Peritoneal dialysis in children: Review of surgical techniques

1992 ◽  
Vol 59 (1_suppl) ◽  
pp. 272-274
Author(s):  
N. Capozza ◽  
G. Mosiello ◽  
M. De Gennaro ◽  
E. Matarazzo ◽  
S. Rinaldi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Technique ◽  
Surgical Techniques ◽  
Average Weight ◽  
Peritoneal Dialysis Catheter ◽  
Peritoneal Dialysis Fluid ◽  
Stage Renal Disease ◽  
End Stage ◽  
Surgical Guidelines ◽  
Pediatric Icu

Peritoneal dialysis has become an effective and widely used technique for the treatment of patients with end-stage renal disease. Peritoneal dialysis has become more practical for use in pediatric patients since equipment and techniques have been adapted for smaller patients. In the present work we describe the surgical technique that we currently use at our institution for surgical placement of peritoneal dialysis catheter. From January 1985 to January 1992, 19 peritoneal catheters were placed in 17 children, at the Bambino Gesù Children's Hospital. At the time of catheter insertion the average weight of the children was 14.2 kg., and the average age was 4 y. 10m. Peritoneal dialysis catheters were always placed under sterile conditions, in an operating room or in a pediatric ICU, with surgical technique. Regarding our surgical technique we recommend: 1) to use Tenckhoff catheter, 2 cuffs pigtail (curled) type; 2) to perform a minilaparatomy with lateral surgical approach and a routine omentectomy; 3) to create a submuscular tunnel (rectus abdominis) to reduce the leakaqe of peritoneal dialysis fluid. Furthermore the various clinical problems encountered in our experience and some surgical guidelines for the prevention of complications are reviewed.

scholarly journals A disposable, ultra-fine endoscope for non-invasive, close examination of the intraluminal surface of the peritoneal dialysis catheter and peritoneal cavity

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Masaaki Nakayama ◽  
Chieko Hamada ◽  
Keitaro Yokoyama ◽  
Yudo Tanno ◽  
Nanae Matsuo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Study ◽  
Peritoneal Cavity ◽  
Abdominal Cavity ◽  
Peritoneal Dialysis Catheter ◽  
Peritoneal Membrane ◽  
Non Invasive ◽  
Luminal Side ◽  
Stage Renal Disease ◽  
End Stage

Abstract The ability to visualize intraluminal surface of peritoneal dialysis (PD) catheter and peritoneal cavity could allow elucidation of the cases of outflow problems, and provide information on changes to the peritoneal membrane leading to encapsulating peritoneal sclerosis. A non-invasive examination that allows those monitoring in need is desirable. We have developed a disposable ultra-fine endoscope that can be inserted into the lumen of the existing PD catheter, allowing observation of the luminal side of the catheter and peritoneal cavity from the tip of the PD catheter, with minimum invasion in practice. In a pre-clinical study in pigs and a clinical study in 10 PD patients, the device provided detailed images, enabling safe, easy observation of the intraluminal side of the entire catheter, and of the morphology and status of the peritoneal surface in the abdominal cavity under dwelling PD solution. Since this device can be used repeatedly during PD therapy, clinical application of this device could contribute to improved management of clinical issues in current PD therapy, positioning PD as a safer, more reliable treatment modality for end-stage renal disease.

scholarly journals Peritoneal dialysis catheter outcomes in infants initiating peritoneal dialysis for end-stage renal disease

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Peace D. Imani ◽  
Jennifer L. Carpenter ◽  
Cynthia S. Bell ◽  
Mary L. Brandt ◽  
Michael C. Braun ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Histoplasma Peritonitis: An Extremely Rare Complication of Peritoneal Dialysis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Asjad Sardar ◽  
Bijin Thajudeen ◽  
Pradeep V. Kadambi
Keyword(s):  
Peritoneal Dialysis ◽  
Histoplasma Capsulatum ◽  
Rare Complication ◽  
Altered Mental Status ◽  
Response To Treatment ◽  
Fungal Peritonitis ◽  
Bacterial Peritonitis ◽  
Peritoneal Dialysis Fluid ◽  
Stage Renal Disease ◽  
End Stage

Bacterial peritonitis is a common complication of peritoneal dialysis, but fungal peritonitis is unusual and is mostly due to Candida species. Peritonitis due to Histoplasma capsulatum is rare and we report one such case. A 63-year-old female presented with progressively worsening abdominal pain, fever, and altered mental status. She had end-stage renal disease and had been on peritoneal dialysis for 4 years. She had abdominal tenderness without rebound or guarding. Laboratory studies and CT of abdomen were significant for leukocytosis and peritoneal membrane thickening, respectively. Peritoneal dialysis fluid study was consistent with peritonitis and culture of the fluid grew Histoplasma capsulatum. Treatment recommendations include removal of catheter and initiation of antifungal therapy. With the availability of newer antifungals, medical management without removal of PD catheter is possible, but at the same time if there is no response to treatment within a week, PD catheter should be removed promptly.

