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 February 19, 2020
672 views
2 answers
1 vote
 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
326 views
1 answer
1 vote
 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
378 views
1 answer
0 vote
 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
273 views
1 answer
0 vote
 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
475 views
1 answer
0 vote
 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
443 views
1 answer
0 vote
 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
513 views
1 answer
0 vote
 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
723 views
1 answer
0 vote