31 August 2017 Precise: Trouble shooting catheter dysfunction
52
1
-
Upload
kamal-khositrangsikun -
Category
Health & Medicine
-
view
102 -
download
0
Transcript of 31 August 2017 Precise: Trouble shooting catheter dysfunction
1
Choicematters:
troubleshooting
PDcatheterDysfunction
KamolKhositrangsikunM.D.MaharajNakhonsithammaratHospital
2
IdealPDaccess
3
IdealPDaccess
¡ Surgicalhandling
¡ Minimaltrauma/pain
¡ Maintainstablepositionwithoutextrusionofcuffs
¡ Hydraulicfunction
¡ Rapidfluidinfusionwithoutpain
¡ Allowcompletedrain4
IdealPDaccess
¡ Biocompatibility
¡ Noinductionofinflammation,sclerosis&
adhesionofperitonealmembrane
¡ Resistancetoinfection
¡ AllowPDtherapyformanyyears
¡ Affordable
5
PERITONEAL DIALYSIS
Beforeinsertion
Catheterwithin
TroubleshootingPDcatheterDysfunction
Beforeinsertion
TroubleshootingPDcatheterDysfunction
ContraindicationtoPD
¡ Contraindicationstopercutaneouscatheterinsertionwere! Openabdominalsurgeryotherthanappendectomyorcesareansection
! Ableedingtendency! Pre-existingherniarequiringsimultaneousrepair▪ Otherwise,thechosenmethodofinsertiondependedlargelyonthecaringphysician’spreferenceandoperatoravailability.
9Perit Dial Int 2012; 32(6):628-635
10Perit Dial Int 2010; 30:424–429
PRACTICEGUIDELINESFORPERITONEALACCESS
PRACTICEGUIDELINESFORPERITONEALACCESS
¡ Guideline1:Theaccessteam¡ Guideline2:Timing&coordinationofreferral&surgery
¡ Guideline3:Implantationprotocol¡ Guideline4:Theimplantationtechnique¡ Guideline5:FacilitiesforPDcatheterinsertion¡ Guideline6:TrainingforPDcatheterinsertion¡ Guideline7:AuditofPDcatheterinsertion
11Perit Dial Int 2010; 30:424–429
PRACTICEGUIDELINESFORPERITONEALACCESS
¡ Guideline1:Theaccessteam¡ Guideline2:Timing&coordinationofreferral&surgery
¡ Guideline3:Implantationprotocol¡ Guideline4:Theimplantationtechnique¡ Guideline5:FacilitiesforPDcatheterinsertion¡ Guideline6:TrainingforPDcatheterinsertion¡ Guideline7:AuditofPDcatheterinsertion
12Perit Dial Int 2010; 30:424–429
PRACTICEGUIDELINESFORPERITONEALACCESS
¡ Guideline1:Theaccessteam¡ Guideline2:Timing&coordinationofreferral&surgery
¡ Guideline3:Implantationprotocol¡ Guideline4:Theimplantationtechnique¡ Guideline5:FacilitiesforPDcatheterinsertion¡ Guideline6:TrainingforPDcatheterinsertion¡ Guideline7:AuditofPDcatheterinsertion
13Perit Dial Int 2010; 30:424–429
Theaccessteam
14
PRACTICEGUIDELINESFORPERITONEALACCESS
¡ Guideline1:Theaccessteam¡ Guideline2:Timing&coordinationofreferral&surgery
¡ Guideline3:Implantationprotocol¡ Guideline4:Theimplantationtechnique¡ Guideline5:FacilitiesforPDcatheterinsertion¡ Guideline6:TrainingforPDcatheterinsertion¡ Guideline7:AuditofPDcatheterinsertion
15Perit Dial Int 2010; 30:424–429
PRACTICEGUIDELINESFORPERITONEALACCESS
¡ Guideline1:Theaccessteam¡ Guideline2:Timing&coordinationofreferral&surgery
¡ Guideline3:Implantationprotocol¡ Guideline4:Theimplantationtechnique¡ Guideline5:FacilitiesforPDcatheterinsertion¡ Guideline6:TrainingforPDcatheterinsertion¡ Guideline7:AuditofPDcatheterinsertion
16Perit Dial Int 2010; 30:424–429
MethodsofplacementTKcatheters
¡ Percutaneous,blind(with/withoutfluroscopy)
¡ Directvisualization
! Peritoneoscopic
! Open,surgicaldissection
! Laparoscopic
17
Open,Surgicaldissection
18
Open,Surgicaldissection
¡ In1968,Dr.HenryTenckhoffdevelopedtheindwellingperitonealcatheter,whichwasplacedviaanopensurgicaltechnique
www.pdiconnect.com/content/3/1/47.full.pdf 19
Seldingertechnique
20
Seldingertechnique
¡ TheSeldingertechniqueisamedical
proceduretoobtainsafeaccesstoblood
vesselsandotherholloworgans.
