I take care for a new patien who just implent pd tube for 8 days, and no DM hx,got H/T hx.on day 7,i try to flush the pd tube, the out flow is good, but when i try 1.5% 1500ml to dwell > 2hr ,i got -1000 for 3 days, after 3 days he get -3000ml inside the boday.we try apd for 3 cycles and also get (-) after dwell! he show no leakage,no hernia,no scrotum edema..symptoms,he got no constipation, no migration after kub & chest x-ray for no hydrothorax.and today we consult GS, let him back to OR again do the scope exceed the tube functional problem. and BUN,CR increas right now,hold PD ,transfer to HD!! What can i do for now to help him get good PD therapy? is it rare? or maybe the data after PET will show very H? The tube function is good!! no obstruction!! what should i do next? is anybody got the same case like this? or is there got any case report about this kind special new case? please help me!!

Questions About PD

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cindy sung, Nurse from taiwan asked
I take care for a new patien who just implent pd tube for 8 days, and no DM hx,got H/T hx.on day 7,i try to flush the pd tube, the out flow is good, but when i try 1.5% 1500ml to dwell > 2hr ,i got -1000 for 3 days, after 3 days he get -3000ml inside the boday.we try apd for 3 cycles and also get (-) after dwell! he show no leakage,no hernia,no scrotum edema..symptoms,he got no constipation, no migration after kub & chest x-ray for no hydrothorax.and today we consult GS, let him back to OR again do the scope exceed the tube functional problem. and BUN,CR increas right now,hold PD ,transfer to HD!! What can i do for now to help him get good PD therapy? is it rare? or maybe the data after PET will show very H? The tube function is good!! no obstruction!! what should i do next? is anybody got the same case like this? or is there got any case report about this kind special new case? please help me!!

1 answer

I think firstly do not do a PET it will not help and it is to early. It sounds mechanical as you have good inflow and even though there are no signs of constipation on x-ray still try strong laxatives it may work. If he has been dehydrated then he will also retain fluid,it also depends on his size, try also shorter cycles or manual exchanges. Ensure there is no fibrin this may cause outflow problems and heparin can be used.Finally it maybe omentum wrapped around the end of the tube and this would cause outflow problems laparascopic or surgical removal maybe necessary.

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