Non-Infectious Complications

1
Non-Infectious Complications
2
Non-infectious Catheter Complications

• Inflow/outflow obstruction
• Hernia
• Leakage

3
Increased Intra-Abdominal Pressure

• Instillation of dialysate into the peritoneal
  cavity leads to increased intra-abdominal
  pressure
• The magnitude of the increase depends upon
• Volume dialysate filled
• Patient age, body mass index
• Coughing, lifting straining at stool
• Position of the patient (sittinggtstandinggtsupine)

4
Inflow/Outflow Obstruction

• Causes
• Mechanical (e.g. tip migration, kink in tubing)
• Constipation
• Catheter blockage
• Outflow obstruction is most frequent
• - Intraluminal (clot, fibrin)
• - Extraluminal
• (constipation, occlusion, omental
• wrapping, tip migration,
  incorrect
• catheter placement)

5
Inflow/Outflow Obstruction - Recommendations

• Establish type of obstruction
• Conservative or non-invasive approaches
• - body position change
• - laxatives
• - heparinised saline
• - fibrinolytic agents
• Aggressive therapies
• -a) blind - fluoroscopically guided wires,
  stylet, whiplash
• -b) direct - peritoneoscopy, surgical catheter
  revision
• or replacement

6
Dialysate Leaks
Early (within 30 days) - Manifest
externally - Do not require imaging - Managed by
temporary discontinuation of PD (75) or
surgery Late (beyond 30 days) - Manifest by poor
outflow, localised oedema, subcutaneous fluid -
30 require imaging - Hernia cause 40 of late
leaks - Most late leaks require surgery (70) -
Frequently lead to change of treatment
Tzamaloukas Adv PD 1990
7
Fluid Leak - CT Cannulogram
8
Abdominal Wall or Pericatheter Leak

• Presentation
• Abdominal swelling or bogginess
• Reduced drain (effluent) output
• Weight gain and abdominal wall oedema, without
  peripheral oedema
• Pericatheter leak wetness or swelling at
  exit-site

9
Abdominal Wall or Pericatheter Leak

• Management
• Reintroduce low pressure PD (APD)
• or
• Temporary transfer to HD to allow healing, or
• Catheter replacement if pericatheter leak,

10
Hernias and Genital Oedema

• Caused by continuous elevation of intra-abdominal
  pressure and abdominal wall tension
• Acquired or congenital defects in the abdominal
  wall
• Inguinal gt Catheter insertion site
• Epigastric gt Richters
• Umbilical gt Enterocoele
• Incisional gt Spigelion
• Ventral gt Obturator

11
Hernias risk factors

• Raised intra-abdominal pressure
• Female sex and multiparity (no. of pregnancies)
• Older age
• Previous hernia
• Polycystic kidney disease

12
Hernias clinical presentation

• Painless or tender lump or swelling
• Bowel incarceration or strangulation
• Peritonitis (transmural leakage of bacteria)
• Treatment
• 1) Surgical repair
• 2) Reintroduce PD with low volumes, supine
  posture, increase volume over 2 weeks

13
Genital Oedema

• Occurs in up to 10 of patients
• Mechanism
• - fluid tracks through soft tissue plane in a
  hernia,
• catheter insertion site, peritoneal fascial
  defect,
• genital oedema associated with abdo wall
  oedema
• - patent processus vaginalis
• - males affected more than females
• Diagnosis
• - can be difficult
• - CT scan with contrast (100-150mls Omnipaque)

14
continuedGenital Oedema

• Treatment
• - bed rest
• - scrotal elevation if symptomatic
• - low volume exchange/NIPD
• stop PD temporarily
• surgical repair if cause is hernia or patent
  processus vaginalis

15
Infusion or Drainage Pain

• CAUSES
• - constipation
• - jet effect
• - fluid pH related
• MANAGEMENT
• - laxatives - slow
  infusion rate
• - incomplete drainage - Bicarbonate buffer
• - 1 lignocaine IP - catheter
  replacement