Icodextrin and Intraperitoneal Inflammation

2008 ◽  
Vol 28 (3_suppl) ◽  
pp. 96-100 ◽  
Author(s):  
Misaki Moriishi ◽  
Hideki Kawanishi
Keyword(s):  
Peritoneal Dialysis ◽  
Degradation Products ◽  
Chronic Glomerulonephritis ◽  
Inflammatory Reactions ◽  
Markers Of Inflammation ◽  
Peritoneal Dialysis Fluid ◽  
Peritoneal Permeability ◽  
Equilibrium Test ◽  
Stage Renal Disease ◽  
End Stage

⋄ Background The peritoneum is impaired by exposure to biocompatible dialysis solutions. Because icodextrin peritoneal dialysis fluid (PDF) is made from cornstarch, a possibility that it induces intraperitoneal inflammation has been reported. In the present study, patients on glucose PDF were switched to icodextrin PDF and then switched back to glucose PDF. Icodextrin PDF-induced intraperitoneal inflammation was investigated based on changes in peritoneal permeability and inflammatory reactions. ⋄ Patients and Methods The subjects were 7 stable peritoneal dialysis patients (4 men, 3 women), with a mean age of 59.1 ± 3.8 years (range: 55.2 - 64.6 years). The mean duration of peritoneal dialysis was 58.3 ± 27.4 months (range: 34.3 - 97.7 months), and the cause of end-stage renal disease was chronic glomerulonephritis in all patients. For the overnight dwell, glucose PDF was changed to icodextrin PDF, and the patients returned to glucose PDF 30 months later. To evaluate peritoneal permeability, a peritoneal equilibrium test (PET) was performed, and dialysate-to-plasma (D/P) ratios of creatinine (Cr), β2-microglobulin (β2M), albumin, immunoglobulin G (IgG), and α2-macroglobulin (α2M) were measured in the overnight dialysate and serum. As markers of inflammation and fibrinolysis or coagulation, interleukin-6 (IL-6) and fibrinogen degradation products (FDPs) were measured in overnight effluent. The evaluations were made every 6 months for 36 months. ⋄ Results A significant elevation in FDP levels was detected in overnight effluent 6 months after the switch to icodextrin PDF, and IL-6 levels tended to increase. The D/P ratios of Cr, β2M, and albumin were also significantly increased, and the D/P ratios of IgG and α2M tended to increase. The D/P ratio of Cr as measured by PET was slightly increased, but the elevation was not significant. In 5 patients, after icodextrin PDF was switched back to glucose PDF at 30 months, the D/P ratios of Cr, β2M, albumin, IgG, and α2M in overnight effluent were significantly reduced. The FDP levels decreased slightly in those patients. In the remaining 2 patients, the D/P ratios of Cr on PET and of Cr, β2M, albumin, IgG, and α2M in overnight effluent, and the FDP and IL-6 levels in overnight effluent were markedly elevated after the switching from glucose to icodextrin PDF, and they remained high after the switch back to glucose PDF. One of these 2 patients developed pre-EPS and was treated with prednisolone and concomitant hemodialysis. The other was switched from peritoneal dialysis to hemodialysis. ⋄ Conclusions Icodextrin dialysis solution may induce an inflammatory reaction in the peritoneum. Further investigation is necessary for the long-term use of icodextrin PDF.

Peritoneal Dialysis Catheter Surgery Using Transversus Abdominis Plane Block

2017 ◽  
Vol 37 (4) ◽  
pp. 429-433 ◽  
Author(s):  
Dean Markic ◽  
Božidar Vujičić ◽  
Mladen Ivanovski ◽  
Kristian Krpina ◽  
Antun Gršković ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Placement ◽  
Transversus Abdominis ◽  
Peritoneal Dialysis Catheter ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Effective Technique ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

BackgroundPeritoneal dialysis (PD) catheter surgery can be performed using regional anesthesia. We present our PD catheter placement and extraction experience using ultrasound-guided transversus abdominis plane (TAP) block.MethodsIn the present study, we analyzed 74 patients from our center with end-stage renal disease (ESRD) who underwent PD catheter placement (60 patients) and removal (14 patients) using a TAP block between June 2011 and December 2015.ResultsThe TAP block was successful for 55/60 (91.7%) patients (insertion) and 13/14 (92.9%) patients (extraction). Other patients had pain at the incision site and required general anesthesia. There were no anesthesia-, surgery- or PD catheter-related complications.ConclusionThe TAP block is a safe and effective technique not only for high-risk ESRD patients but for all patients undergoing PD catheter placement or extraction.

