keyword(s):  
Peritoneal Dialysis ◽  
Hydrostatic Pressure ◽  
Drainage System ◽  
Drainage Volume

Effects of Chondroitin Sulphate on Fluid and Solute Transport during Peritoneal Dialysis in Rats

1991 ◽  
Vol 11 (4) ◽  
pp. 351-354 ◽  
Author(s):  
Andrzej Breborowicz ◽  
Maciej Radkowski ◽  
Jan Knapowski ◽  
Dimitrios G. Oreopoulos
Keyword(s):  
Peritoneal Dialysis ◽  
Hydrostatic Pressure ◽  
Hydraulic Conductivity ◽  
Horseradish Peroxidase ◽  
Solute Transport ◽  
Peritoneal Cavity ◽  
Chondroitin Sulphate ◽  
In Vitro Experiments ◽  
Fluid Removal

The effect of chondroitin sulphate (CS) on peritoneal fluid and solute transport was studied in rats undergoing peritoneal dialysis. In the presence of CS, net ultrafiltration increased, while absorption of glucose and horseradish peroxidase from the peritoneal cavity decreased. Albumin, used instead of CS, did not modify either fluid or solute transport. In in vitro experiments on isolated rabbit mesentery, CS decreased transmembrane water flow induced by hydrostatic pressure, and its effect was not fully reversed 60 minutes after “wash-out” of this glycosaminoglycan. We postulate that the polyanionic CS molecules are trapped in the peritoneal interstitium, thus decreasing its hydraulic conductivity and permeability, which in turn increases net fluid removal during peritoneal dialy sis because of its slower absorption from the peritoneal cavity.

Constant Ventricular Drainage: Pitfalls and Variables Technical Note

Neurosurgery ◽  
1984 ◽  
Vol 15 (1) ◽  
pp. 117-119
Author(s):  
Michael J. Rosner ◽  
Dorothee Hayes ◽  
Marcia Clark
Keyword(s):  
Hydrostatic Pressure ◽  
Drainage System ◽  
Pressure Head ◽  
Volume Of Fluid ◽  
Technical Note ◽  
Pressure Differential ◽  
Ventricular Drainage ◽  
Constant Height

Abstract After observing the erratic performance of a commercially available ventricular drainage system, we examined the hydrostatic pressure exerted by the system as a function of the volume of fluid within the drainage bag (at a constant height). Initially, 3 to 4 cm more than the expected 27 cm of height was required to achieve a drainage pressure of 20 mm Hg. As the volume of fluid increased, there was an initial precipitous fall from the 20 mm Hg preset pressure to 14 to 16 mm Hg; this pressure differential increased as the volume of drained fluid increased. Removal of air from the drainage bag resulted in an additional decrement in the observed hydrostatic pressure. These decrements in pressure were not apparent with another commercially available bag used commonly for ventricular drainage. We therefore recommend that, if ventricular drainage is to be accomplished against a constant hydrostatic pressure head, the system should be configured so that the actual hydrostatic pressure against which drainage occurs can be measured quickly and easily. The system should be checked at frequent intervals as the ventricular drainage bag fills. We note additional pitfalls in use of constant ventricular drainage and suggest solutions.

Complete Dialysate Drainage: An Unnecessary Step in Intermittent Peritoneal Dialysis

1985 ◽  
Vol 5 (4) ◽  
pp. 233-236 ◽  
Author(s):  
Suchati Indraprasit ◽  
Wandee Taramas ◽  
Orasa Panpakde
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Relative Increase ◽  
Considerable Effort ◽  
Drainage Volume ◽  
Paramedical Personnel ◽  
Inaccessible Area

