Effect of Continuous Nursing Model on Nursing Effect of Continuous Peritoneal Dialysis

Objective: To analyze and study the effect of continuous nursing mode for continuous peritoneal dialysis nursing. Methods: 40 patients with continuous peritoneal dialysis received in our hospital were randomly selected as the research object. The research time was from June 2018 to June 2020. The patients were divided into two groups by random number table method. The patients with routine nursing mode were named as the control group and the patients with continuous nursing mode were named as the observation group (20 cases in each group). The clinical nursing effects of different nursing modes are compared. Results: After nursing, the nursing compliance of the observation group was 95%, which was higher than 70% of the control group. There was significant difference between the two groups (P < 0.05). Comparing the blood routine related indexes of the two groups, the blood potassium, hemoglobin, serum creatinine and carbon dioxide binding force of the observation group were better than those of the control group (P < 0.05). The incidence of peritonitis and rehospitalization rate in half a year in the observation group were lower than those in the control group (P < 0.05). Conclusion: The continuous nursing model for patients undergoing continuous peritoneal dialysis can improve the treatment effect of patients, significantly improve the compliance of patients, significantly improve the serological indexes, promote the health of patients, reduce the incidence of peritonitis, and significantly reduce the rehospitalization rate in half a year. It has a broad prospect of clinical promotion.

Double purse-string around the inner cuff of the peritoneal catheter: A novel technique for an immediate initiation of continuous peritoneal dialysis

International guidelines recommended a delayed start of peritoneal dialysis at least 2 weeks between catheter insertion and continuous peritoneal dialysis therapy initiation (break-in period). Up to now, the optimal duration of the break-in period is still unclear. The aim of our study was to evaluate in patients, with immediate initiation of continuous peritoneal dialysis, the efficacy of a double purse-string around the inner cuff in preventing mechanical and infectious complications either in semi-surgical or surgical catheter implantation. From January 2011 to December 2018, 135 peritoneal dialysis catheter insertions in 125 patients (90 men and 35 women, mean age 62.02 ± 16.7) were performed. Seventy-seven straight double-cuffed Tenckhoff catheters were implanted semi-surgically on midline under the umbilicus by a trocar, and 58 were surgically implanted through the rectus muscle. In all patients, continuous peritoneal dialysis was started immediately after catheter placement. Mechanical and infectious catheter-related complications during the first 3 months after initiation of continuous peritoneal dialysis were recorded. The overall incidence of leakages, catheter dislocations, peritonitis, and exit-site infections was 4/135 (2.96%), 2/135 (1.48%), 14/135 (10.3%), and 4/135 (2.96%), respectively. Regarding the incidence of catheter-related complications, no bleeding events, bowel perforations, or hernia formations were observed with either the semi-surgical or surgical technique. Double purse-string technique around the inner cuff allows an immediate start of continuous peritoneal dialysis both with semi-surgical and surgical catheter implantation. This technique is a safe and feasible approach in patients needing an urgent peritoneal dialysis.

Outcome of Continuous Peritoneal Dialysis in Patient with Acute Kidney Injury

Background: Though peritoneal dialysis has several limitations, it is still used in acute kidney injury (AKI) patients as an alternative method of Renal Replacement Therapy (RRT), especially in low socioeconomic countries. Materials and Method: This study included thirty patients diagnosed as AKI. Peritoneal access was established through flexible Tenckhoff catheter for Continuous Peritoneal Dialysis (CPD) and 6-8 exchanges were done in 24 hours. Results: Among 30 patients mean age was (mean±SD) 49.93±14.42 years. Seven (23.33%) patients were hemodynamically unstable. The cause of AKI was drug induced in 6(20.7%), hypovolemia/Acute Tubular Necrosis in 6(20.0%), sepsis in 5(16.7%), heart failure in 2(6.7%) and 11(36.7%) had multiple causes. In initial presentation, mean serum creatinine was 683.42 μmol/L, and the number of sessions required for stabilization of serum creatinine was 7.5±1.43, sessions required for correction of hyperkalemia and metabolic acidosis were 2.15±0.69 and 2.5±0.76 respectively. The delivered Kt/V urea was 1.95±0.14 weekly. Six (20.0%) patients had peritonitis, five (16.7%) had pericatheter leakage and four (13.33%) had catheter blockage. Among 30 patients, three patients (10%) had died, sixteen (59.3%) had recovery of renal function and rest did not recover renal function. Conclusion: CPD was effective for correction of metabolic and electrolyte imbalance.

Abdominal cocoon: a surgical challenge

Encapsulating peritoneal sclerosis (EPS) or sclerosing peritonitis best described as abdominal cocoon is a complex syndrome characterized by formation of a thick fibrocollagenous membrane that totally encloses the small intestinal loops. The etiology is varied and multifactorial. This complex disease is usually associated with continuous peritoneal dialysis (PD), tuberculosis, post renal transplant, or with long term use of beta blockers. A few cases may even be idiopathic in origin. The pathogenesis is attributed to conversion of epithelial cells from the peritoneal lining to mesenchymal cells leading to a formation of a thick membrane. The clinical features range from abdominal pain due to altered gut motility to frank features suggestive of intestinal obstruction. Making a pre-operative diagnosis is the biggest challenge in abdominal cocoon. However computerized tomography provides enough information to arrive at a diagnosis. Surgical intervention continues to remain the final option in an unremitting intestinal obstruction despite the role of conservative therapy using drugs proposed for treatment. The focus of management is early diagnosis and treatment in order to halt the progression to a frank cocoon. The paper reviews the etiopathogenesis and management of this intricate condition.

Exp erimental research of wearable artificial kidney

Aim.The article presents the results of wearable artificial kidney (WAK) biomedical trial based on peritoneal dialysis with continuous dialysate regeneration.Materials and methods.The trial was carried out on a 15-kg dog. First stage: dialysis was carried out on healthy dog to evaluate effect of WAK on blood biochemical indicators. Second stage: 200 ml of X-ray contrast agent was injected into dog’s bloodstream to simulate acute kidney failure.Results. During trial (39.5 hours) WAK was performing continuous peritoneal dialysis with dialysis fluid regeneration. During second stage (34 hours) creatinine and uric acid were eliminated from dialysis solution at the rate of 0.3 mg/h, urea was eliminated at the rate of 0.15 g/h, total removed ultrafiltrate volume was 350 ml. At the end of the second stage blood biochemical indicators stabilised in the range of normal values.Conclusion. Developed WAK can perform continuous blood purification and ultrafiltration with no pathologic impact on blood biochemical indicators.

The Use of Daptomycin to Treat Methicillin-Resistant Staphylococcus Epidermidis Bacteremia in a Critically Ill Child with Renal Failure

Daptomycin is excreted primarily unchanged by the kidney. Dosage regimens in children with renal failure remain to be determined. We report the case of an 8-year-old child with multiorgan failure undergoing continuous peritoneal dialysis, successfully treated with intravenous daptomycin for methicillin-resistant Staphylococcus epidermidis bacteremia. A dosage of 8 mg/kg every 48 hour was used. Plasma peak and trough concentrations of daptomycin were 68 mg/L and 14.6 mg/L, respectively, on day 6 of treatment. The dosage regimen achieved daptomycin exposure comparable to that reported in adults undergoing continuous ambulatory peritoneal dialysis and receiving recommended dosages.