Synchronous Laparoscopic Insertion of Peritoneal Dialysis Catheter and Cholecystectomy in Patients with End-Stage Renal Disease and Gallstones – Our Experience

2019 ◽  
Vol 39 (5) ◽  
pp. 489-491
Author(s):  
Jurij Janež
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Peritoneal Dialysis Catheter ◽  
Peritoneal Catheter ◽  
Gallbladder Polyps ◽  
Stage Renal Disease ◽  
End Stage ◽  
Infective Complications ◽  
Gallbladder Removal

In patients with end-stage renal disease who are candidates for peritoneal dialysis (PD) and have gallstones or gallbladder polyps, it is advised to perform synchronous insertion of PD catheter and cholecystectomy. With gallbladder removal at the time of peritoneal catheter insertion we can avoid infective complications, such as acute cholecystitis and possible PD failure. This article presents our experience with synchronous laparoscopic cholecystectomy and insertion of a PD catheter.

A Technique to Eradicate Tunnel Infection without Peritoneal Dialysis Catheter Removal

1984 ◽  
Vol 4 (3) ◽  
pp. 156-157 ◽  
Author(s):  
Sharon P. Andreoli ◽  
Karen W. West Jay ◽  
L. Grosfeld ◽  
Jerry M. Bergstein
Keyword(s):  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Major Complication ◽  
Catheter Removal ◽  
Dramatic Improvement ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Peritoneal Catheter ◽  
Stage Renal Disease ◽  
End Stage

In two adolescents maintained on CAPD, infections of the peritoneal catheter tunnel were treated by an “unroofing” technique. The infections were eradicated without catheter removal or interruption of CAPD. Continuous ambulatory peritoneal dialysis (CAPD) has produced a dramatic improvement in the care of patients with end-stage renal disease. Peritonitis remains a major complication and the most common cause of CAPD failure (1–3). Most episodes of peritonitis can be attributed to a break in the technique of bag exchanges; however, tunnel infections are also implicated (3,4). Tunnel infections are difficult to cure and, if persistent, may make necessary the removal of an otherwise well functioning catheter. We describe two patients with tunnel infections that were eradicated after “unroofing” of the Tenckhoff catheter.

Recovery of HIV Antigen in Peritoneal Dialysis Fluid

1990 ◽  
Vol 10 (1) ◽  
pp. 67-69 ◽  
Author(s):  
Ricardo Correa-Rotter ◽  
Sergio Saldivar ◽  
Luis E. Soto ◽  
Samuel Ponce De Leon ◽  
Francisco Ojeda ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Dialysis Fluid ◽  
Peritoneal Dialysis Fluid ◽  
Hiv Antibodies ◽  
Hiv Antigen ◽  
Group A ◽  
Group B ◽  
Stage Renal Disease ◽  
End Stage

We investigated the presence of HIV antigen in dialysis fluid of patients with end-stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD), previously known to be infected with this virus. Sixteen adult patients and 6 adult volunteers were included in the study in 4 groups as follows: Group A: 3 patients on CAPD, previously known to be positive for serum HIV antibodies; Group B: 7 patients on CAPD, serum HIV negative; Group C: 6 AIDS patients without renal disease; and Group D: 6 healthy volunteers. Of the 3 patients of Group A, the HIV-1 Ag was positive in dialysis fluid in only 2. In 1, serum Ab and Ag were present, while in the others only serum Ab was detected. The samples from Group B were all negative for the viral antigen in dialysis fluid. We conclude that dialysis fluid of HIV-infected patients may contain the Ag and is therefore potentially infective. The presence of the HIV antigen was not constant, and was not related to antigenemia. It is possible that the presence of the Ag depends on local factors that influence viral replication or to alterations in the permeability of the peritoneal membrane. We discuss other possible factors that could influence the presence of viral Ag in peritoneal dialysis fluid.

Surgical technique determines the outcome of the Brescia/Cimino AVF

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S1-S4 ◽  
Author(s):  
Surendra Shenoy
Keyword(s):  
Surgical Technique ◽  
End Stage Renal Disease ◽  
Surgical Techniques ◽  
The Past ◽  
Straight Line ◽  
Stage Renal Disease ◽  
End Stage ◽  
Oscillatory Shear Stress ◽  
Over Time

Over the past 50 years, since Dr. Appel performed the first internal vascular access procedure for hemodialysis, the distal radiocephalic arteriovenous fistula continues to be the access of choice. Over time, failure to maturation has evolved as a major problem associated with this procedure depriving its benefits to many patients with end-stage renal disease. A variable incidence of this problem within similar patients suggests that surgical technique may play an important role in the development of non-maturation. Evaluating the current surgical techniques based on the hemodynamic consequences of anatomic and physiologic alterations following this procedure highlights the role of surgical technique in mitigating or reducing complications. Piggy-back straight line on-lay, a technique that helps to tailor the blood flow and reduce the oscillatory shear stress appears to reduce the incidence of early juxta-anastomotic problems, which contribute significantly to the problem of non-maturation.

Sign in / Sign up

Export Citation Format

Share Document