Peritoneal dialysis was performed in 16 renal-failure patients to study the necessity of complete drainage during the outflow period. Comparison between complete drainage (CD) and the accelerated inflow and limited outflow (AILO) showed no difference of drainage volume despite the accelerated outflow during the AILO period. It is postulated that the higher level of dialysate in the fluid line during the AILO period resulted in a relative increase availability of the outflow through the catheter perforations. In the CD period the peritoneal clearances of urea, creatinine and inulin were lower because of inefficient transport of these solutes during the outflow phase. The authors concluded that complete drainage is not necessary in intermittent peritoneal dialysis. During intermittent peritoneal dialysis, dialysate drainage volume usually is a major concern among medical and nursing staffs. Particularly during the initial exchange, dialysate frequently is retained because of a pocket of fluid in an inaccessible area of the peritoneal cavity (1). Thus, in subsequent exchanges considerable effort is made to stimulate drainage so as to avoid further accumulation. This prolongs outflow time and takes up the time and attention of paramedical personnel. The present study was done to evaluate the necessity of complete dialysate drainage in term of mechanics and efficiency of dialysis.

A pilot project evaluating a fixed drainage system (U-Drain) for automated peritoneal dialysis

2021 ◽  
pp. 089686082110359
Author(s):  
Dimitrios Poulikakos ◽  
Joanne Martin ◽  
Joanne Collier ◽  
David Lewis
Keyword(s):  
At Risk ◽  
Peritoneal Dialysis ◽  
Drainage System ◽  
Pilot Project ◽  
Automated Peritoneal Dialysis ◽  
Time Saving ◽  
Staff Members ◽  
Delays In Diagnosis ◽  
Healthcare Assistant

U-Drain is a fixed drainage system for automated peritoneal dialysis (APD) connecting the dialysis effluent outflow directly to the household drainage system thus avoiding the need for drain bags, with considerable potential advantages for patient convenience and reduction of plastic clinical waste. Here we present a pilot project reporting on U-Drain patient and staff experience based on questionnaires and on the safety of the technology derived from analysis of characteristics of peritonitis episodes. Overall, 15 patients were included in the pilot project and were followed up over 3 years; 11 patients completed a questionnaire exploring their experiences of APD and U-Drain. A family member 55%, carer 10%, healthcare assistant 10% and patient themselves 25% would normally carry the full drainage bags for disposal. Following the installation of U-Drain, 90% of patients reported that the system saved them time setting up and clearing the machine after dialysis, 80% noted a reduction in storage space required for consumables and all patients noted a reduction in non-recyclable waste requiring disposal. All patients who completed the questionnaire were very satisfied with the installation. All staff members who completed the questionnaire reported that their role was easier and the system was time saving. In total, there were 8 peritonitis episodes, including 2 recurrent infections due to biofilm, over 313 patient months follow up. There was no increase in incidence of peritonitis infection (0.3 episodes per year at risk) compared to that in the unit’s population (0.64, 0.42 and 0.5 episodes per year at risk for the years 2017, 2018 and 2019, respectively) or delays in diagnosis. Approximately 0.8 kg of non-recyclable clinical waste was saved per treatment day from domestic waste by avoiding the use of PD drain bags. This pilot demonstrates increased patient satisfaction and acceptable safety profile of U-Drain technology.

Intraperitoneal hydrostatic pressure and volume in peritoneal dialysis patients

1999 ◽  
Vol 25 (2) ◽  
pp. 16-17
Author(s):  
V. Lauro ◽  
F. Luccio ◽  
M. Colaluca ◽  
F. Francesco ◽  
A. Pintauro
Keyword(s):  
Peritoneal Dialysis ◽  
Hydrostatic Pressure ◽  
Dialysis Patients

Peritoneal Fluid and Tracer Albumin Kinetics in the Rat. Effects of Increases in Intraperitoneal Hydrostatic Pressure

1995 ◽  
Vol 15 (2) ◽  
pp. 118-128 ◽  
Author(s):  
EL Rasheid Zakaria ◽  
Bengt Rippe
Keyword(s):  
Peritoneal Dialysis ◽  
Hydrostatic Pressure ◽  
Peritoneal Cavity ◽  
Peritoneal Fluid ◽  
Loss Rate ◽  
Dry Weight ◽  
Radioactive Tracer ◽  
Fluid Loss ◽  
Abdominal Muscles ◽  
Edema Formation

