The Organization and Implementation of a Peritoneal Dialysis Program

1980 ◽  
Vol 1 (7) ◽  
pp. 134-136 ◽  
Author(s):  
Sheila Clayton
Keyword(s):  
Peritoneal Dialysis ◽  
Home Visits ◽  
Hospitalized Patients ◽  
Chronic Peritoneal Dialysis ◽  
Close Collaboration ◽  
Careful Planning ◽  
Dialysis Unit ◽  
Number Of Patients ◽  
Auxiliary Personnel ◽  
At Home

The organization of a chronic peritoneal dialysis program requires careful planning and close collaboration between nurses and doctors. In-center peritoneal dialysis should be used primarily for back-up dialysis of home PD patients with complications, and for those who cannot be dialyzed at home. If a unit has a large number of patients at home, it needs a larger number of in-center nurses to care for the increased numbers of hospitalized patients. The home peritoneal dialysis unit should be located near the center unit. The home nurses should be responsible for training, home visits, for clinics and for monthly tubing changes. The unit also needs a number of auxiliary personnel to complement the work of the training nurses.

A Survey of Home Visits at Peritoneal Dialysis Centers in the United States

1998 ◽  
Vol 18 (5) ◽  
pp. 528-531 ◽  
Author(s):  
Judith Bernardini ◽  
Carol Dacko
Keyword(s):  
United States ◽  
Peritoneal Dialysis ◽  
Home Visit ◽  
Mail Survey ◽  
Home Visits ◽  
The United States ◽  
Licensed Practical Nurse ◽  
Practical Nurse ◽  
Number Of Patients ◽  
Federal Administration

Objective To determine the frequency and characteristics of home visits in centers that provide training for peritoneal dialysis (PD). Design Mail survey sent to all dialysis centers in the United States providing home PD, using the Health Care Federal Administration (HCFA) Renal Provider list. Results Surveys were mailed to 1247 centers; 13 were undeliverable, resulting in 1234 surveys successfully delivered; 670 (54%) of those surveyed responded. Of those responding, 525 (78.4%) reported home visits were part of the care of home PD patients: 11% made a single home visit, 52% made an initial home visit with at least one followup visit, and 16% made visits only as needed. No home visits were made by 21% of responding centers. A registered nurse (RN) alone made the home visit in 61% of the centers, while a multidisciplinary team accompanied the RN in 35% of centers; 3% of visits were made by a licensed practical nurse, and 1% by the physician. Half of the visits required 0.5 -1 hour, while 41% required 1 -2 hours. Travel time was most often an hour or less one way. Staff were reimbursed for travel expenses by 90% of the centers. The 525 centers making home visits were not different than the 145 centers not making home visits in number of patients per center, number of RNs, rural or urban location, or affiliation with a university. Interpretation of the HCFA regulations concerning home visits was the most important factor influencing centers making home visits. Conclusions Home visits to continuous ambulatory PD and continuous cycling PD patients in the United States are common. Nearly 80% of centers responding to the survey include home visits in the care of their home peritoneal dialysis patients.

A Survey of Home Visits at Peritoneal Dialysis Centers in the United States

1998 ◽  
Vol 18 (5) ◽  
pp. 528-531 ◽  
Author(s):  
Judith Bernardini ◽  
Carol Dacko
Keyword(s):  
United States ◽  
Peritoneal Dialysis ◽  
Home Visit ◽  
Mail Survey ◽  
Home Visits ◽  
The United States ◽  
Licensed Practical Nurse ◽  
Practical Nurse ◽  
Number Of Patients ◽  
Federal Administration

Objective To determine the frequency and characteristics of home visits in centers that provide training for peritoneal dialysis (PD). Design Mail survey sent to all dialysis centers in the United States providing home PD, using the Health Care Federal Administration (HCFA) Renal Provider list. Results Surveys were mailed to 1247 centers; 13 were undeliverable, resulting in 1234 surveys successfully delivered; 670 (54%) of those surveyed responded. Of those responding, 525 (78.4%) reported home visits were part of the care of home PD patients: 11% made a single home visit, 52% made an initial home visit with at least one followup visit, and 16% made visits only as needed. No home visits were made by 21% of responding centers. A registered nurse (RN) alone made the home visit in 61% of the centers, while a multidisciplinary team accompanied the RN in 35% of centers; 3% of visits were made by a licensed practical nurse, and 1% by the physician. Half of the visits required 0.5 -1 hour, while 41% required 1 -2 hours. Travel time was most often an hour or less one way. Staff were reimbursed for travel expenses by 90% of the centers. The 525 centers making home visits were not different than the 145 centers not making home visits in number of patients per center, number of RNs, rural or urban location, or affiliation with a university. Interpretation of the HCFA regulations concerning home visits was the most important factor influencing centers making home visits. Conclusions Home visits to continuous ambulatory PD and continuous cycling PD patients in the United States are common. Nearly 80% of centers responding to the survey include home visits in the care of their home peritoneal dialysis patients.

