Flashcards in Complications Deck (14):
What are the three leading complications of peritoneal dialysis?
Peritonitis, tunnel infection, and catheter exit site infection are leading complications.
What is an abdominal hernia?
A protrusion of the organ through the abdominal wall.
Occurs in a considerable number of patients on CAPD, due to uremia, with its pronounced muscle tenderness, and to increased abdominal pressure from the volume of PD fluid applied and or body position and movement.
The most frequently occurring hernias during PD are incisional, umbilical and inguinal. Hernias are one of the most frequently seen abdominal complications.
Before PD treatment is started, all significant abdominal wall-related hernias should be corrected or otherwise the hernia will become worse due to the increased pressure on the abdominal wall created by the intraperitoneal dialysis fluid
What are causes of abdominal pain?
Abdominal pain during initial dialysis exchanges may occur.
The pain may be caused by rapid inflow, acidic pH of the solutions or the migration of the catheter to the sub-diaphragmatic area.
The pressure of the catheter against the bowel or bladder may also be the cause of abdominal discomfort.
What causes catheter leakage?
It can be related to catheter implantation technique, trauma or patient-related anatomical abnormalities and can have different clinical manifestations depending on whether the leak is external or subcutaneous.
If leakage is apparent at the exit site or through the wound, the risk of a tunnel infection and/or peritonitis is increased.
Peritoneal dialysis should be interrupted when early subcutaneous leakage develops.
It may seal off during a prolonged rest period.
Fluid leaks into the male scrotum, or into the labia in women, can cause swelling.
If this type of leak occurs, PD must be stopped temporarily, until the leak has healed.
A test can be carried out to check the location and size of a leak, and a determination made as to whether or not surgery is needed to repair it.
What should the patient be instructed to do if there is a leak or break of the catheter?
If there is a break in the catheter material or a dialysate leak the patient should be instructed to stop dialysis, clamp the catheter proximal to the site of damage, cover the damaged area with a sterile dressing to prevent further contamination and come to the clinic or emergency center immediately.
What is outflow/inflow obstruction?
Fluid is blocked from exiting or entering the peritoneum.
Outflow and inflow obstructions are the most frequently observed early events within two weeks after catheter implantation, although these complications can also be seen later during PD-related complications, such as peritonitis.
What is one of the most common drainage problems?
One of the most common problems with PD, especially when patients first start PD is poor drainage of dialysis fluid. The most common reason for this is constipation.
If a person becomes constipated, the bowel presses against the catheter and makes the dialysis fluid drain very slowly.
Many people on PD are prone to constipation either because there is not enough fiber in their diet or their level of activity has been greatly decreased due to renal failure.
What are other risks of constipation?
Fluid may also get trapped in pockets of bowel, preventing it from draining properly.
It is very important for patient’s to avoid constipation by improving their diets and by taking stool softeners and/or laxatives as appropriately prescribed.
How does fibrin cause drainage problems?
The PD catheter may also become blocked with a substance called fibrin, which is a form of protein.
A patient may be able to clear the catheter simply by squeezing the tubing to dislodge the fibrin and the nurse should be able to clear the catheter by flushing it.
Some patients may need to have a small quantity of heparin in their overnight dwell to dissolve any fibrin that accumulates in the peritoneum in order to keep the catheter clear.
How does catheter malposition cause poor drainage?
Another reason for poor drainage is that the catheter is in the wrong position.
Sometimes a displaced catheter will “float” back into the right position naturally.
If this does not happen, then surgery may be required to correct the position of the catheter.
What causes pink or red effluent?
Sometimes when PD fluid is drained out at the end of an exchange, it may look slightly red or pinkish in color.
This happens if any of the small blood vessels in the peritoneum are broken.
This may be caused by lifting something heavy, coughing or can happen while playing sports.
In females, red or pink-
tinged effluent can occur during menstruation.
Patients are always advised to contact their clinic if the effluent doesn’t clear up in a few days, or if the effluent looks very bloody and is not just light pink or red colored.
What are the risks of fluid imbalance?
Fluid overload can lead to an increase in body weight, high blood pressure, swollen ankles and shortness of breath.
Hypervolemia can be caused from inadequate fluid removal and excessive fluid intake.
Hypovolemia can be caused from excessive fluid removal or inadequate intake and usually results in hypotension.
What is catheter cuff extrusion?
PD catheters have a cuff of material that anchors the catheter inside the abdomen.
Because of the resilience of silicone, a catheter attempts to reassume its original configuration after insertion; e.g. when a straight catheter is placed so that the subcutaneous segment is in a curved configuration, over time it will tend to straighten out.
This then exerts a forward force on the external cuff.
Extrusion also can occur from tugging and pulling on the catheter or placing the external cuff too close to the skin exit.
The complications that may result from this are chronic exit site infections, subcutaneous tunnel infections and peritonitis.