Peritoneal Dialysis in the Pacific

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 448-451 ◽  
Author(s):  
Margaret J. King
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Practice ◽  
Medical Condition ◽  
Tertiary Education ◽  
Research Quality ◽  
Exit Site Infection ◽  
Home Dialysis ◽  
The Pacific ◽  
Number Of Patients ◽  
Management Issues

Peritoneal dialysis (PD) in the Pacific is the predominant dialysis modality for home dialysis patients. Patient location, age, personal preference, and medical condition are all taken into consideration. However, with the steadily increasing number of patients on PD, financial constraints are now affecting the nurse-patient ratios. As a consequence, PD nurses are constantly seeking new and improved clinical practice regimes with which they can provide and maintain quality, cost-effective nursing care. To enable PD nurses to provide such care, they are now, more than ever, Involved in patient, professional, and management issues. These patient issues include, but are not limited to: the elderly, the diabetic, the indigenous patient, and their carers, peritonitis, exit-site infection, and adequate dialysis. Professional issues include the development of standards of clinical practice, nursing research, quality improvement, and tertiary education. Management issues are constantly encroaching into the clinical practice setting, therefore the PD nurse must now justify spending, develop strategic plans, and meet annual budgets. In conclusion, it can be seen that PD nurses in the Pacific are faced with similar patient-care, professional, and management issues as their counterparts throughout the world.

Peritoneal Dialysis in Adult Patients with Permanent Suprapubic Catheter: A Single-Center Experience and Literature Review

2018 ◽  
Vol 38 (6) ◽  
pp. 424-429 ◽  
Author(s):  
Abdullah K. Al-Hwiesh ◽  
Ibrahiem Saeed Abdul-Rahman ◽  
Mohammad Ahmed Nasr El-Din ◽  
Amani Al-Hwiesh ◽  
Aisha Alosail ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Suprapubic Catheter ◽  
Site Infection ◽  
Single Center ◽  
Exit Site ◽  
Exit Site Infection ◽  
Single Center Experience ◽  
Number Of Patients ◽  
The Difference

Background The aim of this paper was to review the feasibility of peritoneal dialysis (PD) in the presence of a permanent supra-pubic catheter over a long follow-up period. Methods Twelve patients with automated PD and permanent suprapubic catheters were studied for complications over a period of 10 years. Results In all 12 patients, PD went smoothly. Two of our patients required removal of the PD catheter due to peritonitis. The overall rate of exit-site infection throughout the study was 41.7/patient-month and the difference between patients 60 years or older and those 25 years or younger was not significant ( p = 0.3673). The overall peritonitis rate for all patients was 38.3 episode/patient-month, and none of the patients with ventriculoperitoneal shunt (VPS) had peritonitis. All patients with episodes of infection responded well to the proper antibiotics. Conclusions The available data supported the feasibility of PD in patients with permanent suprapubic catheters; however, a greater number of patients with a longer follow-up period need to be studied to support our results.

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.

Repeat Peritoneal Dialysis Exit-Site Infection: Definition and Outcomes

2019 ◽  
Vol 39 (4) ◽  
pp. 344-349 ◽  
Author(s):  
Hannah Beckwith ◽  
Michelle Clemenger ◽  
Jacqueline McGrory ◽  
Nora Hisole ◽  
Titus Chelapurath ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Peritoneal Dialysis ◽  
Dialysis Modality ◽  
Site Infection ◽  
Exit Site ◽  
Retrospective Case ◽  
Exit Site Infection ◽  
Catheter Exchange ◽  
Number Of Patients

