Training of Peritoneal Dialysis Patients—Taiwan's Experiences

2008 ◽  
Vol 28 (3_suppl) ◽  
pp. 72-75 ◽  
Author(s):  
Tzen-Wen Chen ◽  
Szu-Yuan Li ◽  
Jinn-Yang Chen ◽  
Wu-Chang Yang
Keyword(s):  
Peritoneal Dialysis ◽  
Signs And Symptoms ◽  
Cardiovascular Complications ◽  
Observation Study ◽  
Exit Site Infection ◽  
Anatomy And Physiology ◽  
Routine Tasks ◽  
Catheter Implantation ◽  
Diet Control ◽  
The Relationship

In Taiwan, peritoneal dialysis (PD) was launched in 1984. Since then, the Taiwan Society of Nephrology (TSN) has taken the responsibility for supervising PD programs. All PD programs are required to pass evaluations from the TSN before inception. Every new PD patient receives individual training from a qualified PD nurse. The training, accompanied by a review test, is usually provided in the hospital during the week right after catheter implantation. To evaluate the effect of the patient training program on PD outcomes, we designed a retrospective observation study and reviewed the post-training tests of 100 new PD patients. The post-training test has 10 parts: anatomy and physiology, overview of chronic kidney disease, overview of PD, complications of peritonitis and exit-site infection, diet control, cardiovascular complications, PD skills and procedures, aseptic techniques, management of peritonitis, and routine tasks. The relationship between the post-training test scores and peritonitis was analyzed. Results showed that risk of peritonitis is not related to the post-training test score. However, based on our experiences, we believe that PD patient training should be lengthened and repeated periodically as suggested by the International Survey of Peritoneal Dialysis Training Programs. Training on certain issues such as the signs and symptoms of peritonitis should be especially enhanced.

scholarly journals Urgent-start peritoneal dialysis after laparoscopic dialysis catheter implantation: a single-center experience

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Naohiro Toda ◽  
Motoko Yanagita ◽  
Hideki Yokoi
Keyword(s):  
Peritoneal Dialysis ◽  
Early Initiation ◽  
University Hospital ◽  
Early Group ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Single Center Experience ◽  
Catheter Malfunction ◽  
Catheter Implantation ◽  
Late Group

Abstract Background Appropriate timing of peritoneal dialysis (PD) catheter implantation and PD initiation is important. Several guidelines suggest starting PD at least 2 weeks after PD catheter implantation. Recently, urgent-start PD is widespread throughout the world. However, the ideal time to start PD after laparoscopic catheter implantation is not known. We investigated the safety and feasibility of early initiation (within 7 days) PD following laparoscopic peritoneal catheter implantation. Methods We retrospectively analyzed patients who underwent laparoscopic PD catheter implantation at the Kyoto University Hospital from January 1, 2006, to December 31, 2016. Based on when PD was initiated, the patients were divided into two groups, namely, early group, ≤ 7 days and late group, > 7 days after catheter implantation. Catheter-related complications and catheter survival were analyzed. Results We analyzed 29 and 26 patients in early and late groups, respectively. The age, sex, the incidence of diabetes and APD, and the follow-up period were not significantly different between the two groups. The interval from catheter implantation to the start of PD was 4.28 ± 1.83 and 162 ± 157.8 days in the early and late groups, respectively (P < 0.01). In a late group, 17 patients (65.4%) underwent catheter implantation using the Moncrief–Popovich technique. The use of bridge hemodialysis was higher in the early group (P < 0.01). No patients developed dialysate leakage in both groups, and no significant differences were observed for catheter malfunction (24.1% vs. 19.2%, P = 0.66), exit-site infection (ESI, 24.1% vs. 28%, P = 0.87), and peritonitis (7.14% vs. 8.0%, P = 0.91) within 6 months. Furthermore, early initiation of PD did not increase the risk of ESI, peritonitis, and PD withdrawal at 1, 2, and 5 years compared to that in the late group. Conclusions Urgent-start of PD with laparoscopic catheter implantation did not increase infection-related complications and PD withdrawal. Laparoscopic PD catheter implantation may allow the initiation of PD earlier than 7 days after implantation.