Peritoneal Sclerosis in Chronic Peritoneal Dialysis Patients: Analysis of Clinical Presentation, Risk Factors, and Peritoneal Transport Kinetics

1997 ◽  
Vol 17 (2) ◽  
pp. 136-143 ◽  
Author(s):  
Pascale M.E.M. Hendriks ◽  
Marja M. Ho-Dac Pannekeet ◽  
Thomas M. Van Gulik ◽  
Dirk G. Struijk ◽  
Saphire S.K.S. Phoa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Bowel Obstruction ◽  
Control Group ◽  
Academic Medical Centre ◽  
Dialysis Unit ◽  
Presenting Symptoms ◽  
Peritoneal Transport ◽  
Number Of Patients ◽  
Glucose Exposure

Objective To analyze clinical features of peritoneal sclerosis (PS) in a group of peritoneal dialysis (PD) patients, and to compare potential risk factors and peritoneal transport characteristics with a control group matched for duration of PD. Design Study 1: Retrospective study of 16 PD patients with PS. Study 2: Case-control study comparing 10 patients with evident PS to 30 control patients who were matched for duration of PD. Setting Continuous Ambulatory Peritoneal Dialysis unit in the Academic Medical Centre in Amsterdam. Results The incidence of PS was 3.5 per 1000 patient years. PS was diagnosed either during PD (n = 10), in patients on hemodialysis (n = 2), or after successful transplantation (n = 4). Presenting symptoms were bowel obstruction, ascites, blood-stained effluent, and impaired net ultrafiltration. Macroscopic confirmation of the diagnosis was possible in 13 patients. Sclerotic encapsulation was present in 8 of them. Patients with PS were divided into three groups based on clinical symptoms and typical macroscopical findings. In category I the diagnosis PS was obvious (10 patients), in category II the diagnosis was highly suggestive (3 patients), and in category III it was doubtful (3 patients). Treatment was conservative in most patients. Surgical treatment was only possible in four and immunosuppressive therapy was given in 5 patients. Peritoneal sclerosis was the direct cause of death in 1 patient. Five patients died during follow-up due to other causes. At present, 7 patients are well and 3 patients (all from category I) still have recurrent bowel obstruction. Compared to matched controls, no difference existed in peritonitis incidence, or in the percentage of patients with former renal transplantations. The number of patients treated with β-blocking agents and the number of previous abdominal surgeries were not different. The number of catheter-related surgical procedures was higher in the PS patients than in the control group. The mass transfer area coefficient (MTAC) of creatinine was higher in PS patients and net ultrafiltration with 1.36% glucose was lower. The estimated cumulative glucose exposure until the diagnosis of PS was made was larger in PS patients than in their controls. This difference was already present in the first year of PD treatment in 8 of 10 patients. The initial values for the MTAC creatinine were similar in both groups. Conclusions The presenting symptoms of PS were bowel obstruction, ascites, and blood-stained effluent, often in combination with loss of net ultrafiltration. Peritoneal sclerosis is a complication of long-duration PD and could also become manifest after a successful renal transplant. Treatment should be conservative unless complications require surgical intervention. Patients with PS had lower net ultrafiltration and higher transport rates compared to controls who were matched for duration of PD. Although peritonitis incidence was similar, a relation of PS with severe peritonitis may be present in some patients. Glucose exposure is likely to be an important risk factor for PS.

