I've worked with PD in the hospital setting for 11 years, but in the last 2 years have worked in the chronic setting. While in the hospital, it was routine to flush newly inserted PD catheter with 1L of dialysate, however I was informed recent by my direct supervisor that a PD catheter should never be flushed with more than 500 mL per ISPD guidelines. When I research this information on your website, I did not find any information stating this. I only found where it stated that 500 mL was commonly used when flushing PD catheter. Could you please provide some information based on this. I failed to mention that we have a doctor order to flush catheter with 1 L of dialysate

Questions About PD

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T.S., Nurse from U.S. asked
I've worked with PD in the hospital setting for 11 years, but in the last 2 years have worked in the chronic setting. While in the hospital, it was routine to flush newly inserted PD catheter with 1L of dialysate, however I was informed recent by my direct supervisor that a PD catheter should never be flushed with more than 500 mL per ISPD guidelines. When I research this information on your website, I did not find any information stating this. I only found where it stated that 500 mL was commonly used when flushing PD catheter. Could you please provide some information based on this. I failed to mention that we have a doctor order to flush catheter with 1 L of dialysate

1 answer

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.

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