Questions About PD
The practice has been quite empirical with the principle that small dwell volume should be used immediately after implantation of PD catheter to avoid leaking, and also avoiding abdominal distending discomfort. There was no RCT on the optimal volume, but 1 liter dwell is generally well tolerated. I take care of the much smaller size Asian patients, and routinely ordered 1 liter flushing for a few cycles +/- hourly dwell cycle if immediate dialysis is needed. It is well tolerated. Leaking and distending discomfort is extremely uncommon. Please note that we use minilaparotomy approach with tight purse string around the peritoneum opening for catheter implantation. For blind implantation without purse string, the chance of leakage may be higher with 1 L dwell.