http://en.wikipedia.org/wiki/Seldinger_technique#cite_note-Seldinger-1 21
Seldingertechnique
¡ Dr.Sven-IvarSeldinger
.:(1921-1998)
¡ Swedishradiologistfrom
Mora,DalarnaCounty,
whointroducedthe
procedurein1953.
22
23
Siteforincisiontomakeentry
24
Abdominalwallthickness
Newsiteforincision
25
26Perit Dial Int 2017; 37(2):141–154
PREVENTIONOFCATHETER-RELATEDINFECTIONS
PREVENTIONOFCATHETER-RELATEDINFECTIONS
27Perit Dial Int 2017; 37(2):141–154
PRACTICEGUIDELINESFORPERITONEALACCESS
¡ Guideline1:Theaccessteam¡ Guideline2:Timing&coordinationofreferral&surgery
¡ Guideline3:Implantationprotocol¡ Guideline4:Theimplantationtechnique¡ Guideline5:FacilitiesforPDcatheterinsertion¡ Guideline6:TrainingforPDcatheterinsertion¡ Guideline7:AuditofPDcatheterinsertion
28Perit Dial Int 2010; 30:424–429
PRACTICEGUIDELINESFORPERITONEALACCESS
¡ Guideline1:Theaccessteam¡ Guideline2:Timing&coordinationofreferral&surgery
¡ Guideline3:Implantationprotocol¡ Guideline4:Theimplantationtechnique¡ Guideline5:FacilitiesforPDcatheterinsertion¡ Guideline6:TrainingforPDcatheterinsertion¡ Guideline7:AuditofPDcatheterinsertion
29Perit Dial Int 2010; 30:424–429
PeritonealDialysisCatheters
30
PeritonealDialysisCatheters
31http://slideplayer.com/slide/9705087/
Tungstentip
PeritonealDialysisCatheters
http://www.covidien.com/dialysiscatheter/pages.aspx?page=Products/PeritonealAccess32
33
PRACTICEGUIDELINESFORPERITONEALACCESS
Perit Dial Int 2010; 30:424–429
PREVENTIONOFCATHETER-RELATEDINFECTIONS
34Perit Dial Int 2017; 37(2):141–154
Catheterwithin
TroubleshootingPDcatheterDysfunction
PDcatheterflowdysfunctionalgorithm
¡ Step1:Evaluateforextraluminalissues
¡ Step2:Evaluateforintraluminalissues
¡ Step3:Evaluateforcatheterposition
¡ Step4:Evaluateforanatomicalinterference
36https://www.homebybaxter.com/Documents/Downloadable%20Files/AL12172A-AFP-PD-Catheter-Flow-Dysfunction-Algorithm.pdf
37
PDcatheterflowdysfunctionalgorithm
https://www.homebybaxter.com/Documents/Downloadable%20Files/AL12172A-AFP-PD-Catheter-Flow-Dysfunction-Algorithm.pdf
NonsurgicalapproachesforthecorrectionofmalfunctioningPDcatheters
• Stiffwiremanipulation
• Fluoroscopicmanipulation
• Fogartycathetermanipulation
• Doubleguidewiremethod
• Non-traumaticmaneuverforrepositioning38
Fluoroscopicmanipulation
39
Stepsinmanualrepositioningofamigratedperitonealdialysiscatheter.
40Wen-Ting Tu, Perit Dial Int 2009; 29:325–329
Stepsinmanualrepositioningofamigratedperitonealdialysiscatheter.
41Wen-Ting Tu, Perit Dial Int 2009; 29:325–329
Stepsinmanualrepositioningofamigratedperitonealdialysiscatheter.
42Wen-Ting Tu, Perit Dial Int 2009; 29:325–329
SurgicalapproachesforthecorrectionofmalfunctioningPDcatheters
• Minilaparotomy
• Laparoscopictechnique
• Noveltechniqueforrepositioning
43
Previously-trytomanipulate
44
Previously-trytomanipulate
45
Newcatheter
46
BackUpHemodialysis
47
Troubleshooting?
48
Beyourself
49
youtubetknephrologist
50
youtubetknephrologist
51
ThankYouforYourAttention
52
