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Flashcards in Peritonitis Deck (18):

What is Peritonitis?

It is an inflammation of the peritoneum, the membranous coat lining the abdominal cavity.

Exit site and tunnel infections often lead to peritonitis. Infectious complications are a leading cause of morbidity among PD patients, ultimately leading to patient dropout.

In order to maintain patients on PD, this complication must be managed effectively.

Prevention is the key! A thorough understanding of PD cultures and their significance is an important step in this process.


What are the most common reasons people on PD get peritonitis?

They touch the connection between the dialysate and the catheter.

However, even if PD exchanges are scrupulously clean, infection can still enter the abdomen from the outside world through the catheter.

Poor hand washing technique, not wearing a mask and breathing on the catheter along with environmental contamination are known to contribute to the peritonitis rates.


What are the symptoms of peritonitis?

They are rigid or board-like abdomen, abdominal pain, vomiting, elevated temperature and cloudy effluent.

Patients should contact the clinic immediately if they develop any signs and symptoms of peritonitis.


How is peritonitis classified? (6)

1. Infectious peritonitis
2. Refractory
3. Relapsing
4. Recurrent
6. Repeat
7. Nosocomial peritonitis


Infectious peritonitis

inflammation of the peritoneum related to •


Refractory peritonitis

(resistant peritonitis): Failure of the effluent to clear after 5 days of •
appropriate antibiotics.


Relapsing peritonitis

Peritonitis that occurs within 4 weeks of completing antibiotic therapy with the same organism or another negative culture.


Recurrent peritonitis

Peritonitis that occurs within 4 weeks of completing antibiotic therapy but with a different organism.


Repeat peritonitis

(reinfection) an episode that occurs after 4 weeks of completing antibiotic therapy with the same organism


Nosocomial peritonitis –

Develops in the hospital in a patient who had no infection at time of admission


What are the most common organisms causing peritonitis?

Gram positive bacteria such as Staphylococcus Epidermis and Staphylococcus Aureus cause two-
thirds of the episodes of peritonitis. Gram negative (pseudomonas) cause about 28% of all episodes. In rare cases fungus has been the cause.

To prevent infection from occurring, good aseptic and sterile technique must be used.

Any break in technique can cause a serious infection for the patient.

A “positive culture” alone is not considered a “diagnosis of peritonitis”


Treatment of Peritonitis consists of:

Adding one or more antibiotics to the dialysate (remember peritonitis may result in increased protein losses).

Cultures are necessary when using any antibiotic regimen.

Cultures are especially helpful in determining the effectiveness of the antibiotic treatment.

Occasionally a patient may have several attacks of peritonitis in a row.

The doctor may then decide to replace the catheter or to “rest” the abdomen by not using it for PD for a period of 4-6 weeks.

When this happens the patient will need to have hemodialysis until PD is resumed.


What could the patient be instructed on regarding prevention of peritonitis?

Use good hand washing with antibacterial soap then completely dry hands before performing procedures.

Wear a mask to reduce contamination from bacteria from the nose and throat. Ensure a safe environment for exchanges free from pets, close doors and windows, and turn off fans and clean work surface prior to performing the exchange.

Prophylactic antibiotic therapy reduces PD Catheter related infections and should be given prior to any surgical or dental procedures, endoscopy, or colonoscopies.

Patients should also inform the nurse if swimming, or after trauma to exist site.


How are exit site and tunnel infections prevented?

Some patients get exit site infections regularly, where as others may never get them.

Keeping the catheter taped down will help reduce the likelihood of an exit site infection, especially when the catheter is new, by preventing pulling on the catheter which may cause trauma to the exit site.

Daily showering and dressing changes will also help prevent an infection. Use of good exchange technique, as well as proper hand washing, helps to prevent infection.


Treatment of exit site infections includes:

Antibiotics either given orally, IV or intraperitoneally.

Tunnel infections are frequently exit site infections that have spread down the catheter “tunnel”.

Antibiotics are not always effective when someone has a tunnel infection and therapy may include removal of the catheter to allow the tunnel to heal.

Usually there is no need to remove the catheter.


What are the indications for catheter removal?

Catheter or tunnel infections, persistent peritonitis, bowel perforations, and cuff erosion and protrusion are the main causes of catheter removal.


What causes back and shoulder pain?

Shoulder pain can be deferred pain from the diaphragm caused from air in the peritoneal cavity due to infusion of air (tubing not primed before use), bowel perforation or the accumulation of small amounts of air over a period of time.

Shoulder pain may also be caused from a malpositioned peritoneal catheter.


What are steps the patient can take to alleviate shoulder pain?

Some patients are more at risk for back and shoulder pain.

Some ways to help prevent or treat include teaching good posture and proper body mechanics, muscle strengthening exercises such as pelvic tilts, decrease exchange volumes, muscle relaxants or anti-inflammatory agents.

Some patients may do better on nightly cycler therapy.