Optimization of Abdominal Cavity Limitation Method for Prolongation of Peritoneal Dialysis in Experiment

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.

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Peritonitis Associated with Intra-Abdominal Pathology in Continuous Ambulatory Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686089301302s83 ◽

1993 ◽

Vol 13 (2_suppl) ◽

pp. 335-337 ◽

Cited By ~ 33

Author(s):

Antonios H. Tzamaloukas ◽

Leo E. Obermiller ◽

Laurence J. Gibel ◽

Glen H. Murata ◽

Barbara Wood ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Abdominal Cavity ◽

Severe Infection ◽

Exploratory Laparotomy ◽

Enteric Pathogens ◽

Severe Malnutrition ◽

Diagnostic Features ◽

Free Air ◽

Bowel Gangrene

Features helpful in diagnosis and associated with death were evaluated In 26 episodes of peritonitis associated with intra-abdominal pathology (IAP) In continuous ambulatory peritoneal dialysis (CAPD) patients. Culture of multiple enteric pathogens, or of a single unusual enteric pathogen, from the dialysate was useful for diagnosis in 22/26 instances. Other diagnostic features (fecal material in dialysate, diarrhea containing dialysate, Increasing free air in the abdominal cavity) were infrequently found. A comparison of patients who died (n=11, 42%) and those who survived revealed that death was associated with bowel gangrene (5/6 died), recovery of bacteroides from the dialysate, more frequent and severe comorbid conditions (bacteremia, pneumonia, intra-abdominaland intracerebral bleeding, septic shock, hepatic failure), the development of severe malnutrition and thrombocytopenia during infection, and multiple surgical procedures until the diagnosis was established. Peritonitis associated with intra-abdominal pathology In CAPD patients is a severe infection with considerable diagnostic difficulty and high mortality. Early exploratory laparotomy upon suspicion of the nature of the peritonitis, usually raised by the recovery of enteric pathogens from the dialysate, may improve mortality.

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Surgical Complications during Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686088500500110 ◽

1985 ◽

Vol 5 (1) ◽

pp. 39-42 ◽

Cited By ~ 16

Author(s):

Giovanni Valenti ◽

Donata Cresseri ◽

Maria Luisa ◽

Bianchi Enzo ◽

Corghi Marc Lorenz ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Surgical Complications ◽

Abdominal Cavity ◽

Temporary Change ◽

Elderly Males ◽

Group A ◽

Main Factors ◽

Group B ◽

Diaphragmatic Hernias

In 30 patients (20 males and 10 females) undergoing CAPD, we observed 15 catheter-related complications -group A: leakage, dislodgement, slipping-out, protrusion of the external cuff, hemoperitonitis, and eight abdominal-cavity complications -group B: umbilical, inguinal, incisional and diaphragmatic hernias. Group A complications which occurred in 30% of the men and 80% of the women (mean age 47.2 ± 9) were easy to manage; group B complications developed mainly in elderly males (seven men and one woman, mean age 61.4 ± 5); these required temporary change of mode of dialysis in three, and permanent transfer from CAPD in two. From this review we have concluded that loss of anatomical integrity of the abdominal cavity is one of the main factors which prevents the continuation of CAPD.

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Modification of laparoscopic catheter setting for peritoneal dialysis in patients with chronic kidney disease

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2019-23(1)-28 ◽

2019 ◽

Vol 23 (1) ◽

pp. 159-162

Author(s):

A. B. Kebkalo ◽

A. O. Reyti ◽

V. V. Gryanila ◽

I. M. Yatsyk

Keyword(s):

