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Apd
This document discusses acute peritoneal dialysis (PD) catheter insertion. It begins by outlining the basic principles of hemodialysis (HD) and PD. It then focuses on inserting an acute PD catheter, including contraindications, preparation, entry technique using ultrasound guidance, and troubleshooting potential issues. The key steps are examining the patient, determining the entry site, using ultrasound to guide insertion of the catheter into the peritoneum, and performing an initial flush and drain cycle to confirm proper placement. Complications may arise from circuit leaks, obstructions, or improper catheter positioning and can sometimes be addressed by using a trocar to relieve clots or repositioning the catheter under imaging guidance.
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Apd
- 1. Acute P.D. catheter insertion HafezM. Bazaraa MMXVI
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- 3. PATIENT BLOOD DIALYZATE Membrane Solute diffusion UF UFΔP HD dialyzer Concentrate + HCO3 + Treated water Mechanical TMP
- 4. PATIENT BLOOD DIALYZATE Membrane Solute diffusion UF UFΔP PD peritoneum IP via catheter Osmosis DIALYZATE EXCHANGES THROUGH PERITONEUM •I.P. catheter •Dialyzate •Exchange prescription & implementation
- 5. What we WON’Tdiscuss Indications of dialysis P.D. vs H.D.? C.P.D. Catheter care Dialysis adequacy Detailed PD complications
- 6. Is there arole for APD catheter? APD IS a simple & useful mode of RRT Acute HD is sometimes not feasible/ available Patient may be unfit for HD & CRRT is not always available Vs long-term PD catheters; short-term indications & not always available
- 7. Contraindications Omphalocoele orGastroschisis Diaphragmatic Hernia Bladder extrophy Obliterated Peritoneal Cavity Recent abdominal Surgery* Abdominal Malignancy* * Relative
- 8. Before insertion Whoshould do it? Patient examined Determine site of entry Consent Ensure empty bladder I.V. access Assemble dialyzate & lines Sedation/ Anesthesia Patient monitoring Asepsis
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- 11. •MIDLINE is safest •Skinpuncture (near) vertical; NEVER < 60-70° •Towards pelvis generally preferable •A lateral-directed entry may NOT be attempted or unintentionally allowed until IP
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- 14. Fluid-filled peritoneum Facilitatesentry Reduces visceral injury May facilitate U/S guided entry Usually requires initial puncture for prefilling (unless ascites) When prefilling, don’t advance further once IP. FIX POSITION DURING FILLING 10-40 mL/Kg ( 2L)
- 15. Recognition of I.P.entry DRY ABDOMEN (before infusion or direct entry) Release of resistance Drip release Test flush Realtime U/S visualization Free flow (! bladder ! intestine) Respiratory fluctuation FLUID FILLED PERITONEUM Release of resistance Realtime U/S visualization Free outflow Respiratory fluctuation
- 16. Catheter Entry Adequate(NOT EXCESSIVE) incision skin ± deeper NOT peritoneal Avoid false abd wall track ALL side holes must be IP Entry may be made – With trocar-catheter (sheath trocar tip once IP) – Seldinger technique Suture MAY be needed
- 17. Saudi J KidneyDis Transplant 1994;5(2):184-189 IMMEDIATE fill-drain flush cycle
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- 23. TROUBLESHOOTING Closed 3-way,kinked line, air in line No run in Underfilling (↑ volume, insert catheter deeper, reposition patient, install 2nd “only!” dwell) Circuit leak (external or abd. wall) Partial obstruction - Blood clots, fibrin attempt relief using trocar - Catheter kink trocar may relieve - Intraabdominal: adhesions, omentum catheter repositioning
- 24. TROUBLESHOOTING Closed 3-way,kinked line, air in line Inadequate gravity drive (height of bag) Poor venting of non-collapsible bags Catheter tip position (reposition patient or catheter) Obstruction - Blood clots, fibrin attempt relief using trocar - Catheter kink trocar may relieve - Intraabdominal: adhesions, omentum catheter repositioning
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