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 .

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Diane M., Nurse from Newtown Pa. asked
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 .

1 answer

Johann Morelle, MD January 31, 2019

Thank you for your question.
Inadequate peritoneal UF can result from 4 mechanisms:

  • catheter dysfunction,
  • mechanical problems (incl. sequestration or excessive fluid absorption),
  • membrane failure (including EPS),
  • inadequate prescription.

It would be interesting to know if the immediate drainage after instillation works well, and if icodextrin generates a positive UF after a dwell lasting 8-12 hours. 
Then, would suggest:

  • to perform a peritoneal equilibration test (ideally using hypertonic glucose during a 4-h dwell) to assess net UF (is it UF failure?), peritoneal solute transport rate (fast transport status?), and sodium sieving (i.e. altered osmotic conductance, potentially suggesting severe membrane fibrosis and an increased risk of EPS?);
  • to consider imaging studies, including: X-ray of the abdomen (location of the tip of the catheter?), CT scan of the abdomen (signs of EPS?) and/or, based on results of previous tests, a CT peritoneography (adhesions? sequestration? other causes for abnormal drainage?).

The results of the workup should then help choosing the best solution (catheter replacement, adaptation of prescription, or transition to HD? – or adhesiolysis if restricted to an area of the abdomen?).
Hope it helps. Do not hesitate to provide a feed-back and/or ask additional questions.

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