Peritoneal Dialysis ◽

Abdominal Cavity ◽

Outer Edge ◽

Parietal Peritoneum ◽

Laparoscopic Technique ◽

Catheter Migration ◽

Camera Port ◽

Point Of Entry ◽

Tunnel Infection ◽

Surgical Tactics

Reducing the complications of the peritoneal dialysis (PD) procedure prolongs its use. The purpose of the work was to justify prolongation of peritoneal dialysis by modifying its setting. The study included 54 patients with chronic renal insufficiency, they carried out laparoscopic setting of PD; 14 patients were with omentopexy and 40 – with a classical statement. The operation was performed under general anesthesia. Surgical tactics were as follows: omentum folds were fixed to the parietal peritoneum; the control catheter was inserted through the window into the mesentery of the colon, and the dialysis portion at the bottom of the pelvis; sutured the window of the mesentery of the colon. Before insertion of the camera port, pneumoperitoneum was induced with a Veress needle, 10 mm below the navel. The pressure of abdominal gas was 12 mm Hg. Art. The point of entry into the abdominal cavity was established by the Hassan method: 5 cm lateral and 7 cm below the navel along the outer edge of the rectus abdominis muscle. A control catheter was inserted into the window under the transverse colon and inflated the balloon, the omentum was fixed to the parietal peritoneum 3 cm above the navel and the window in the colon mesentery was sutured. All early and late postoperative complications of the patients were recorded for 12 months (wound infections, including “tunnel infection”, dialysate leakage past the catheter, obturation of the catheter lumen, loss of tightness of omentoperitoneopexy). The study included 8 men and 6 women, aged from 43 to 76 years, of whom 2 patients had previously been operated on the abdominal organs. The operative intervention time averaged 54,6±15,4 min. No obstruction, catheter migration, or “tunnel infection” was established during the study. We have developed a laparoscopic technique of peritoneopexy of the upper half of the abdominal cavity, which will be used when the resource of the lower half of the abdominal cavity is exhausted and the effectiveness of preventing mechanical complications of the catheter PD has been proven.

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Waist circumference as a predictor of mortality in peritoneal dialysis patients: a follow-up study of 48 months

British Journal Of Nutrition ◽

10.1017/s0007114517001179 ◽

2017 ◽

Vol 117 (9) ◽

pp. 1299-1303 ◽

Cited By ~ 5

Author(s):

Ana Catarina M. Castro ◽

Ana Paula Bazanelli ◽

Fabiana B. Nerbass ◽

Lilian Cuppari ◽

Maria A. Kamimura

Keyword(s):

Peritoneal Dialysis ◽

Waist Circumference ◽

Cox Regression ◽

Abdominal Cavity ◽

Common Finding ◽

Cox Regression Analysis ◽

Reactive Protein ◽

Reliable Marker ◽

Changes Over Time ◽

Over Time

AbstractBody-fat gain is a common finding among peritoneal dialysis (PD) patients, and the accumulation of adipose tissue occurs predominantly in the abdominal area. Waist circumference (WC) is a reliable marker of abdominal obesity and its association with worse outcomes has been demonstrated in non-dialysis and haemodialysis patients. We aimed at investigating whether WC measurements as well as the changes over time in WC were able to predict mortality in PD patients. This prospective study included 109 patients undergoing PD (57 % male, age 52 (sd16) years, 32 % diabetics, 48 % BMI≥25 kg/m2). WC was measured at the umbilicus level (empty abdominal cavity), and values >88 cm for women and >102 cm for men were considered high. Nutritional status and laboratory parameters were also evaluated. WC was measured at baseline and after 6 months, and mortality was registered during a period of 48 months. High WC was observed in 55 % of women and in 23 % of men at baseline. After 6 months, 61 % of the patients showed an increased WC. At the end of the study, twenty-seven deaths were registered. A significant increase in WC was observed only in the non-survivor group. In the Cox regression analysis adjusting for sex, age, duration on dialysis, diabetes, BMI, serum albumin and C-reactive protein, high WC at baseline as well as the 6-month increase in WC were independently associated with mortality. This study demonstrated that a high WC and the increase over time in WC were both predictors of mortality in PD patients.

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Accidental Insertion of a Peritoneal Dialysis Catheter in the Urinary Bladder

Case Reports in Nephrology and Dialysis ◽

10.1159/000488642 ◽

2018 ◽

Vol 8 (1) ◽

pp. 76-81 ◽

Cited By ~ 1

Author(s):

Shivraj Riar ◽

Mohammed Abdulhadi ◽

Christine Day ◽

Bhanu Prasad

Keyword(s):

Peritoneal Dialysis ◽

Urinary Bladder ◽

Ultrasound Guidance ◽

Abdominal Cavity ◽

Stable State ◽

Clinic Visit ◽

Peritoneal Dialysis Catheter ◽

Distended Bladder ◽

Percutaneous Insertion ◽

Diagnostic Ct

Percutaneous insertion of a peritoneal dialysis (PD) catheter has inherent risks of complications, more so if done “blind” (without fluoroscopy and ultrasound guidance). Despite the perceived disadvantages, there are very few reported cases of mechanical complications after PD catheter insertion. We present an 81-year-old man who underwent percutaneous insertion of dual-cuffed coiled Tenckhoff PD catheter under local anesthesia by a trained nephrologist. The procedure was uneventful, and the patient was discharged 45 min later in a stable state. A day later, he noticed a decline in the urine output. A week later at a scheduled clinic visit, upon unclamping the PD catheter, there was a sudden gush of amber colored fluid. A diagnostic CT scan confirmed the presence of PD catheter entering the abdominal cavity inferior to the umbilicus and the distal end coiled in the urinary bladder. This case illustrates the need for prophylactic Foley catheterization in individuals at high risk for a distended bladder either as a consequence of a mechanical obstruction from an enlarged prostate or due to a neurogenic bladder while undergoing “blind” percutaneous placement.