BackgroundThe most common complication of peritoneal dialysis (PD) is infection. Despite this, there are no clear guidelines for the management of repeat exit-site infection (ESI), and best practice is not known. We describe our unit's experience of repeat ESI and clinical outcomes in this cohort.MethodsRetrospective case note review of all PD patients with positive ESI swabs at our center between 1 January 2012 and 1 January 2018. Patients were included in the study if they had 2 or more ESI with the same organism within a 12-month period and an initial positive response to antibiotic therapy.ResultsOverall, 31 of 248 patients had repeat ESI. The 2 most common causative organisms were Staphylococcus aureus ( n = 16, 52%) and Pseudomonas aeruginosa ( n = 10, 32%). Twenty (65%) patients developed subsequent peritonitis. The infection resolved with further antibiotics alone in 10 (32%) patients and in 6 patients after PD catheter exchange. The PD catheter was removed in 16 (52%) patients (including 5 after an initial catheter exchange) requiring transfer to hemodialysis (HD). Six (19%) patients died within 12 months of repeat ESI. Both repeat Pseudomonas aeruginosa and Staphylococcus aureus infections were associated with high rates of dialysis modality change (70% and 50%, respectively).ConclusionWe have developed the first definition for repeat ESI. Repeat ESI is clinically important and results in significant morbidity and mortality. Following repeat ESI, peritonitis rates are high and a significant number of patients switch dialysis modality. Studies are needed to determine whether interventions such as early catheter exchange would improve outcomes.

scholarly journals HOME DIALYSIS DURING COVID-19 OUTBREAK– IT IS WORTH TO CONSIDER

2020 ◽  
Vol 73 (10) ◽  
pp. 2316-2318
Author(s):  
Paweł Żebrowski ◽  
Jacek Zawierucha ◽  
Wojciech Marcinkowski ◽  
Tomasz Prystacki ◽  
Inga Chomicka ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Medical Personnel ◽  
Medical Facility ◽  
Immune Disorders ◽  
Dialysis Patients ◽  
Home Hemodialysis ◽  
Home Dialysis ◽  
Number Of Patients

The epidemic with the new SARS-CoV-2 virus poses a serious threat to patients treated with renal replacement therapy. Besides clinical risk factors (such as numerous comorbidities, immune disorders), dialysis patients are additionally exposed to the virus through regular stays for several hours in a dialysis center and ambulance journeys. In such an epidemiological situation, it seems that peritoneal dialysis and home hemodialysis are good alternatives for treatment. Currently available telemedicine and medical technologies allow for effective renal replacement therapy also outside dialysis centers. Thanks to this, it is possible to limit the stay of patients in a medical facility to clinically justified situations. For this reason, increasing the number of patients treated with peritoneal dialysis, which is carried out at home and without contact with medical personnel, seems to be a good solution. Enabling patients to undergo home hemodialysis treatment, nowadays unavailable in Poland and establishing it as a guaranteed benefit in the health care system will enable renal replacement therapy to be adapted to the clinical condition and the need for isolation.

scholarly journals Home dialysis and Covid-19 in french speaking countries (RDPLF data-base)

2021 ◽  
Vol 4 (3) ◽  
pp. 227-237
Author(s):  
Christian Verger ◽  
Emmanuel Fabre ◽  
Pierre-Yves Durand ◽  
Jacques Chanliau ◽  
Isabelle Vernier ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Data Base ◽  
Dialysis Patients ◽  
Home Hemodialysis ◽  
Home Dialysis ◽  
Number Of Patients ◽  
French Speaking ◽  
Surgical Teams ◽  
At Home

Aims of the study: to assess the frequency of symptomatic Covid-19 in home dialysis patients and its influence on the number of patients treated at home in dialysis units of centers included in the French-speaking peritoneal and home hemodialysis Registry (RDPLF). Focus is placed on patients treated by peritoneal dialysis (PD) in mainland France. Results: in home hemodialysis (HHD)the incidence is 6% in Belgium and 4.8% in mainland France. On peritoneal dialysis it is 10.6% in Belgium, 6.7% in mainland France, 10.8% in Morocco and 11.5% in Tunisia. Lethality is less than 5% in HHD and between 8.4% and 42.7% in PD depending on age and associated comorbidities. In France, the percentage of patients who have had symptomatic Covid-19 is lower on home dialysis, all methods combined. Nevertheless, among the home methods, the higher frequencies and severities are observed in mainland France in home assisted PD: these are the oldest and most co-morbid patients. Transfers from PD to in center hemodialysis have increased during Covid-19 pandemic while the number of transplants has decreased. Conclusion: if the drop in the number of transplants can be explained by a reduced availability of operating theaters and surgical teams during a pandemic period, it is paradoxical that the prescription of home dialysis, which should be supposed to limit the risk of contagion, has decreased. More investigation should be performed to understand this paradox.  

