With the recent outbreak of the coronavirus, I was asked by some of my colleagues on how to discard the PD effluent of patients suspected or confirmed infected? Since this is a novel virus, our knowledge is still limited. Reviewing our data on SARS virus, I did not come across in my readings of report that the virus is isolated in PD effluents. So is it safe to handle the PD effluent the same way as any infectious bodily fluid, which is to double flush it into the toilet or clinical sink?
ANSWERED Rose, B. answered 22 hours ago
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 In the 2016 ISPD Peritonitis Recommendations Update on Prevention and Treatment on page 488 it is noted that the IP route is preferred unless there is also systemic sepsis. In case where IV antimicrobial therapy may be needed, what is a reasonable dose for imipenem/cilastatin ? This antimicrobial is not included in Table 6 on page 490. Ertapenem is but does not have Pseudomonal coverage. Possibly imipenem/cilastatin 500 mg IV q 12 is reasonable since ertapenem is listed at half of the normal dosing? Thanks for your time and consideration.
ANSWERED Andrea C answered February 11, 2020
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 When obtaining a fluid sample for culture, what process should be followed on disinfecting prior to collection of fluid? Do you recommend cleaning the tops of culture bottles with alcohol wipe prior to use? (similar to collecting blood cultures) Do you recommend cleaning sample port with only betadine or alcavis, or will alcohol wipe work as well? thank you! Is "clean catch" appropriate when collecting a sample? (pouring from drain bag into sterile urine cup)… – Just want to get this done the right way!
ANSWERED Gwen answered February 10, 2020
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 I had a pt taken off pd with catheter removal on September 26th 2019 for pantoea agglomerans and enterococcus fecalis peritonitis after fortaz , vanco and later addition of gentamicin did not clear the infection over 10 days with persistently positive cell counts in pd fluid. I wanted to ask you when I can try pd again and put the catheter back . I wanted to wait 3-4 months but pt is desperate to go back to pd and wants it now
ANSWERED zubair, A answered February 6, 2020
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 I had a pt taken off pd with catheter removal on September 26th 2019 for pantoea agglomerans and enterococcus fecalis peritonitis after fortaz , vanco later addition of gentamicin did not clear the infection over 10 days with persistently positive cell counts in pd fluid. I wanted to ask you when I can try pd again and put the catheter back . I wanted to wait 3-4 months but pt is desperate to go back to pd and wants it now
ANSWERED Zubair, A answered November 22, 2019
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 We have a patient we will be training in November that only speaks Burmese. We do have access to a translator device for the training, however we were looking for some written patient education materials in Burmese for her to refer to at home if she has questions. We were looking for at least something discussing signs and symptoms of peritonitis, exit site infection, when to contact the clinic, etc. Does anyone have access to any training materials specific for peritoneal dialysis in that language? I have tried reaching out to several PD programs in more metropolitan areas thinking they may have a more diverse population they have trained, but all seem to only have Spanish information.
ANSWERED Julie Yordy answered November 1, 2019
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 After a change for the dialysate provider four weeks ago to a solution of 2.3%, we have observed in 12 patients out of 24 the following changes: it starts with myalgia, arthralgia, disconfort, asthenia, adynamia, and a change in the colour of the draining dialysate which becomes cloudy, reddish to red, or yellowish, or bloodstained. You can see pictures on the online folder: https://www.dropbox.com/sh/p6aomjsmrtshuvm/AACQR3wZvTgmuBLS4BJ29tdPa?dl=0 // After this, we proceed to reduce the interval and the concentration of the dialysate liquid. After 4 days, the patients present an increase in fibrine with subsequent obsruction of the PD Cathether. We never observed this pattern with the previous fluids provider. CORRECTIVE MEASURES 1.- reduce the frequency and concentration of the PD Fluid 2.- culture and antibiogram of the peritoneal liquid 3.- culture and antibiogram of the catheter exit site 4.- change to HD 5.- communicate as an adverse effect 6.- analysis of the PD liquid 7.- hospitalisation with antibiotherapy // We should remark that we have obtained a positive culture result for Candida.
