Feasibility of percutaneous endoscopic gastrostomy insertion in children receiving peritoneal dialysis

2021 ◽  
pp. 089686082110576
Author(s):  
Caroline Kempf ◽  
Johannes Holle ◽  
Susanne Berns ◽  
Stephan Henning ◽  
Philip Bufler ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Demographic Data ◽  
Prophylactic Antibiotic ◽  
Antifungal Prophylaxis ◽  
Minimal Invasive ◽  
Single Centre ◽  
Endoscopic Gastrostomy ◽  
Simultaneous Surgery ◽  
End Stage

Background: Peritoneal dialysis (PD) is the preferred dialysis modality for paediatric patients with end-stage kidney disease. Frequently, malnutrition is encountered. Percutaneous endoscopic gastrostomy (PEG) is the preferred mode of feeding because of its minimal invasive mode of placement and easy handling in daily life. However, reports of a high risk for early post-interventional peritonitis hampered this procedure during PD and controlled studies on the benefit of peri-interventional management to prevent peritonitis are lacking. Here, we report the safety profile of PEG insertion among a cohort of children on PD by using a prophylactic antibiotic and antifungal regimen as well as modification of the PD programme. Methods: We performed a single-centre analysis of paediatric PD patients receiving PEG placement between 2015 and 2020. Demographic data, peri-interventional prophylactic antibiotic and antifungal treatment as well as modification of the PD programme were gathered and the incidence of peritonitis within a period of 28 days after PEG was calculated. Results: Eight PD patients (median weight 6.7 kg) received PEG insertion. Antibiotic and antifungal prophylaxis were prescribed for median time of 4.0 and 5.0 days, respectively. After individual reduction of PD intensity, all patients continued their regular PD programme after a median of 6 days. One patient developed peritonitis within 24 h after PEG insertion and simultaneous surgery for hydrocele. Conclusions: Applying an antibiotic and antifungal prophylactic regime as well as an adapted PD programme may reduce the risk for peritonitis in paediatric PD patients who receive PEG procedure.

Infection Prophylaxis in Peritoneal Dialysis Patients: Results from an Australia/New Zealand Survey

2017 ◽  
Vol 37 (2) ◽  
pp. 191-197 ◽  
Author(s):  
Denise J. Campbell ◽  
David W. Mudge ◽  
Martin P. Gallagher ◽  
Wai Hon Lim ◽  
Dwaraka Ranganathan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
New Zealand ◽  
Antifungal Prophylaxis ◽  
Catheter Insertion ◽  
Infection Prophylaxis ◽  
Infection Rates ◽  
Clinical Practices ◽  
Tenckhoff Catheter ◽  
Mupirocin Ointment ◽  
End Stage

BackgroundClinical practice guidelines aim to reduce the rates of peritoneal dialysis (PD)-related infections, a common complication of PD in end-stage kidney disease patients. We describe the clinical practices used by Australian and New Zealand nephrologists to prevent PD-related infections in PD patients.MethodsA survey of PD practices in relation to the use of antibiotic and antifungal prophylaxis in PD patients was conducted of practicing nephrologists identified via the Australia and New Zealand Society of Nephrology (ANZSN) membership in 2013.ResultsOf 333 nephrologists approached, 133 (39.9%) participated. Overall, 127 (95.5%) nephrologists prescribed antibiotics at the time of Tenckhoff catheter insertion, 85 (63.9%) routinely screened for nasal S. aureus carriage, with 76 (88.4%) reporting they treated S. aureus carriers with mupirocin ointment. Following Tenckhoff catheter insertion, 79 (59.4%) prescribed mupirocin ointment at the exit site or intranasally, and 93 (69.9%) nephrologists routinely prescribed a course of oral antifungal agent whenever their PD patients were given a course of antibiotics.ConclusionsAlthough the majority of nephrologists prescribe antibiotics at the time of Tenckhoff catheter insertion, less than 70% routinely prescribe mupirocin ointment and/or prophylactic antifungal therapy. This variation in practice in Australia and New Zealand may contribute to the disparity in PD-related infection rates that is seen between units.

P1193URGENT X EARLY START PERITONEAL DIALYSIS: PATIENTS´ PROFILE AND OUTCOMES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Viviane Calice-Siva ◽  
Helen Ferreira ◽  
Bruna Tonial ◽  
Izabel Ribeiro ◽  
Pedro Daudt ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Demographic Data ◽  
Dropout Rate ◽  
Catheter Insertion ◽  
Catheter Placement ◽  
Early Start ◽  
Fill Volume ◽  
Catheter Tip ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims In the last ten years, peritoneal dialysis (PD) has been considered a safe option to start renal replacement therapy (RRT) in end-stage renal disease patients in need to start dialysis urgently. The definition applied to the Urgent Start PD (US-PD) varies widely worldwide. Recently, it was proposed that US-PD definition should be according to patients’ necessity of starting dialysis, considering “urgent start” when PD started up to 72 hours of catheter placement and “early start” PD when it is starts between 3 and 14 days after catheter placement. Considering this new definition, we aimed to compare demographical and clinical characteristics of patients´ that started PD therapy as urgent and early starts as well as 30-day complications, 6-month hospitalization and dropout rate. Method All adult patients that started PD therapy up to 14 days after catheter insertion in our institution between October 2016 and February 2019 were included in the analyses. Patients were placed on urgent-start (US-PD) group if therapy started until 72-h after catheter insertion or early-start (ES-PD) group if PD initiated between 3 and 14 days. Dialysis records were reviewed to obtain clinical and demographic data, fill volume prescribed for the first PD session, 30-days complications (leakage, bleeding, catheter tip migration and peritonitis) and 6-month hospitalization and dropout rate. Results In our study, 72 patients were analyzed (US-PD=52, ES-PD=20), mean age was 53.2 ± 15.2 years old. No differences between US-PD and ES-PD regarding demographic characteristics, 30-day complications and 6-month hospitalization and dropout events were found. The most frequent short-term complication in patients who started PD urgently was leakage (US-PD 6 (11%) x ES-PD 2(10%) patients). The most common cause of patient’s dropout was transfer to HD.Only patients from the US-PD group needed to switch to that modality (5 (10%)). Conclusion Almost three-quarters of our sample started PD less than 72 hours after catheter insertion. The lack of difference in the measured outcomes compared to patients that had therapy initiated after this period encourages the use of PD when urgent dialysis is needed.

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