Features of the complex treatment of ulcerative colitis in clinical practice

2020 ◽  
pp. 6-11
Author(s):  
Svetlana Svetlana ◽  
Mikhail Klimentov ◽  
Olga Neganova ◽  
Alina Nazmieva ◽  
Anastasiya Kochurova
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Practice ◽  
Statistical Study ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
Unknown Etiology ◽  
Number Of Patients ◽  
First Republic ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Nowadays there are certain difficulties in the early diagnosis of ulcerative colitis, proceeding with minimal intestinal symptoms. The etiology of the disease remains unclear to this day; there is no exact information about the prevalence of the disease due to the large number of latent forms and the low number of patients seeking medical help. This article presents the results of a retrospective analysis of the incidence of ulcerative colitis in the coloproctology department of the First Republic Clinical Hospital of Izhevsk. The study was conducted to assess the frequency of occurrence and determine the internal picture of ulcerative colitis. To achieve this goal, we selected 34 patients with ulcerative colitis. A statistical study was conducted on the following criteria: gender composition, age groups, forms of the disease, localization, complications, and main complaints. The length of hospital stay often was not more than 20 days. The literature on this pathology was also studied and presented in the form of a theoretical basis, which consisted of the determination and etiology of inflammatory bowel diseases. Due to the unknown etiology, insufficiently studied pathogenesis, difficult differential diagnosis with other intestinal diseases and insufficiently perfect treatment methods, there are a large number of unresolved problems in the field of ulcerative colitis. That is why, in this article we tried to reveal the problem of the features of the course and complex therapy of that disease in clinical practice.

Imaging of Bacteria: Is there Any Hope for the Future Based on Past Experience?

2018 ◽  
Vol 24 (7) ◽  
pp. 772-786 ◽  
Author(s):  
Thomas Ebenhan ◽  
Elena Lazzeri ◽  
Olivier Gheysens
Keyword(s):  
Clinical Practice ◽  
Sterile Inflammation ◽  
Ageing Population ◽  
Major Health Problem ◽  
Major Health ◽  
Number Of Patients ◽  
Implanted Medical Devices ◽  
Neutropenic Patients ◽  
Socio Economic Impact ◽  
Made In

Infectious diseases remain a major health problem and cause of death worldwide. It is expected that the socio-economic impact will further intensify due to escalating resistance to antibiotics, an ageing population and an increase in the number of patients under immunosuppressive therapy and implanted medical devices. Even though radiolabeled probes and leukocytes are routinely used in clinical practice, it might still be difficult to distinguish sterile inflammation from inflammation caused by bacteria. Moreover, the majority of these probes are based on the attraction of leukocytes which may be hampered in neutropenic patients. Novel approaches that can be implemented in clinical practice and allow for swift diagnosis of infection by targeting the microorganism directly, are posing an attractive strategy. Here we review the current strategies to directly image bacteria using radionuclides and we provide an overview of the preclinical efforts to develop and validate new approaches. Indeed, significant progress has been made in the past years, but very few radiopharmaceuticals (that were promising in preclinical studies) have made it into clinical practice. We will discuss the challenges that remain to select good candidates for imaging agents targeting bacteria.

scholarly journals Late Thrombectomy in Clinical Practice

2021 ◽  
Author(s):  
Moriz Herzberg ◽  
Korbinian Scherling ◽  
Robert Stahl ◽  
Steffen Tiedt ◽  
Frank A. Wollenweber ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Outcome ◽  
Perfusion Imaging ◽  
Time Window ◽  
Ct Perfusion ◽  
Large Trial ◽  
Real World Data ◽  
Baseline Trial ◽  
Good Outcome ◽  
Number Of Patients