Vertical Tunnel-based Low-site Peritoneal Dialysis Catheter Implantation Decreases the Incidence of Catheter Malfunction

2015 ◽  
Vol 81 (11) ◽  
pp. 1157-1162 ◽  
Author(s):  
Cheng Sun ◽  
Miao Zhang ◽  
Chunming Jiang
Keyword(s):  
Peritoneal Dialysis ◽  
Open Surgery ◽  
Abdominal Segment ◽  
Implantation Technique ◽  
Peritoneal Dialysis Catheter ◽  
The Novel ◽  
Exit Site Infection ◽  
Catheter Dysfunction ◽  
Catheter Malfunction ◽  
Catheter Implantation

Peritoneal dialysis (PD) is often complicated by catheter dysfunction. We designed a PD catheter implantation technique to reduce catheter dysfunction. Between June 2008 and 2012, 89 patients with end-stage renal disease were enrolled into a prospective study and randomly assigned to receive traditional catheter implantation by open surgery (n = 41) or vertical tunnel-based low-site PD catheter implantation (n = 48). Both procedures used Baxter straight double-cuffed Tenckhoff catheters. The novel implantation technique involves a low-site (7 cm above the midpoint of the pubic symphysis), individually tailored intra-abdominal segment, and increased vertical subcutaneous tunnel. Patients were followed for 1-year after procedure. The vertical tunnel-based low-site method implanted catheters were 3.7 ± 0.9 cm long, with an 11.3 ± 0.9 cm intra-abdominal segment. The incidence of postoperative bleeding, PD fluid leakage, outer cuff extrusion, inflow or outflow pain, peritonitis, tunnel inflammation, or exit-site infection did not differ significantly between the two surgical techniques; however, the incidence of catheter displacement and non-catheter displacement malfunctions after the novel technique (4.2%) was significantly lower than that in traditional open surgery (19.5%, P < 0.05). In conclusions, vertical tunnel-based low-site PD catheter implantation can significantly reduce the occurrence of PD catheter malfunction, particularly catheter displacement.

Staphylococcus Aureus Peritonitis is Associated with Staphylococcus Aureus Nasal Carriage in Peritoneal Dialysis Patients

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 232-335 ◽  
Author(s):  
Beth Piraino ◽  
Jeffrey A. Perlmutter ◽  
Jean L. Holley ◽  
Judith Bernardini
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Nasal Carriage ◽  
Site Infection ◽  
Dialysis Patients ◽  
Exit Site ◽  
Exit Site Infection ◽  
Increased Risk ◽  
Definition Of ◽  
The Relationship

Although the definition of S. aureus nasal carriage in peritoneal dialysis patients Is variable, carriage is often defined as 2 or more positive cultures for S. aureus. We Investigated the relationship between S. aureus Infections and nasal carriage (defined as 1 or more positive nose cultures) In 138 patients on peritoneal dialysis. By this definition, approximately 50% of the patients were carriers. The rates of S. aureus exit-site infection (0.28/year vs 0.43/year, p<0.001) and peritonitis (0.08/year vs 0.20/year, p<0.001) were lower in the noncarriers (patients with no positive nose cultures) than in those patients who had 1 or more positive nose cultures. Patients with only 1 positive nose culture had a similar S. aureus exit-site infection rate (0.31/year vs 0.28/year), but a higher peritonitis rate (0.24/year vs 0.08/year, p<0.001) compared to those petients with no positive nose cultures. However, patients with 2 or more positive nose cultures were at Increased risk for both S. aureus exit-site Infections and peritonitis. This relationship held even when only petients with frequent nose cultures were Included In the analysis. Thus patients with even 1 positive nose culture for S. aureus are at risk for S. aureus peritonitis and should not be classified as noncarriers.

