Manuel Battegay Div. Infectious Diseases & Hospital Epidemiology HIV complications and morbidity.
Non-Infectious Complications
description
Transcript of Non-Infectious Complications
![Page 1: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/1.jpg)
Peritoneal Dialysis
Non-Infectious Complications
![Page 2: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/2.jpg)
Peritoneal Dialysis
Non-infectious Catheter Complications
Inflow/outflow obstructionHerniaLeakage
![Page 3: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/3.jpg)
Peritoneal Dialysis
Increased Intra-Abdominal Pressure
Instillation of dialysate into the peritoneal cavity leads to increased intra-abdominal pressure
The magnitude of the increase depends upon:- Volume dialysate filled- Patient age, body mass index- Coughing, lifting straining at stool- Position of the patient (sitting>standing>supine)
![Page 4: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/4.jpg)
Peritoneal Dialysis
Inflow/Outflow ObstructionCauses:- Mechanical (e.g. tip migration, kink in tubing)- Constipation- Catheter blockage
Outflow obstruction is most frequent:
- Intraluminal (clot, fibrin)
- Extraluminal
(constipation, occlusion, omental
wrapping, tip migration, incorrect
catheter placement)
![Page 5: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/5.jpg)
Peritoneal Dialysis
Inflow/Outflow Obstruction - Recommendations Establish type of obstruction Conservative or non-invasive approaches
- body position change
- laxatives
- heparinised saline
- fibrinolytic agents Aggressive therapies
-a) blind - fluoroscopically guided wires, stylet, whiplash
-b) direct - peritoneoscopy, surgical catheter revision
or replacement
![Page 6: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/6.jpg)
Peritoneal Dialysis
Early (within 30 days)
- Manifest externally
- Do not require imaging
- Managed by temporary discontinuation of PD (75%) or surgery
Late (beyond 30 days)
- Manifest by poor outflow, localised oedema, subcutaneous fluid
- 30% require imaging
- Hernia cause 40% of late leaks
- Most late leaks require surgery (70%)
- Frequently lead to change of treatment
Tzamaloukas Adv PD 1990
Dialysate Leaks
![Page 7: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/7.jpg)
Peritoneal Dialysis
Fluid Leak - CT Cannulogram
![Page 8: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/8.jpg)
Peritoneal Dialysis
Abdominal Wall or Pericatheter Leak
Presentation
Abdominal swelling or bogginess Reduced drain (effluent) output Weight gain and abdominal wall oedema,
without peripheral oedema Pericatheter leak: wetness or swelling at exit-
site
![Page 9: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/9.jpg)
Peritoneal Dialysis
Abdominal Wall or Pericatheter Leak
Management
Reintroduce low pressure PD (APD)
or Temporary transfer to HD to allow healing, or Catheter replacement if pericatheter leak,
![Page 10: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/10.jpg)
Peritoneal Dialysis
Hernias and Genital Oedema
Caused by continuous elevation of intra-abdominal pressure and abdominal wall tension
Acquired or congenital defects in the abdominal wall
Inguinal > Catheter insertion site Epigastric > Richters Umbilical > Enterocoele Incisional > Spigelion Ventral > Obturator
![Page 11: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/11.jpg)
Peritoneal Dialysis
Hernias – risk factors
Raised intra-abdominal pressure Female sex and multiparity (no. of pregnancies) Older age Previous hernia Polycystic kidney disease
![Page 12: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/12.jpg)
Peritoneal Dialysis
Hernias – clinical presentation
Painless or tender lump or swelling Bowel incarceration or strangulation
Peritonitis (transmural leakage of bacteria)
Treatment:
1) Surgical repair 2) Reintroduce PD with low volumes, supine posture,
increase volume over 2 weeks
![Page 13: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/13.jpg)
Peritoneal Dialysis
Genital Oedema
Occurs in up to 10% of patients Mechanism:
- fluid tracks through soft tissue plane in a hernia,
catheter insertion site, peritoneal fascial defect,
genital oedema associated with abdo wall oedema
- patent processus vaginalis
- males affected more than females
Diagnosis:
- can be difficult
- CT scan with contrast (100-150mls Omnipaque)
![Page 14: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/14.jpg)
Peritoneal Dialysis
continued…Genital Oedema
Treatment:
- bed rest
- scrotal elevation if symptomatic
- low volume exchange/NIPD
- stop PD temporarily
- surgical repair if cause is hernia or patent processus vaginalis
![Page 15: Non-Infectious Complications](https://reader033.fdocuments.in/reader033/viewer/2022051418/56815560550346895dc32b38/html5/thumbnails/15.jpg)
Peritoneal Dialysis
Infusion or Drainage Pain
CAUSES
- constipation
- jet effect
- fluid pH related
MANAGEMENT
- laxatives - slow infusion rate
- incomplete drainage - Bicarbonate buffer
- 1% lignocaine IP - catheter replacement