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Peritoneal Defense Mechanisms—the Effects of New Peritoneal Dialysis Solutions

Peritoneal Dialysis International ◽

10.1177/089686080902902s40 ◽

2009 ◽

Vol 29 (2_suppl) ◽

pp. 198-201 ◽

Cited By ~ 17

Author(s):

Rumeyza Kazancioglu

Keyword(s):

Peritoneal Dialysis ◽

Host Defense ◽

Defense Mechanisms ◽

Abdominal Cavity ◽

Peritoneal Macrophages ◽

Continuous Exposure ◽

Lymphatic Uptake ◽

Smooth Membrane ◽

Micro Organisms ◽

Dialysis Solutions

It remains to be determined whether the peritoneal dialysis procedure induces abnormalities in the normal host defenses of the abdominal cavity and whether these perturbations are important in the pathogenesis of peritonitis. The peritoneum is a smooth membrane that lines the abdominal cavity and participates in the diffusion of water and solutes during peritoneal dialysis. The diaphragmatic lymphatic uptake and the opsonization of micro-organisms, with phagocytosis and killing by peritoneal macrophages, mesothelial cells, lymphocytes, polymorphonuclear leukocytes, and newly defined proteins such as defensins, play a combined role in the peritoneal host defense. Because the composition of earlier peritoneal dialysis fluids is clearly non-physiologic, continuous exposure of peritoneal cells to these solutions may result in an impairment of the local peritoneal host defense mechanisms. However, with the newer solutions, it has been shown that peritoneal defense mechanisms may improve.

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SANITATION OF THE ABDOMINAL CAVITY IN WIDESPREAD PERITONITIS

Kharkiv Surgical School ◽

10.37699/2308-7005.4.2020.07 ◽

2020 ◽

pp. 37-42

Author(s):

V. N. Lykhman ◽

A. N. Shevchenko ◽

A. O. Merkulov ◽

D. A. Myroshnychenko ◽

S. V. Tkach ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Postoperative Period ◽

Absolute Risk ◽

Multiorgan Failure ◽

Abdominal Cavity ◽

Average Degree ◽

Average Weight ◽

Results Of Treatment ◽

Dialysis Solution ◽

Purulent Peritonitis

Summary. Purpose. Study of the effectiveness of permanent transmembrane peritoneal dialysis in “semi-closed” management of the abdominal cavity (BP) in patients with advanced purulent peritonitis (APP). Materials and methods. The results of treatment of 63 patients with APP with “semi-closed” administration in the abdominal cavity (BP) were analyzed. Depending on the features of BP drainage, patients with RGP were divided into two groups: comparison group (CG) — 31 patients who used traditional methods of abdominal drainage and the main group (MG) — 32 patients who underwent permanent peritoneal surgery in the postoperative period. dialysis through an artificial semipermeable membrane. Results and discussion. A study of the relationship between the levels of molecules of average weight in spent dialysis solution with the severity of multiorgan failure (MF) on the SOFA scale using Spearman’s correlation analysis revealed an average degree of correlation: 1 day after surgery - r = 0.63 (p = 0.01), for 3 days — r = 0.75 (p = 0.001). The average degree of correlation between these indicators can be explained by the fact that in addition to endotoxicosis, the severity of MF in the next day after surgery also affects surgery. This is also confirmed by the increase in the correlation coefficient by 3 days, when the degree of influence of the operating aid on the severity of MF decreases. The postoperative period was complicated in 14 (22.2 ± 5.2 %) patients with APP: in CG in 10 (32.3 ± 8.4 %) cases in MG - in 4 (12.5 ± 5.8 %) p = 0.059). Mortality of patients with APP at “semi-closed” management of an abdominal cavity made 19,0 ± 4,9 %: in MG — (25,8 ± 7,9) %, in MG — (12,5 ± 5,8) % (p = 0,179). Conclusions. The proposed method of peritoneal dialysis reduced the absolute risk of postoperative complications in patients with advanced purulent peritonitis by 19.8 %.

