I have a patient on Hemodialysis short term due to polymicrobial peritonitis requiring catheter removal. Patient is on maintenance warfarin but bridged over to Lovenox for insertion of new PD cath. Post op day 10 patient felt unwell, weak, SOB. Hemoglobin was 65 (INR 5.3) and patient was determined to have hemoperitoneum. CT has shown no active bleed and after 4 units PRBC's, hemoglobin has remained stable. Over a number of days we have drained a total of 3.5L blood from peritoneum through patients PD cath. Wondering if you have any recommendations. Should we be draining hemoperitoneum? When we determine it is fully drained is it ok to restart PD? Thank you.
I have a patient on Hemodialysis short term due to polymicrobial peritonitis requiring catheter removal. Patient is on maintenance warfarin but bridged over to Lovenox for insertion of new PD cath. Post op day 10 patient felt unwell, weak, SOB. Hemoglobin was 65 (INR 5.3) and patient was determined to have hemoperitoneum. CT has shown no active bleed and after 4 units PRBC's, hemoglobin has remained stable. Over a number of days we have drained a total of 3.5L blood from peritoneum through patients PD cath. Wondering if you have any recommendations. Should we be draining hemoperitoneum? When we determine it is fully drained is it ok to restart PD? Thank you.
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JENNIFER,H, Nurse from NEWFOUNDLAND, CANADA asked
I have a patient on Hemodialysis short term due to polymicrobial peritonitis requiring catheter removal. Patient is on maintenance warfarin but bridged over to Lovenox for insertion of new PD cath. Post op day 10 patient felt unwell, weak, SOB. Hemoglobin was 65 (INR 5.3) and patient was determined to have hemoperitoneum. CT has shown no active bleed and after 4 units PRBC's, hemoglobin has remained stable. Over a number of days we have drained a total of 3.5L blood from peritoneum through patients PD cath. Wondering if you have any recommendations. Should we be draining hemoperitoneum? When we determine it is fully drained is it ok to restart PD? Thank you.

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⋅ Susie Hu, MD (USA) ⋅ April 2, 2021

I would recommend continuing exchanges to determine if the hemoperitoneum is improving after cessation or dose reduction of the anticoagulation (if that is possible).  You may use IP heparin to prevent clott obstruction of the PD catheter as heparin should not cross the peritoneal membrane. However, if patient continues to bleed, then you may not be able to continue PD.

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