Objectives To study the peritoneal fluid loss rate, the clearance (CI) of radioactive tracer albumin (RISA) eliminated from the peritoneal cavity (PC), as well as the peritoneal-to-plasma RISA clearance (CI -+ P) during acute peritoneal dialysis (PD) at large elevations in intraperitoneal hydrostatic pressure (IPP). Design Experimental study in anesthetized Wistar rats. Methods The intraperitoneal volume (IPV) was assessed using RISA dilution, correcting for the RISA CI from the PC. Volume recovery at termination of the dwells was obtained using graduated cylinders and preweighed gauze tissues. Measurements of CI and CI -+ P were obtained by repeated micro-sampling of dialysate and plasma, respectively. The IPP was continuously measured, and could be varied by external concentric abdominal compression using an inflatable cuff. On termination of the experiments, samples from tissues lining the PC were analyzed with respect to their content of RISA and edema, the latter being assessed from wet/dry weight ratios. Results At 2 mm Hg of IPP (control) the RISA CI was 27.1:1:2.0(:1:SE)μL.min-l, whereas CI→ Pwasonly 8.07:1:0.67 μL.min-l, at a total fluid loss rate of 10.1:1:5.4μL.min-1 for 1.36% Dianeal. At an IPP of 14 mm Hg, the CI increased to 55.3±4.1 μL.min -1 and the peritoneal fluid absorption rate was 34.4±5.6 μL.min -l, whereas CI -+ P was just moderately increased as compared to control (11.2:1:1.4 μL. min -I). Furthermore, a pleural effusion of 1.16:1:0.08 mL was detectable at elevated IPPs. The degree of edema formation in the anterior abdominal muscles (AAM) and the diaphragm (DIA) was largely insignificant during 150 min at 2 mm Hg of IPP, but increased markedly at 14 mm Hg, as did the RISA uptake to the AAM and DIA. The discrepancy between CI and CI -+ P was largely accounted for by tracer entrance into tissues lining the peritoneal cavity, mainly the AAM. Conclusions At a nearly unchanging capillary Starling equilibrium, the losses of fluid and of RISA from the PC were markedly elevated at increased IPPs. However, the RISA clearance to the plasma appeared to be only moderately altered at elevated IPP and represented only a minor fraction of the RISA clearance out of the PC. Tissues lining the PC apparently act as a variable ‘sink’ for intraperitoneal proteins and fluid during peritoneal dialysis (PD).

scholarly journals P1158DOES THE PERITONEUM SWELLS OR SHRINK DURING PERITONEAL DIALYSIS?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jacek Waniewski ◽  
Joanna Stachowska-Pietka ◽  
Roman Cherniha ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Dialysis ◽  
Elastic Modulus ◽  
Hydrostatic Pressure ◽  
Reflection Coefficient ◽  
Connective Tissue ◽  
Osmotic Pressure ◽  
Interstitial Fluid ◽  
Fluid Volume ◽  
Free Fluid ◽  
Dialysis Fluid