Emergence of Mupirocin-Resistant Staphylococcus Aureus in Chronic Peritoneal Dialysis Patients using Mupirocin Prophylaxis to Prevent Exit-Site Infection

2001 ◽  
Vol 21 (6) ◽  
pp. 554-559 ◽  
Author(s):  
Rajeev Annigeri ◽  
John Conly ◽  
Stephen I. Vas ◽  
Helen Dedier ◽  
Kannam P. Prakashan ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Chronic Peritoneal Dialysis ◽  
Site Infection ◽  
Exit Site ◽  
Total Study Population ◽  
Exit Site Infection ◽  
Dialysis Unit ◽  
Mannitol Salt Agar ◽  
High Level

Objective To determine the prevalence of the carriage of Staphylococcus aureus (SA), methicillin-resistant Staphylococcus aureus (MRSA), and mupirocin-resistant Staphylococcus aureus (MuRSA) in chronic peritoneal dialysis (CPD) patients after 4 years of prophylactic mupirocin application to the exit site, in a peritoneal dialysis unit. Methods Three swabs were collected from the nares, axillae/groin, and exit site, respectively, from 149 patients on CPD between May and July 2001. All swabs were cultured on solid selective agar (mannitol salt agar) and in mannitol salt broth. Staphylococcus aureus isolates were tested for methicillin resistance using oxacillin screening plates, and mupirocin resistance using E-test strips. Low-level MuRSA was defined as minimum inhibitory concentration (MIC) of 4 mg/mL or more, and high-level MuRSA as MIC of 256 mg/mL or more. Results Staphylococcus aureus was isolated from 26 (17%) patients (25 from nares/axilla/groin, and 1 from the exit site). High-level MuRSA was isolated from 4 patients (3% of the total study population; 15% of total SA isolates). No MRSA was detected. One patient with high-level MuRSA had peritonitis due to SA, resulting in treatment failure and catheter loss, soon after the swabs were collected for the study. Conclusion We report the emergence of high-level MuRSA in CPD patients after a 4-year practice of continuous use of mupirocin in a small number of patients in our unit. Our results may have significant implications for the future practice of prophylactic use of mupirocin by CPD patients to prevent exit-site infection.

Development of the “Peritoneal Dialysis First” Model in Hong Kong

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 53-55 ◽  
Author(s):  
Alex Wai-Yin Yu ◽  
Ka-Foon Chau ◽  
Yiu-Wing Ho ◽  
Philip Kam-Tao Li
Keyword(s):  
Hong Kong ◽  
Peritoneal Dialysis ◽  
Survival Rates ◽  
Chronic Hemodialysis ◽  
Dialysis Unit ◽  
Number Of Patients ◽  
Maintenance Dialysis ◽  
The 1960S ◽  
Stage Renal Disease ◽  
End Stage

Maintenance dialysis is an expensive treatment modality for patients with end-stage renal-disease (ESRD). The number of patients on maintenance dialysis is rising rapidly and will reach 2.5 million globally by 2010. The predicted expenditure will be US$1 trillion. Since the 1960s, Hong Kong has faced financial restraints on the provision of dialysis. Continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis at home were found to be less expensive than in-centre chronic hemodialysis. The development of a “peritoneal dialysis first” (PD-First) policy has contributed significantly to a successful dialysis program in Hong Kong since 1960. Currently in Hong Kong, 80% of ESRD patients on maintenance dialysis are on PD, mainly CAPD; 20% are on hemodialysis. The success of the PD-First policy is a combination of accumulated experience of PD in each dialysis unit that has at least 200 CAPD patients under care and of impressive technique and patient survival rates for this modality. Concerted effort by government and charity organizations and commitment on the part of nephrologists and nursing staff to patient education are also important in making the PD program in Hong Kong a successful one.

scholarly journals Effectiveness of Home Visits to Pediatric Peritoneal Dialysis Patients

2012 ◽  
Vol 32 (4) ◽  
pp. 419-423 ◽  
Author(s):  
Eileen N. Ellis ◽  
Christine Blaszak ◽  
Sherida Wright ◽  
Andrea Van Lierop
Keyword(s):  
Peritoneal Dialysis ◽  
Home Visit ◽  
Pediatric Patients ◽  
Clinical Care ◽  
Home Visits ◽  
Home Dialysis ◽  
Number Of Patients ◽  
Continuous Cycling ◽  
Trained Personnel ◽  
The Cost

Home visits by trained personnel to patients undergoing home dialysis are required, but little is reported about the effectiveness of such home visits. We retrospectively reviewed home visits to 22 pediatric patients undergoing continuous cycling peritoneal dialysis (PD) at home. A trained dialysis nurse completed each home visit. An average of 1.5 pertinent dialysis findings and 1 pertinent medication finding was noted for each home visit to these patients. The interdisciplinary dialysis team reviewed the home visit findings and made specific recommendations after each home visit. In addition, the training process has been enhanced to incorporate visit findings for future home PD patients. Although not statistically significant in this small number of patients, peritonitis rates declined in the 6 months after initiation of the home visit program. The average cost for a dialysis nurse to complete a home visit is less than the cost of antibiotics for 1 episode of peritonitis. Home visits are valuable for improving clinical care in pediatric patients on home PD.

