PD Flashcards
TK block cause and mgt?
- constipation: laxative
- catheter kinking: check cath
- fibrin plug: 20ml heparinized saline flush, then 500 unit/l heparin PDF, or urokinase 5000 unit in 40ml NS flush
- malposition: KUB: cath malposition, guidewire maniputation
- omental wrap: laparoscopy
fibrin in dialyzate mgt?
heparin 500 unit/L into PDF
rule out peritonitis
inflow pain cause and mgt?
can be transient in new PD catheter
due to acidity of lactate buffered solution
or hypertonic glucose, aged solution, overdistention of abdo
catheter malposition
(can also has shoulder and pleuritic pain)
slow the inflow
r/o peritonitis
use HCO3 buffered dialysate at physiologic pH
tidal APD
laparoscopy
outflow pain cause and mgt?
(can be in genital area / rectum)
due to pelvic irritation of catheter tip
mgt by tidal APD
blood stained PDF cause and mgt?
menstruation
diagnosis of CAPD peritonitis?
PDF WCC > 100 / mm3
abdo pain / turbid PDF
PDF C/ST +ve
Dose of IP gentamycin?
0.6mg/kg/d
dose of IP vancomycin?
15-30mg/kg Q5-7days
MRSA peritonitis Tx?
IP vancomycin x 21 days, screen for carriage
how to check PET?
2.5% PDF 2L dwell x 4 hours and check D/P urea / creatinine
pericatheter leak Ix and mgt?
high glucose fluid area ES
delay PD x 2 weeks
Abx
reduce UF ddx
Mechanical: outflow problem
membrane failure: UFF, peritonitis
leakage: PPV, PPF, retroperitoneal, subcutaneous
glycemic control
fungal PD peritonitis Tx?
TK removal
antifungal x 10 days
Tx AmphoB + flucytosine
fluconazole: Candida species and Cryptococcus.
Echinocandin (Micafungin): Aspergillus species and non-albicans Candida species
flucytosin needs monitor level and BM supp, amphoB IP chemical peritonitis, amphoB IV poor availablility
amphoB when filamentous fungi cultured
catheter removal indication?
ESI + CAPD peritonitis
refractory ESI > 3 weeks of effective Tx
Pleural effusion in PD?
transudative causes: CHF, low UF
exudative: infection, malignancy, connective tissue disease
PD: PPF, uremic pleuritis
