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CAPD Non-infectious Complications
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CAPD Non-infectious Complications

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Complications of CAPD not related to infections includes different anatomical due to IP pressure, Fluids flow and Solute and Water transfer.

Complications of CAPD not related to infections includes different anatomical due to IP pressure, Fluids flow and Solute and Water transfer.

Published in: Health & Medicine

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  • 1. Non-Infectious Complications Of peritoneal dialysis  BY: Dr. Shima Al Sanhoury
  • 2. Non Infectious complications  Are 3 types :  Problems related to IP pressure  Problems related to fluid flow  Problems related to solute and water transfer
  • 3. 1. Problems related to IP Pressure Can cause : Hernias Leaks ◦ Genital edema, hydrothorax, or soft tissue edema . Pain or discomfort ◦ Back pain, sense of fullness
  • 4. Problems related to IP pressure 1.Hernias  More frequent in elderly females  It needs Repair prior to or at time of catheter insertion  Common sites ◦ Ventral ◦ Incisional, including catheter site ◦ Umbilical ◦ Inguinal
  • 5. 1.1.Hernias  Cause ◦ Increased IP pressure  Signs and symptoms ◦ Painless swelling or out-pouching ◦ Tender lump  Treatment ◦ Surgical repair ◦ Low exchange volumes  Cycling may be needed
  • 6. 1.Problems related to IP pressure 1.2.Leaks  Can cuse :  Genital edema ◦ From dialysate leaking through soft tissue or patent processus vaginalis ◦ Seen as scrotal swelling (hydrocele) or labial edema ◦ Treatment  Bed rest with elevation  Low exchange volume / cycling  Surgical repair
  • 7. 1.2.2.Leaks  Also can cause :  Hydrothorax ◦ Diaphragmatic defect - small or large ◦ Signs & symptoms  Shortness of breath  May be asymptomatic ◦ Treatment  Discontinue peritoneal dialysis  Thoracentesis if needed ...  Or Low volume exchanges / cycling  Pleurodesis  Surgical repair
  • 8. 1.2.3.Leaks  Also cause :  Soft tissue edema ◦ Due to Peritoneo-fascial defect ◦ Signs & symptoms  Abdominal wall, flank, thigh, or buttocks edema  Poor dialysate drainage ◦ Treatment  Low volume exchanges  Surgical repair
  • 9. 1.Problems related to IP pressure 1.3.1.Pain or Discomfort  Back pain ◦ Causes  Change in position  Weight of fluid ◦ Treatment  Strengthening exercises  Change to cycling
  • 10. 1.3.2.Pain or Discomfort  Discomfort / sense of “fullness” ◦ This related to exchange volume  Large volumes better tolerated when patient is supine  Smaller exchanges may be needed to solve the problem. ◦ Also may cause appetite suppression ◦ This usually diminishes with time .
  • 11. 2.Problems related to Fluid Flow Poor drainage Pain ◦ Inflow, rectal, suprapubic, shoulder Bloody effluent
  • 12. 2.Problems related to fluid flow 2.1.Poor drainage  Can be due to :  1.Catheter malposition  2.Catheter obstruction ◦ Constipation, omental capture, kinks, fibrin  3.Mechanical / equipment-related ◦ Kinks or clamps on lines ◦ Defective equipment ◦ Inappropriate fill or drain times ◦ Inappropriate height for gravity drain
  • 13. 2.Problems related to fluid flow 2.2.1.Pain  Inflow pain ◦ Causes  Dialysate pH (low)  High dialysate flow rate ◦ Treatment  Balance/ bicavera solutions
  • 14. 2.Problems related to fluid flow 2.2.2.Pain  Rectal or suprapubic / abdominal ◦ If the pain at end of drain ◦ Can be due to :  Internal catheter too long  Poor catheter position ◦ Treatment  Infuse fluid  IPD patient may need reserve left in
  • 15. 2.Problems related to fluid flow 2.2.3.Pain  Shoulder pain ◦ Usually localized to left shoulder ◦ Causes  Referred pain from diaphragm  Pneumoperitoneum  Due to infusion  Slow accumulation possible  Post catheter insertion  Perforated bowel
  • 16. 2.Problems related to fluid flow 2.2.3.Pain  Shoulder pain ◦ Treatment  Analgesics  Drain inTrendelenburg position ◦ Usually resolves without treatment
  • 17. 2.Problems related to Fluid Flow 2.3.Bloody effluent  Important to assess etiology!  Common causes ◦ Trauma - catheter insertion / abdominal ◦ Menstruation or ovulation  Most common cause (33%)  Less common causes : ◦ Abdominal diseases ◦ Anticoagulant therapy
  • 18. Bloody effluent  Signs & symptoms ◦ Pink to frankly bloody effluent  2 ml in 2 liters is noticeable! ◦ Pain not usual  Treatment ◦ Flush and evaluate ◦ Add heparin..
  • 19. 3.Problems related to Solute & Water Transfer Fluid overload Dehydration Electrolyte imbalance Protein loss Weight gain Hypertriglyceridemia
  • 20. 3.Problems related to Solute & Water Transfer 3.1.Fluid Overload  Causes ◦ Not enough hypertonic solution ◦ Excessive fluid intake ◦ Excessive salt intake ◦ Poor catheter function ◦ Change in insensible losses  Weather, physical activity ◦ Decreased lymphatic absorption ◦ Membrane fatigue
  • 21. Problems related to Solute &Water Transfer  Fluid Overload:  Signs & symptoms ◦ Common  Hypertension, edema, SOB, weight gain ◦ Severe - CHF, pulmonary edema  Treatment ◦ More hypertonic solution ◦ Decrease fluid & salt intake ◦ Decrease IP pressure ◦ Patient education!
  • 22. 3.Problems related to Solute & Water Transfer 3.2.Dehydration  Causes ◦ Increased insensible loss ◦ Inaccurate dry weight ◦ Overuse of hypertonic solution ◦ Vomiting or diarrhea  Signs & symptoms ◦ Hypotension, cramping, dizziness, weight loss, dry mouth
  • 23. Dehydration  Treatment ◦ Less hypertonic solution ◦ Assess I & O ◦ Assess dry weight ◦ Treat low BP if present  Evaluate use of antihypertensives  Salty broth or bouillon if severe ◦ Patient education
  • 24. 3.Problems related to Solute 3.3.Electrolyte Imbalance  Potassium ◦ Hypokalemia  All dialysate is K+ free  Closely monitor patients who  Are sick or eating poorly  Follow an overly restrictive diet  Are hospitalized ◦ Hyperkalemia  Rare
  • 25. 3.Problems related to Solute  Calcium ◦ Hypercalcemia  Monitor patients on large doses of  Vitamin D / calcitriol  Calcium-based phosphate binders  Low calcium dialysate is available ◦ Inappropriate use of low Ca solution increases PTH imbalance
  • 26. Transfer 4.Protein loss  Usually constant in an individual ◦ But varies from patient to patient  Dialysate loss ◦ 5 - 15 gm / 24 hours average ◦ Increases during peritonitis by 50 - 100%  Treatment ◦ Recommended DPI 1.2 - 1.5 g/kg/day
  • 27. 5.Weight Gain / Hypertriglyceridemia  Seen in 60 - 80% of PD patients ◦ Weight gain ◦ Elevated lipid levels  Increased caloric load from dialysate  Treatment ◦ Diet low in fat and calories ◦ Increase activity and exercise ◦ Minimize need for hypertonic solutions

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