Clinical Outcomes of Immediate Full-Volume Exchange One Year after Peritoneal Catheter Implantation for CAPD

2000 ◽  
Vol 20 (2) ◽  
pp. 194-199 ◽  
Author(s):  
Joon Ho Song ◽  
Gyeong A. Kim ◽  
Seoung Woo Lee ◽  
Moon-Jae Kim
Keyword(s):  
Peritoneal Dialysis ◽  
University Hospital ◽  
Peritoneal Catheter ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Catheter Implantation ◽  
Group 2 ◽  
One Year ◽  
Full Volume ◽  
Group 1

Objective To evaluate actual risk of complications and 1-year catheter survival of immediate full-volume 2000-mL dialysate exchange after peritoneal catheter implantation. Design and Setting A prospective randomized comparative study in a university hospital kidney center. Patients The study included 59 end-stage renal disease patients entering into a continuous ambulatory peritoneal dialysis program between January 1996 and December 1997. Interventions In group 1 ( n = 21), exchange volume was gradually increased from 500 mL per 3 hours to full-volume exchange over 13 days. In group 2 ( n = 38), full-volume exchange per 6 hours was performed from the day of catheter implantation. Bed rest with minimal activity was recommended for the first 3 days in both groups. Main Outcome Measures Occurrence of catheter-related complications such as dialysate leakage, drainage failure, malposition, infectious complications, and, ultimately, catheter loss were observed for 1 year. Results After straight Tenckhoff catheter implantation, pericatheter dialysate leaks occurred in 9.5% of group 1 and in 10.5% of group 2 patients (no significance, NS). Within 1 month of implantation, the incidences of tunnel or exit-site infection, catheter malposition, and outflow failure were not significantly different between the two groups. Abdominal discomfort was noted in 2 patients from group 2. Peritonitis occurred in 9.5% and 5.3% (NS) within 2 weeks of catheter implantation, and in 14.3% and 10.5% (NS) after more than 2 weeks in group 1 and group 2, respectively. Early catheter loss within 1 month occurred in 4.8% of patients in group 1 and 5.3% in group 2 (NS). The causes of loss were persistent leakage in group 1, and persistent leakage combined with tunnel infection and outflow failure in group 2. The duration of hospitalization from the day of catheter insertion to discharge was definitely shorter in group 2 compared to group 1 (9.9 ± 0.6 days vs 15.0 ± 0.8 days, p < 0.001). For 1-year follow-up, the frequencies of peritonitis were 0.062 ± 0.015/patient-month in group 1 and 0.076 ± 0.018/patient-month in group 2 (NS). The actual 1-year catheter survival was 85.7% in group 1 and 84.2% in group 2 (NS). Conclusions One-year catheter survival after immediate full-volume peritoneal dialysis exchange was 84.2%. This study did not show any evidence that immediate full-volume exchange causes more short- or long-term complications compared to the stepwise volume increment method.

scholarly journals Frequency and Microbiology of Peritonitis and Exit-Site Infection among Obese Peritoneal Dialysis Patients

2013 ◽  
Vol 33 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Sharon J. Nessim ◽  
Paul Komenda ◽  
Claudio Rigatto ◽  
Mauro Verrelli ◽  
Manish M. Sood
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Univariate Analysis ◽  
High Body Mass Index ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Multivariate Adjustment ◽  
Increased Risk ◽  
The Relationship

