Hi I was wondering if anyone had any information / literature on preoperative bowel therapy prior to insertion of tenckhoff. Do any units have procedures in place to properly clear patients bowels prior to insertion and if they have any success at reducing complications when starting training?

Questions About PD

Trudy H, Nurse from australia asked
Hi I was wondering if anyone had any information / literature on preoperative bowel therapy prior to insertion of tenckhoff. Do any units have procedures in place to properly clear patients bowels prior to insertion and if they have any success at reducing complications when starting training?

1 answer

Nurse, Canada November 2, 2018

We thank you for your important question. Unfortunately, there is limited literature on preoperative bowel regimens prior to PD catheter insertion, or even on constipation in general for patients on PD (1).
 
If you go to the ISPD website and look under the tab Education & Guidelines, then Lecture Series https://ispd.org/ispd-lecture-series/ the U.S. surgeon and expert on PD catheter insertion, Dr. Crabtree, has a talk on “Preoperative Assessment and Preparation for Peritoneal Dialysis Catheter Implantation”. Dr. Crabtree focuses on what he considers best practices, which include bowel preparation. One of his suggestions is Polyethelene glycol solution (e.g. CoLyte, GoLytely, PegLyte) 1 L/day PO for 2 days preoperatively.  He also suggests for patients with constipation postoperatively Lactulose 30 – 60 mL PO daily until bowel movement to prevent catheter flow dysfunction. Of note, phosphate- or magnesium-containing enemas in patients with advanced kidney disease should always be avoided (2).
 
1. Lee A. Constipation in patients on peritoneal dialysis: a literature review. Renal Society of Australia Journal 2011; (7)3:122-29.
2. Abdel-Aal AK, Dybbro P, Hathaway P, et al. Best Practices Consensus Protocol for Peritoneal Dialysis Catheter Placement by Interventional Radiologists. Peritoneal Dialysis International. 2014 Jul-Aug; 34(5):481-93 available at ncbi.nlm.nih.gov/pmc/articles/PMC4114666/

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