ANSWERED Patricio G answered June 4, 2019
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 My wife is on CAPD for over 2 years. She is doing well and is comfortable. Her ultrafiltration levels ranges between 1700-ml to 1900-ml per day. But now I see that her fluid levels in the body is low. She is also having low BP (90/60). Presently we are doing 4 exchanges per day (1.5% PD solution twice and 2.5% PD solution twice. Even then there is no gain in body weight. Could you please advise how to normalize her BP and increase her body weight. Her Albumin levels are around 4.
ANSWERED Sushant K Santra answered May 9, 2019
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 Is there a guideline or any research that recommends how long heparin should be used for treatment of fibrin in effluent? Our current policy states to continue the heparin for a minimum of 48 hours after fibrin is noticed (even if the fibrin clears before then). We are considering changing the policy to use the heparin until the fibrin has cleared (not to wait for a full 48 hours) and would like some input. Thanks very much.
ANSWERED Unknown User answered March 4, 2019
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 We had a PD patient whom presented to the Emergency Department with abdominal pain x one week (he never contacted us- Home Dialysis). He subsequently had an appendectomy. His PD catheter is in the lower right quadrant. Our on call Nephrologist requested the PD catheter be removed; the surgeon continues to disagree and wants to save the catheter. The pathology report is below: Gross Description (See result below) Received in formalin labeled “appendix” is a 6.2 x 1.6 x 1.5 cm tubular tan appendix with abundant attached mesoappendix and proximal staple line. The serosa is pink-tan. The lumen is focally dilated to 0.8 cm and contains no fecaliths. The soft tissue immediately adjacent to stapled margin is inked black and representative sections are submitted labeled (A1-A2). Microscopic Description (See result below) Sections show an edematous appendix with acute inflammation on the peritoneal surfaces. No inflammation is present in the appendiceal wall or the mucosa of the appendix . No true appendicitis or perforation is identified. The appearance is consistent with acute peritonitis of unknown cause. Home Dialysis was requested to obtain cell count, cultures and gram stain. Small volume (500 ml) was utilized to obtain these specimens as follows: 9/11: WBC’s 658 (91% neutrophils); no growth in cultures (he has been receiving IV antibiotic since his surgery on 9/9- Zosyn) (1.5% Dialysate used for flush) 9/13: WBC’s 840 (81% neutrophils); on call Nephrologist ordered Vancomycin for today and it was hung around the time I was obtaining specimens today. (Normal Saline used for flush) 9/14 specimen obtained as well but no results so far. We would appreciate any Best Practice Recommendations concerning removal or preservation of this PD catheter.
ANSWERED A.Clark answered February 7, 2019
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 I have a patient that developed cloudy fluid post pd catheter placement. He was asymptomatic, no belly pain, fever ect. Total WBC was 450, PMN 3, Eosinophils 1 but Mononuclear cells were 97 Gram Stain was NOS and so far nothing has grown on the Culture after 3 days. This is not the first time I have seen a higher total WBC (greater than 100), normal polymorph cells and eosinophils but very high mononuclear cells (greater than 90%). What could be the cause?
ANSWERED Amy O answered February 5, 2019
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 Have a CCPD patient who has been on PD for 4 years. He recently developed drain problems unrelated to constipation/fibrin. He was recently seen by his surgeon.Findings: a lot of adhesion and a small bowel wrap in pelvis. This was corrected but patient still having drain problems. Drains better supine and or on left side. Patient would probably do better on CAPD but declines due to his life style. I have placed him on Tidal but still positional drain problems. Any suggestions he would like to remain on PD .
ANSWERED Diane M. answered January 31, 2019
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 Patient completed treatment of cefepime and Vancomycin for a no growth peritonitis. Cultures that were repeated one week after completion and again three weeks are growing sphingomonas paucimobilis however the patient does not currently have an active peritonitis. Cell count of pd fluid is negative. Could this possibly be a biofilm on the catheter and if so any suggestions on treatment? The patient has refused catheter removal and temporary hemodialysis. Thank You
ANSWERED Laura V answered January 28, 2019
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