BackgroundData on obesity as a risk factor for peritonitis and catheter infections among peritoneal dialysis (PD) patients are limited. Furthermore, little is known about the microbiology of PD-related infections among patients with a high body mass index (BMI).MethodsUsing a cohort that included all adult patients residing in the province of Manitoba who received PD during the period 1997 – 2007, we studied the relationship between BMI and PD-related infections. After categorizing patients into quartiles of BMI, a multivariate Cox regression model was used to determine the independent relationship between BMI and peritonitis or exit-site infection (ESI). We also studied whether increasing BMI was associated with a propensity to infections with particular organisms.ResultsAmong 990 PD patients, 938 (95%) had accurate BMI data available. Those 938 patients experienced 1338 peritonitis episodes and 1194 exit-site infections. In unadjusted analyses, patients in the highest BMI quartile (median: 33.5; interquartile range: 31.9 – 36.4) had an increased risk of peritonitis overall, and also an increased risk of peritonitis with gram-positive organisms and coagulase-negative Staphylococcus (CNS). After multivariate adjustment for age, sex, diabetes, cause of renal disease, Aboriginal race, PD modality, and S. aureus nasal carriage, the relationship between overall peritonitis risk and BMI disappeared, but the increased risk of CNS peritonitis among patients in the highest BMI quartile persisted (hazard ratio: 1.80; 95% confidence interval: 1.06 to 3.06; p = 0.03). There was no increased risk of ESI among patients in the highest BMI quartile on univariate analysis or after multivariate adjustment.ConclusionsAmong Canadian PD patients, obesity was not associated with an increased risk of peritonitis overall, but may be associated with a higher risk of CNS peritonitis.

scholarly journals Relationship between initial peritoneal dialysis modality and risk of peritonitis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Maiko Kokubu ◽  
Masaru Matsui ◽  
Takayuki Uemura ◽  
Katsuhiko Morimoto ◽  
Masahiro Eriguchi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Lower Risk ◽  
Observational Studies ◽  
Primary Outcome ◽  
Propensity Scores ◽  
First Episode ◽  
Connection Type ◽  
Adjusted Model ◽  
The Relationship ◽  
Nara Prefecture

Abstract Peritonitis is a critical complication of peritoneal dialysis (PD). Investigators have reported the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) versus automated peritoneal dialysis (APD), but the available evidence is predominantly based on observational studies which failed to report on the connection type. Our understanding of the relationship between peritonitis risk and PD modality thus remained insufficient. We studied 285 participants who began PD treatment between 1997 and 2014 at three hospitals in Nara Prefecture in Japan. We matched 106 APD patients with 106 CAPD patients based on their propensity scores. The primary outcome was time to first episode of peritonitis within 3 years after PD commencement. In total, PD peritonitis occurred in 64 patients during the study period. Patients initiated on APD had a lower risk of peritonitis than did those initiated on CAPD in both the unadjusted and adjusted models. The hazard ratio (HR) and 95% confidence interval (CI) for the primary endpoint were 0.30 (0.17–0.53) in the fully adjusted model including connection type. In the matched cohort, APD patients had a significantly lower risk of peritonitis than did CAPD patients (log-rank: p < 0.001, HR 0.32, 95% CI 0.16–0.59). The weighting-adjusted analysis of the inverse probability of treatment yielded a similar result (HR 0.35, 95% CI 0.18–0.67). In conclusion, patients initiated on APD at PD commencement had a reduced risk of peritonitis compared with those initiated on CAPD, suggesting APD may be preferable for prevention of peritonitis among PD patients.

scholarly journals Overdiagnosis and overtreatment of nipple and breast candidiasis: A review of the relationship between diagnoses of mammary candidiasis and Candida albicans in breastfeeding women

2021 ◽  
Vol 17 ◽  
pp. 174550652110314
Author(s):  
Pamela Douglas
Keyword(s):  
Candida Albicans ◽  
Human Milk ◽  
Signs And Symptoms ◽  
Breast Pain ◽  
Breastfeeding Support ◽  
Candida Spp ◽  
Healthy Human ◽  
Nipple Areolar Complex ◽  
Areolar Complex ◽  
The Relationship