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Various Clinical Approaches to Minimise Complications in Peritoneal Dialysis

The International Journal of Artificial Organs ◽

10.1177/039139880202500504 ◽

2002 ◽

Vol 25 (5) ◽

pp. 365-372 ◽

Cited By ~ 9

Author(s):

B. Stegmayr

Keyword(s):

Peritoneal Dialysis ◽

Abdominal Cavity ◽

Rectus Muscle ◽

Controlled Study ◽

Technical Problems ◽

X Ray ◽

Ultrafiltration Failure ◽

Sampling Procedures

The main reason for a failure of peritoneal dialysis is due to technical problems or infections. By starting PD immediately after the insertion of a dialysis catheter (instead of starting HD before optimal healing of the PD-catheter) it may be easier to achieve acceptance for PD by the patients. An easy and tight access is achieved when inserting the PD-catheter through the rectus muscle, fixing it with three purse string sutures, two of them fixing the inner cuff between the peritoneal membrane and the inner rectus fascia. Thereby early and late leakage will be rare and good drainage is normally achieved besides a low risk for exit site infections. Using Coloplast® adhesive insulin can be injected into the PD bags in a simple way even by patients with bad vision. Using ultraviolet light, as additional exchange device (UV-box), the risk for peritonitis is reduced compared to classic manual connection. Using the Y-set or duo-bag system the risk for peritonitis is further lowered. Malfunction by dislocation of the intraperitoneal part of the catheters can often be corrected without surgery using a bent stylet. A controlled study showed that antibiotic prophylactics could significantly reduce the risk for peritonitis in the follow up after insertion of PD catheters. Additionally the risk for peritonitis is reduced using a special connector for the PET-sampling procedures. X-ray of catheter location in the abdominal cavity can be performed by injection of 20-ml contrast media into 100 ml of PD fluid residing in the PD-bag. After mixing, small portions of this fluid can be infused into the abdomen for X-ray determination of the location. An increased ultrafiltration failure during PD may be due to use of beta-blocker medication. After ceasing this medication recovery may occur. Avoiding pets in the room used for PD-exchange may lower the risk for peritonitis further. A devoted nurse and physician will keep up the patients' spirit and help to convert patients not suitable for PD to HD or the other way round. By such measures the incidence of peritonitis can be reduced to 1 in 40 treatment months or less.

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Peritoneal Dialysis with Marked Pneumoperitoneum

Case Reports in Nephrology ◽

10.1155/2020/1063219 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Norio Nakamura ◽

Masamichi Nakata ◽

Daiki Nagawa ◽

Ikuyo Narita ◽

Takeshi Fujita ◽

...

Keyword(s):

Abdominal Pain ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Abdominal Cavity ◽

X Ray ◽

Free Air ◽

Old Japanese ◽

Dialysis Bag ◽

Stage Renal Disease ◽

End Stage

Pneumoperitoneum, the presence of free air within the peritoneal cavity, is often caused by the perforation of gas-containing viscus and commonly requires surgical treatment. However, in patients with peritoneal dialysis, free air is commonly seen on X-ray. We present the case of a patient with peritoneal dialysis with marked pneumoperitoneum. A 75-year-old Japanese male with end-stage renal disease due to antineutrophil cytoplasmic antigen-associated vasculitis had been receiving continuous ambulatory peritoneal dialysis for 9 years. He had a poor appetite and general malaise without abdominal pain or fever. These symptoms gradually worsened, and he was hospitalized. At the time of admission, chest X-ray revealed bilateral free air in the abdomen. Subsequent computed tomography of the abdomen revealed marked pneumoperitoneum. Peritonitis due to perforation of the digestive tract was considered; however, the absence of abdominal pain, fever, and turbidity of dialysis drainage indicated that peritonitis was unlikely. Insufficient air venting during continuous ambulatory peritoneal dialysis bag replacement was suspected. The bag was carefully changed, resulting in a gradual decrease in the free air. We encountered a patient with continuous ambulatory peritoneal dialysis who had significant free air in the abdominal cavity in the absence of peritonitis. The source of the air was determined to be the dialysis bag due to insufficient venting during replacement. This case underscores the importance of instructing patients with continuous ambulatory peritoneal dialysis on the thorough removal of air from the bag during replacement.

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