I have a patient who has his pd catheter for over 1 year, but has not needed dialysis yet. The catheter was being flushed once every 2-3 weeks with 1000ml of Dianeal and after the flush heparin was instilled before capping off. The catheter functioned well until two months ago. Abdominal xray was done and the catheter migrated out of the pelvis. The catheter was surgically repositioned and it is work fine again. Is there a better way to maintain this catheter, the patient still doesnot need dialysis and not sure when dialysis will be started. The patient’s creatinine has been in the 3’s for over a year.
RESOLVEDLiz,S asked February 5, 2011
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 What do you use to warm the CAPD bags?we used to use the microwave and warm the CAPD 2L or 2.5 L bags for 2 minutes only but according to the studies it is not the efficient way due to the glucose degradation products.We received trays from the companys but it is not a practical way because we have to wait a minimum of 4-6 hrs for the bag to be warmed.It is difficult to do it with emergency situations and unscheduled patients.Thank you inadvance.
RESOLVEDWAFIKA FOUDA answered January 25, 2011
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 I have a pt with a PD cell count of 0 and effluent has always been clear. Preliminary culture was negative. Three days later it came back gm positive cocci. Pt has never had any symptoms and effluent remains clear. Pt is being treated with antibiotics. My question is do I classify this as peritonitis or could it be possible there was a contamination of the culture. Another culture and cell count has been done. What is the criteria to be classified as peritonitis.
RESOLVEDMiriam R answered January 22, 2011
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 Technique in catheter placement is important. The superficial cuff if placed appropriately would result in a well healed exit site. The exit site would lead to a blind sinus with the end at the fibrosed Dacron cuff. I find that, after each shower with cleansing of the exit site with normal shower soap and water, followed by dabbing it dry, one does not need to do any dressing with povidone and topical antibiotic application. The healthy exit site can be left without any gauze covering and the end of catheter with transfer set can be safely immobilized to prevent accidental pulling and traction. In fact without the gauze covering, it prevents chronic irritation from the plaster, catheter degradation from antiseptics, and free sinus discharge from any debris collection.I have practiced this on few patients and they do well. What do you think?
RESOLVEDBee BC answered December 9, 2010
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 It is true that fat weight does not contribute to uremic state and both DOQI and uptodate recommend using ideal rather than actual body weight for determination of weekly KT/V. However, there are some people who are overweight but also have big muscles and not all their excess weight is fat. My own belief is an adjusted body weight similar to what is used in TPN calculations should be used for these patients. I would like Dr. Oreoupoulos to comment on this issue. What is the position of ISPD on this issue?
RESOLVEDali s answered September 16, 2010
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