Have a CCPD patient who has been on PD for 4 years. He recently developed drain problems unrelated to constipation/fibrin. He was recently seen by his surgeon.Findings: a lot of adhesion and a small bowel wrap in pelvis. This was corrected but patient still having drain problems. Drains better supine and or on left side. Patient would probably do better on CAPD but declines due to his life style. I have placed him on Tidal but still positional drain problems. Any suggestions he would like to remain on PD .
ANSWEREDDiane M. answered January 31, 2019
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 Patient completed treatment of cefepime and Vancomycin for a no growth peritonitis. Cultures that were repeated one week after completion and again three weeks are growing sphingomonas paucimobilis however the patient does not currently have an active peritonitis. Cell count of pd fluid is negative. Could this possibly be a biofilm on the catheter and if so any suggestions on treatment? The patient has refused catheter removal and temporary hemodialysis.Thank You
ANSWEREDLaura V answered January 28, 2019
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 I have a young ESRD Pt on PD who was admitted for migraines. She was receiving IP heparin at 1000 units per exchange for fibrin clots in her PD fluid. Also receiving SQ heparin for DVT prophylaxis. She developed progressive thrombocytopenia and HIT Ab was positive. Hematology has started angiomax (argatroban not on hospital formulary). I want to know if anyone has experience with an alternative agent for fibrin clots in PD fluid. Has anyone used fibrinolytics in PD fluid ? and what dose to use in 2 liter PD exchanges. I have done literature search and there are case reports of Pt’s developing HIT from heparin in PD fluid
ANSWERED answered September 28, 2018
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 I had a 75 year old man who started CAPD since December in 2017. He suffered from CAPD peritonitis on 9th of Jan in 2018 and ascites culture revealed proteus mirabilis. Ceftazidime IP was given for three weeks and peritonitis totally subsided. However, he suffered from another episode of peritonitis on 18th of Feb in 2018 (ascites white blood cell 10786/uL with neurophil 94%). We collect ascites culture by blood culture bottle but this time ascites culture revealed no bacteria growth. Ceftazidime IP and cefazolin IP was given for two weeks according to ISPD guideline for culture negative peritonitis. My Question is how to define these episodes? repeat peritonitis or different peritonitis? What’s your suggestion about protocol of ascites culture collection to avoid culture negative? What’s the regimen you will give this patient for his second CAPD peritonitis? Thank you very much.
ANSWERED answered September 28, 2018
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 I am a second year nephrologist fellow in SUNY downstate medical center, Brooklyn, NY. We have a large HD program but very limited PD program. I will be attending the PD university course for the fellows coming up in March/April of 2019.After this course I am interested in a self sponsored 1 month PD fellowship /clinical exposure .I would be grateful if you could provide me with recommendations/information on list of institutions with strong PD programs in Canada, Mexico, Europe or South Africa that can accommodate my need.After my nephrology fellowship training in june 2019, i plan to start a clinical practice of nephrology in US.Thank you.
ANSWEREDAbayomi answered September 17, 2018
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 Good morning. Does the ISPD have a position on use of Effluent Sample Bags specifically developed and designed to collect specimens from the patient transfer set for culture when peritonitis is suspected? The sample bag that I have seen is made by a well known vendor of CAPD solutions and supplies (dual bag, y-connection), and the procedure for collection of the specimen mirrors that used for connection and disconnection during an exchange. The product is essentially a miniature drain bag. There is no instillation of solution involved.
ANSWEREDCheryl G answered April 19, 2018
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