Austere peritoneal dialysis - Revision history

ClaireLewis: /* References */

2019-10-07T13:36:55Z

References

2019-04-21T16:07:14Z

Overview

← Revisión anterior		Revisión del 16:07 21 abr 2019
Línea 3:		Línea 3:
	*Indications in the austere setting are the same in non-austere settings		*Indications in the austere setting are the same in non-austere settings
	*Consider contacting a nephrologist via telemedicine if available		*Consider contacting a nephrologist via telemedicine if available
			*Effective for [[hyperkalemia]], though much slower than hemodialysis
			**Relatively ineffective for [[uremia]] and eliminating BUN

	==Indications==		==Indications==

2019-01-27T18:10:48Z

← Revisión anterior		Revisión del 18:10 27 ene 2019
Línea 8:		Línea 8:
	*However, there are certain situations that are more likely in disaster or combat situations:		*However, there are certain situations that are more likely in disaster or combat situations:
	**[[Rhabdomyolysis]] from crush injuries		**[[Rhabdomyolysis]] from crush injuries
	**Severe pediatric dehydration and AKI		**Severe pediatric [[dehydration (peds)\|dehydration]] and AKI
	**Toxin clearance		**Toxin clearance

Línea 63:		Línea 63:
	==Complications==		==Complications==
	*Hemorrhage, bowel or solid organ injury		*Hemorrhage, bowel or solid organ injury
	*Peritonitis, including fungal peritonitis not otherwise covered by prophylactic antibiotics		*[[Peritoneal dialysis-associated peritonitis\|Peritonitis]], including fungal peritonitis not otherwise covered by prophylactic antibiotics
	*Dialysate leakage, especially in abdominal surgical patients with newly healing abdominal wounds		*Dialysate leakage, especially in abdominal surgical patients with newly healing abdominal wounds
	*Hydrothorax		*Hydrothorax

2018-06-12T17:45:03Z

Dialysate

← Revisión anterior		Revisión del 17:45 12 jun 2018
Línea 50:		Línea 50:
	**Generally, dextrose concentrations increase 1% for every 20 mL of D50 per liter		**Generally, dextrose concentrations increase 1% for every 20 mL of D50 per liter
	*500 units of heparin per liter can prevent PD catheter obstruction		*500 units of heparin per liter can prevent PD catheter obstruction
	[[File:peritoneal dialysate.jpg\|400px]]		[[File:peritoneal dialysate.jpg\|400px]]

	==Dialysis Process==		==Dialysis Process==

2018-06-12T12:33:48Z

Dialysate

← Revisión anterior		Revisión del 12:33 12 jun 2018
Línea 45:		Línea 45:

	==Dialysate==		==Dialysate==
	*Lactated ~~ringer~~'s is the most readily available IVF ~~that is~~ most similar to commercial dialysate fluid, but dextrose must be added to produce an osmotic dialysate		*Lactated Ringer's is the most readily available IVF and most similar to commercial dialysate fluid, but dextrose must be added to produce an osmotic dialysate
	*Increasing dextrose concentration increases volume removal for hypervolemic patients		*Increasing dextrose concentration increases volume removal for hypervolemic patients
	**Commercial dialysates usually have 1.5-4.25% dextrose		**Commercial dialysates usually have 1.5-4.25% dextrose

2018-06-12T12:33:19Z

Procedure

← Revisión anterior		Revisión del 12:33 12 jun 2018
Línea 35:		Línea 35:
	**Ensure sterile technique in creating dialysate		**Ensure sterile technique in creating dialysate
	**Additionally, antibiotics such as cephalosporins can be added to each PD bag		**Additionally, antibiotics such as cephalosporins can be added to each PD bag
	*Approach depends on catheter type
	*Improvised flexible		*Improvised flexible
	**Local anesthesia, then midline ~~incision~~ 2 cm below umbilicus		**Local anesthesia, then midline incise 2 cm below umbilicus
	**Blunt ~~dissection~~ to linea alba, then puncture through linea alba with rigid catheter, ~~with insertion of~~ a small volume of dialysate under US guidance		**Blunt dissect to linea alba, then puncture through linea alba with rigid catheter, and insert a small volume of dialysate under US guidance
	**~~Insertion of~~ a guidewire through the initial catheter, then ~~dilation~~ using Seldinger technique to final catheter		**Insert a guidewire through the initial catheter, then dilate using Seldinger technique to final catheter
	*Rigid catheter		*Rigid catheter
	**Local anesthesia to area just lateral to umbilicus		**Local anesthesia to area just lateral to umbilicus

2018-06-12T12:31:58Z

Procedure

← Revisión anterior		Revisión del 12:31 12 jun 2018
Línea 32:		Línea 32:
	==Procedure==		==Procedure==
	*Consider giving preprocedural antibiotics such as ertapenam before start		*Consider giving preprocedural antibiotics such as ertapenam before start
			**Fungal coverage where suspected to be an issue
	**Ensure sterile technique in creating dialysate		**Ensure sterile technique in creating dialysate
	**Additionally, antibiotics such as cephalosporins can be added to each PD bag		**Additionally, antibiotics such as cephalosporins can be added to each PD bag

2018-06-12T12:30:47Z

Equipment Needed

← Revisión anterior		Revisión del 12:30 12 jun 2018
Línea 21:		Línea 21:

	==Equipment Needed==		==Equipment Needed==
	*~~Two types~~ of possible peritoneal catheters		*Types of possible peritoneal catheters:
	**Flexible Tenckhoff catheter is gold standard, but not available in austere setting		**Flexible Tenckhoff catheter is gold standard, but not available in austere setting
	**Rigid trocar, non-tunneled catheter		**Rigid trocar, non-tunneled catheter
	**Improvised: NGTs, suprapubic catheters, pediatric chest tubes, large bore central venous catheters ("Cordis"), pigtail catheters		**Improvised: NGTs, suprapubic catheters, pediatric chest tubes, large bore central venous catheters ("Cordis"), pigtail catheters, 8-10 Fr Foley catheters
	*Scalpel		*Scalpel
	*Lidocaine		*Lidocaine

2018-06-12T12:29:59Z

Contraindications

← Revisión anterior		Revisión del 12:29 12 jun 2018
Línea 14:		Línea 14:
	*No absolute contraindications		*No absolute contraindications
	*Relative contraindications include:		*Relative contraindications include:
	**Recent abdominal surgery~~, diaphragmatic~~ injury with communication into thoracic space		**Recent abdominal surgery
	**Overlying diffuse abdominal wall infection~~, known~~ severe peritoneal adhesions		**Diaphragmatic injury with communication into thoracic space
			**Overlying diffuse abdominal wall infection
			**Known severe peritoneal adhesions
	**Patients with severe respiratory failure that may not do well with intraperitoneal fluid		**Patients with severe respiratory failure that may not do well with intraperitoneal fluid

2018-06-12T12:29:34Z

Indications

← Revisión anterior		Revisión del 12:29 12 jun 2018
Línea 6:		Línea 6:
	==Indications==		==Indications==
	*See indications in [[AKI]]		*See indications in [[AKI]]
	*However, there are certain situations that are more likely in disaster or combat situations ~~without prompt evacuation~~:		*However, there are certain situations that are more likely in disaster or combat situations:
	**[[Rhabdomyolysis]] from crush injuries		**[[Rhabdomyolysis]] from crush injuries
	**Severe pediatric dehydration and AKI		**Severe pediatric dehydration and AKI