Outpatient management of malignant ascites using ultrasound, a trocar, and a Tenckhoff catheter

1992 ◽  
Vol 2 (4) ◽  
pp. 175-178 ◽  
Author(s):  
D. S. Young ◽  
S. S. Lentz ◽  
R. J. Barrett ◽  
H. D. Homesley ◽  
J. S. Moore
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Malignant Ascites ◽  
Chronic Peritoneal Dialysis ◽  
Outpatient Management ◽  
Sonographic Guidance ◽  
Tenckhoff Catheter ◽  
Blind Insertion ◽  
Surgical Implantation ◽  
At Home

The Tenckhoff catheter provides useful access to the peritoneal cavity for chronic peritoneal dialysis and treatment of intraperitoneal malignancy. The usual methods of placement of Tenckhoff catheters include: blind insertion, open surgical implantation and peritoneoscopic guided placement. This is a description of a technique for percutaneous introduction using a trocar. Sonographic guidance is used to assure a safe insertion and proper location. This technique has been used in the office to provide access to the peritoneal cavity to allow palliative management of massive, intractable malignant ascites. The patient or selected caretaker can care for and access the catheter intermittently at home for relief of symptoms.

Adiponectin Levels and Atherosclerotic Risk Factors in Pediatric Chronic Peritoneal Dialysis Patients

2005 ◽  
Vol 25 (4) ◽  
pp. 357-361 ◽  
Author(s):  
Sevcan A. Bakkaloglu ◽  
Necla Buyan ◽  
Tohru Funahashi ◽  
Hatice Pasaoglu ◽  
Atilla H. Elhan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Apolipoprotein B ◽  
University Hospital ◽  
Chronic Peritoneal Dialysis ◽  
Cross Sectional ◽  
Dialysis Unit ◽  
Lipoprotein A ◽  
Control Subjects ◽  
Significant Difference

Background Atherosclerotic vascular diseases are the major cause of mortality in patients with end-stage renal disease (ESRD) treated with chronic peritoneal dialysis (CPD), even in children. Adiponectin (ADPN) is a recently discovered adipocyte-derived plasma protein having anti-atherogenic properties. ADPN levels are elevated in ESRD but it has been reported that ESRD patients with low plasma ADPN levels have a high risk of cardiovascular death. Objective To clarify the atherosclerotic risk and especially the significance of ADPN levels in pediatric patients on CPD. Design Cross-sectional study in the pediatric peritoneal dialysis unit of a university hospital. Patients 18 children, aged 12.6 ± 5.6 years, being treated with CPD and 20 healthy age- and sex-matched control subjects were enrolled in this study. Methods Serum ADPN levels and other risk factors, including blood pressure, blood glucose, serum lipid/lipoprotein fractions, apolipoprotein B, C-reactive protein (CRP), lipoprotein(a), and homocysteine levels, were studied in CPD patients and compared to the controls. Results Serum ADPN levels were three times higher in the CPD group compared to the control subjects, as was previously reported. Apolipoprotein B and CRP levels were also high in the CPD group. No significant difference was found in other atherosclerotic parameters, including lipoprotein(a) and homocysteine levels. Interestingly, we found a negative correlation between log ADPN and creatinine levels among the CPD patients ( r = –0.54, p < 0.05). There was no correlation between log ADPN and duration of CPD. Creatinine and low-density lipoprotein levels could account for 54% of the total variation in ADPN levels. Conclusion Among pediatric CPD patients, serum levels of the anti-atherogenic protein, ADPN, were inversely associated with creatinine. ADPN level might be a novel marker to predict prognosis in pediatric CPD patients.