Background: Breastfeeding mothers commonly experience nipple pain accompanied by radiating, stabbing or constant breast pain between feeds, sometimes associated with pink shiny nipple epithelium and white flakes of skin. Current guidelines diagnose these signs and symptoms as mammary candidiasis and stipulate antifungal medications. Aim: This study reviews existing research into the relationship between Candida albicans and nipple and breast pain in breastfeeding women who have been diagnosed with mammary candidiasis; whether fluconazole is an effective treatment; and the presence of C. albicans in the human milk microbiome. Method: The author conducted three searches to investigate (a) breastfeeding-related pain and C. albicans; (b) the efficacy of fluconazole in breastfeeding-related pain; and (c) composition of the human milk mycobiome. These findings are critiqued and integrated in a narrative review. Results: There is little evidence to support the hypothesis that Candida spp, including C. albicans, in maternal milk or on the nipple-areolar complex causes the signs and symptoms popularly diagnosed as mammary candidiasis. There is no evidence that antifungal treatments are any more effective than the passage of time in women with these symptoms. Candida spp including C. albicans are commonly identified in healthy human milk and nipple-areolar complex mycobiomes. Discussion: Clinical breastfeeding support remains a research frontier. The human milk microbiome, which includes a mycobiome, interacts with the microbiomes of the infant mouth and nipple-areolar complex, including their mycobiomes, to form protective ecosystems. Topical or oral antifungals may disrupt immunoprotective microbial homeostasis. Unnecessary use contributes to the serious global problem of antifungal resistance. Conclusion: Antifungal treatment is rarely indicated and prolonged courses cannot be justified in breastfeeding women experiencing breast and nipple pain. Multiple strategies for stabilizing microbiome feedback loops when nipple and breast pain emerge are required, in order to avoid overtreatment of breastfeeding mothers and their infants with antifungal medications.

scholarly journals Covid-19 and acute conjunctivitis: Controversial data from a tertiary refferral Italian center

2021 ◽  
pp. 112067212199104
Author(s):  
Giuseppe D’Amico Ricci ◽  
Claudia Del Turco ◽  
Elena Belcastro ◽  
Marco Palisi ◽  
Mario R Romano ◽  
...  
Keyword(s):  
Emergency Department ◽  
Odds Ratio ◽  
Signs And Symptoms ◽  
Time Span ◽  
Nasopharyngeal Swab ◽  
Eye Disorders ◽  
Eye Examination ◽  
The Relationship ◽  
Acute Conjunctivitis ◽  
Piedmont Region

Purpose: Although acute conjunctivitis has been listed from the beginning as a possible sign of COVID-19, the likelihood of this association remains unclear. The aim of this study was to investigate the relationship between COVID-19 and conjunctivitis. Methods: In this retrospective, observational study, we recruited all patients with signs and symptoms of acute conjunctivitis seen at the Eye Emergency Department (ED), Turin Eye Hospital, between 01/01/2020 and 12/05/2020 and cross-checked our data with the Piedmont Region online COVID-19 registry in the same period. Results: Among 10,065 patients seen at our ED during the timespan considered, 88 underwent a nasopharyngeal swab (NS) for SARS-CoV-2 detection within 4 weeks before/after our examination. On average, NS was performed −0.72 ± 1.8 weeks before/after eye examination. Of the 77 patients with a negative NS, 26 (33.8%) had a diagnosis of acute conjunctivitis, whereas the remaining 51 (66.2%) had other eye disorders. Among the 11 patients with COVID-19, 7 (63,6%) had a diagnosis of acute conjunctivitis. We found a non-statistically significant increase in NS positivity rate (21.2%) among cases examined at our ED for acute conjunctivitis, compared to the NS positivity rate (7.3%) in patients examined for all other eye conditions ( p = 0.092). The Odds Ratio of having a positive NS in patients with acute conjunctivitis was 3.43 (95% I.C. = 0.9–12.8, p = 0.06). Considering online-registry data of Turin population during the same time-span, among 2441 positive NS cases only 27 (1.1%) presented with acute conjunctivitis. Conclusion: Our results do not reveal a statistically significant correlation between COVID-19 and acute conjunctivitis. Synopsis The present study analyzes retrospectively data from a tertiary eye referral center to investigate the relationship between COVID-19 infection and conjunctivitis.

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