Abstract Background and Aims The width of the peritoneum (composed mainly of connective tissue and relatively free of vasculature) is increased in patients on peritoneal dialysis compared to healthy subjects. We investigated to what extent increased intraperitoneal (ip) hydrostatic and osmotic pressures following the infusion of dialysis fluid will change hydration status and width of the peritoneum. Method Using linear theory of poroelasticty, clinical data on transport parameters and experimental data on elastic characteristics of the interstitium, the relative change of the width of the poroelastic layer subject to the combined effect of external hydrostatic and effective osmotic pressures (that is, ideal osmotic pressure multiplied by reflection coefficient for osmotic agent) can be described as a function of effective pressure and elastic modulus of the layer: Lmod/L0 = 1/(1-deltaP*/lambda*), where L0 is initial thickness of the tissue, Lmod is modified thickness of the layer, deltaP* is change in effective combined pressure, and lambda* is the elastic modulus of the poroelastic material. The same formula describes also the change in fractional free fluid volume ratio, thetaF. The elastic modulus of the connective tissue was assumed to be 110 mmHg, as measured for the subcutaneous layer of the tip of mouse tail by Swartz et al (J Biomech, 1999), and reflection coefficient for glucose in the interstitium of 0.0035 as estimated by Stachowska-Pietka et al (NDT, 2019) from clinical data for patients on peritoneal dialysis. Results The ip hydrostatic pressure increases by 2-3 mmHg to 15 mmHg at rest depending on infused volume of dialysis fluid (and posture, body weight and location in abdominal cavity), and may increase to 100 mmHg during activities as coughing, whereas the osmotic pressure of glucose 3.86% dialysis fluid is around 400 mmHg above the osmotic pressure of plasma and interstitial fluid (in equilibrium with plasma). However, due to the low reflection coefficient of interstitium, the effective osmotic pressure of dialysis fluid minus the physiological value of interstitial osmotic pressure is only 1.4 mmHg, and is quickly decreasing with dwell time. Therefore, hydrostatic pressure is the dominant factor for interstitial hydration. Assuming ip pressure of 15 mmHg, the stretch of the peritoneum increases its equilibrium width (at 0 mmHg and isotonic interstitial fluid) by 15%. During physical activities peritoneum may transiently thicken even more. Conclusion The peritoneum becomes overhydrated after infusion of dialysis fluid, which increases interstitial hydrostatic pressure; the thickness and fractional free fluid volume of the peritoneum increase by 15% although transiently higher increases may occur following activities that increase intraperitoneal pressure. The mechanical changes in the peritoneum may contribute to the biological changes in cells present there, as fibroblasts and mesothelial cells. The swelling of the peritoneum is in agreement with the increase in the fractional free fluid volume of the intramuscular interstitium behind the peritoneum as reported by Zakaria et al (Am J Physiol Heart Circ Physiol, 1999).

Reduplicated Basal Lamina of Small Venules and Mesothelium of Human Parietal Peritoneum: Ultrastructural Changes of Reduplicated Peritoneal Basement Membrane

1985 ◽  
Vol 5 (4) ◽  
pp. 212-215 ◽  
Author(s):  
Lazaro Gotloib ◽  
Pnina Bar-Sella ◽  
Abshalom Shostak
Keyword(s):  
Peritoneal Dialysis ◽  
Electron Microscope ◽  
Hydrostatic Pressure ◽  
Basement Membrane ◽  
Basal Lamina ◽  
Parietal Peritoneum ◽  
Ultrastructural Changes ◽  
Diabetic Patients ◽  
Uniform Thickness ◽  
Capillary Bed

We examined under the electron microscope samples of parietal peritoneum obtained from nine nondiabetic chronic uremics -six of them on maintenance intermittent peritoneal dialysis, ranging in age from 52 to 82 years -mean 64.4 ± 8.1 years and of nine non-uremic, non-diabetic patients -mean age 40.7 ± 12.2 years. Postcapillary venules and small venules showed areas with several layers of reduplicated basal lamina. Some microvessels showed gaps in basallamina with and/or without focal reduplication. Reduplicated submesothelial basal lamina was found in only one patient. These changes were not observed in the nine non-uremic, non-diabetic controls. To the best of our knowledge, this is the first description in humans of such alterations in the aforementioned locations, which may well be secondary to aging and/or to the intense mesothelial renewal observed in I.P.D. patients. We need to determine the possible influence of these ultrastructural changes on transperitoneal transfer of water and solutes during peritoneal dialysis. The basal lamina of blood vessels may not be of uniform thickness. Human non-diabetic adults show significant increase in capillary basal lamina thickness as one moves from head to foot (1). Those regional variations may be related to differences in venous hydrostatic pressure effective on the capillary bed (1). This paper decribes the first observations of reduplicated basal lamina of microvessels in the parietal peritoneum and of that subjacent to mesothelial cells in elderly, non-diabetic uremic patients.

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