Peritoneal Transport Kinetics of Proteins in Children on Chronic Peritoneal Dialysis

2003 ◽  
Vol 23 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Klaus Arbeiter ◽  
Regina Stemberger ◽  
Laurence Greenbaum ◽  
Thomas Mueller ◽  
Andrea Konstantin ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Close Correlation ◽  
Cross Sectional Study ◽  
Transport Kinetics ◽  
Chronic Peritoneal Dialysis ◽  
Cross Sectional ◽  
Dialysis Unit ◽  
Pediatric Dialysis ◽  
Molecular Weights ◽  
Peritoneal Transport

Objective This study describes a modified 4-hour peritoneal equilibration test (PET) for analyzing peritoneal transport characteristics of proteins with different molecular weights and predicting daily peritoneal protein losses in children on chronic peritoneal dialysis (PD). Design Cross-sectional study. Setting A single regional pediatric dialysis unit in a teaching hospital. Patients 9 stable pediatric dialysis patients; 4 were on continuous ambulatory PD, 5 were on continuous cycling PD. Main Outcome Measures Serum and dialysate concentrations of IgG, albumin, β2-microglobulin, and transferrin were determined during a PET. Changes in dialysate-to-plasma (D/P) ratios were determined hourly. Agreement between PET-derived and measured daily peritoneal protein losses was examined. Results The D/P ratio decreased with increased molecular radius ( p < 0.0001). Many children had low plasma levels of IgG, albumin, and transferrin, but elevated levels of β2-microglobulin. The D/P ratio increased linearly during the PET for all measured proteins, regardless of molecular weight. There was close correlation between 4-hour PET protein losses and 24-hour losses during routine PD. Conclusions Proteins are lost through the peritoneum according to their size, demonstrating linear transport kinetics during a 4-hour PET. The PET-derived data predicted daily protein losses in children on chronic PD. This approach might help to eliminate inaccuracies due to incomplete dialysate collection.

scholarly journals Chronic Peritoneal Dialysis in Children with Special Needs or Social Disadvantage or Both: Contraindications are not Always Contraindications

2012 ◽  
Vol 32 (4) ◽  
pp. 424-430 ◽  
Author(s):  
Nejat Aksu ◽  
Onder Yavascan ◽  
Murat Anil ◽  
Orhan Deniz Kara ◽  
Alkan Bal ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Special Needs ◽  
Vesicoureteral Reflux ◽  
Psychosocial Problems ◽  
Infectious Complications ◽  
Social Disadvantage ◽  
Children With Special Needs ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Unit ◽  
Children With Disability

ObjectiveOur aim in the present study was to identify outcomes in children with special needs or social disadvantage, or both, receiving chronic peritoneal dialysis (CPD) treatment in a pediatric dialysis unit.MethodsAmong 110 children started on CPD in our unit during the period between November 1995 and November 2008, we identified 13 patients (8 girls, 5 boys) with major physical, mental, or psychosocial problems. Age at CPD initiation in the group with disability ranged from 4.0 years to 16.5 years (median: 7.5 years). Under lying diseases were vesicoureteral reflux (4 patients), neuropathic bladder and vesicoureteral reflux (3 patients), chronic pyelonephritis (3 patients), amyloidosis (2 patients), and Alport syndrome (1 patient). Challenges encountered were adverse family or social circumstances (4 patients), cerebral palsy (3 patients), Down syndrome (1 patient), rectovesical fistula in conjunction with ectopic anus and previous multiple abdominal surgery (1 patient), blindness and deafness (1 patient), ventriculoperitoneal shunt (1 patient), colostomy and malnutrition (1 patient), and mental retardation and blindness (1 patient). All catheters were implanted percutaneously.ResultsMedian duration of dialysis was 18 months (range: 6 – 124 months). The frequency of peritonitis was not different between children with and without disability ( p > 0.05). In children with disability compared with children without disability, the frequencies of catheter- related infections (1 episode/79.3 patient–months vs 1 episode/32.4 patient–months) and of catheter-related non-infectious complications (1 episode/238 patient–months vs 1 episode/115.7 patient–months) were lower ( p < 0.05). Chronic peritoneal dialysis was terminated in 5 children (for renal transplantation in 3, switch to hemodialysis in 1, death in 1).ConclusionsOur results suggest that, with appropriate family support and an experienced multidisciplinary team, CPD can be effectively performed in children with special needs or social disadvantage, or both.

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