Abstract Background and Purpose To provide real-world data on outcome and procedural factors of late thrombectomy patients. Methods We retrospectively analyzed patients from the multicenter German Stroke Registry. The primary endpoint was clinical outcome on the modified Rankin scale (mRS) at 3 months. Trial-eligible patients and the subgroups were compared to the ineligible group. Secondary analyses included multivariate logistic regression to identify predictors of good outcome (mRS ≤ 2). Results Of 1917 patients who underwent thrombectomy, 208 (11%) were treated within a time window ≥ 6–24 h and met the baseline trial criteria. Of these, 27 patients (13%) were eligible for DAWN and 39 (19%) for DEFUSE3 and 156 patients were not eligible for DAWN or DEFUSE3 (75%), mainly because there was no perfusion imaging (62%; n = 129). Good outcome was not significantly higher in trial-ineligible (27%) than in trial-eligible (20%) patients (p = 0.343). Patients with large trial-ineligible CT perfusion imaging (CTP) lesions had significantly more hemorrhagic complications (33%) as well as unfavorable outcomes. Conclusion In clinical practice, the high number of patients with a good clinical outcome after endovascular therapy ≥ 6–24 h as in DAWN/DEFUSE3 could not be achieved. Similar outcomes are seen in patients selected for EVT ≥ 6 h based on factors other than CTP. Patients triaged without CTP showed trends for shorter arrival to reperfusion times and higher rates of independence.

scholarly journals Repeat exit site infection in peritoneal dialysis patient with polycythemia vera – a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Edyta Gołembiewska ◽  
Kazimierz Ciechanowski
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Peritoneal Dialysis ◽  
Case Report ◽  
Polycythemia Vera ◽  
Significant Risk ◽  
Renal Amyloidosis ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
First Case

Abstract Background Infectious complications of peritoneal dialysis (PD) remain a common cause of catheter loss and discontinuation of PD. Exit site infection (ESI) constitutes a significant risk factor for PD-related peritonitis and determination of predisposing states is relevant. We here present a case of repeat ESI due to Pseudomonas aeruginosa in a PD patient with skin changes in the course of polycythemia vera (PV). Case presentation A 73-year-old PD patient with chronic kidney disease secondary to renal amyloidosis and ankylosing spondylitis, presented to the nephrology unit with signs of ESI. In 2006 he was diagnosed with PV and since then has was successfully treated with hydroxyurea; however, he reported recurrent episodes of developing skin nodules in the course of the disease. Exit site swab yielded Pseudomonas aeruginosa and the infection developed in the ulcerated PV nodule that appeared in exit site 2 weeks earlier. Patient was treated with intraperitoneal amikacin and oral ciprofloxacin, however, due to neurological complications, the treatment had to be interrupted and finally catheter was removed. Similar episode of ESI with Pseudomonas aeruginosa developed in the patient two years earlier and also required catheter removal. Conclusion This is the first case report demonstrating the development of ESI on the polycythemia vera skin lesion in this area. Skin manifestations of PV might be a predisposing factor to ESI in PD patients.

Exit-Site Infection during Continuous and Cycling Peritoneal Dialysis in Children

1990 ◽  
Vol 10 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Maurice Levy ◽  
J. Williamson Balfe ◽  
Dennis Geary ◽  
Sue Fryer-Keene ◽  
Robert Bannatyne
Keyword(s):  
Peritoneal Dialysis ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Daily Dialysis ◽  
Pseudomonas Species ◽  
Before And After ◽  
Species Being ◽  
Catheter Replacement

A 10-year retrospective review of pediatric patients on peritoneal dialysis showed that 50 of 83 had 132 episodes of exit-site infection (ESI). Thirty-nine episodes were purulent. The most prevalent organism was Staphylococcus aureus. Staphylococcus epidermidis was also common, usually occurring in purulent infections. Gramnegative organisms were responsible for 23 ESls, with Pseudomonas species being the most common. Age, sex, concomitant primary disease type, length of training, dressing techniques, quality of daily dialysis technique, use of diapers, and pyelostomies did not affect the incidence of ESI. However, 40% of children with a skin infection from other sites had associated peritoneal catheter ESI. Thirty-eight episodes of ESI in 28 patients resulted in peritonitis; the main organisms involved were Staphylococcus and Pseudomonas species. Catheters were replaced in 13 patients with peritonitis, but there was no difference in the incidence of ESI before and after catheter replacement.

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