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     I have a patient who previously had a MDR serratia peritonitis and than a fungal peritonitis followed by removal of the PD catheter. He is now running out of all vascular access and having multiple problems maintaining it. I do have an option of getting a translumbar HD catheter but I want any input regarding maybe putting him back on PD. I wanted to know if with the 2 previous infections, which were more than 9 months ago now, is their an absolute contraindication against putting him back on PD.
    ANSWEREDzubair, A answered July 24, 2016
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     Message Body:I am reviewing our policy for pts undergoing a colonoscopy.All PD pts get in order of preference1. cipro 200mg prior to procedure. if allergic use #22. ampicillin 2 gms plus gentamycin 1 mg/kg prior to procedure3 If allergic to PCN use vancomycin4. neomycin or tobramycin may be given in place of gentamycin– the GI physician may also order 2 doses of metronidazole, po 6 to 8 hours apart on the day of the colonoscopy.Could you please tell me if this is still the best practice. Our policy was written in 2012.Thanks – Sue Reed
    ANSWEREDSusan R answered June 17, 2016
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     I am looking for an educational program on how to mark a PD exit site preoperatively. Our surgeons would like the acute dialysis nurses in the hospital to mark the exit site prior to PD catheter insertion. None of us have training on this.Our surgeons also only insert 62 cm double cuff standard tenckhoff catheters for ALL patients. What is the recommendation regarding having multiple catheter options? I feel like this is not best practice.
    ANSWEREDSuzy B. answered June 16, 2016
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     I am reviewing our policy.All PD pts get in order of preference1. cipro 200mg prior to procedure. if allergic use #22. ampicillin 2 gms plus gentamycin 1 mg/kg prior to procedure3 If allergic to PCN use vancomycin4. neomycin or tobramycin may be given in place of gentamycin – the GI physician may also order 2 doses of metronidazole, po 6 to 8 hours apart on the day of the colonoscopy.Could you please tell me if this is still the best practice. Our policy was written in 2012.Thanks – Sue Reed
    ANSWEREDSusan R answered March 31, 2016
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    2 answers
    0 vote
     I have a PD patient who have initiated PD for past 3 months. His ESRD primary disease is diabetes. He is a low average transporter with residual renal volume of 800 mls/day. His total ultrafiltration is persistently low with reabsorption each exchanges (5-6 hours dwell time) even with 2.5% solution bags. His abdominal x-ray revealed PD catheter in pelvis. Inflow and outflow time good. No evidence of extra-peritoneal leaks and blood sugar control is good. He is perpetually overloaded with the poor UF. I did peritoneal resting for 4 weeks and reinitiate PD but he still reabsorbs.
    ANSWEREDLily M answered January 18, 2016
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     I have a surgeon in the area who insist that I flush the PD catheter 2-3 days after placement to make sure the catheter does not become occluded. I do not believe this is necessary if the catheter is flushed well during placement. When I have to flush so soon, I am needing to take down the original dressing to get to the catheter/transfer set. I do not want to be changing the dressing so soon post-op. Are there any articles that speak to how soon the catheter should be flushed after placement? The surgeon is going to want to see any evidence based papers regarding flushing PD catheters after placement for them to change their practice and I have not been able to locate any specific recommendations. Thank you.
    ANSWEREDAmy L answered December 7, 2015
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