KEY ACTIVITIES
External leaks:
- Verify that clear fluid at incision or exit-site contains glucose, using glucose test strip
- Document condition of exit-site, subcutaneous cuff, tunnel, and/or wound
- Alter dressing change procedure to accommodate increased fluid drainage
- Reduce leak by use of dry days, supine low volume dialysate exchanges, or temporary suspension of PD
- Leaks increase the risk of peritonitis, and consideration should be given to prophylactic antibiotic administration
Subcutaneous leaks:
- Monitor girth
- Examine flank and back for subcutaneous fluid
- Examine for scrotal, penile, or labial swelling
- Order/review abdominal computerized tomography (CT) with intraperitoneal (IP) contrast, peritoneal scintigraphy, or magnetic resonance imaging (MRI) without gadolinium3, 4, 5 (see section Imaging Techniques)
- Increase clinic visits as needed for observation
IMAGING TECHNIQUES
- CT peritoneography3 (see Appendix)
- Peritoneal scintigraphy4 (see Appendix)
- Peritoneal MRI with dialysate as “contrast medium”5 (see Appendix)
Pericatheter Leak
CT without IP contrast revealing a pericatheter leak in a patient with improper placement of the catheter.
White arrows indicate catheter and leak area identified by different contrast to other subcutaneous tissue.
Radiograph courtesy of Ali Abu-Alfa, MD
CT Peritoneography
CT peritoneography with IP contrast showing dye around the cord structures in the upper scrotum on the right side (arrow) at the level of the root of the penis.
Radiographs courtesy of John Crabtree, MD
Peritoneal Scintigraphy
Peritoneal scintigraphy postdrain image demonstrating right inguino-scrotal fluid collection.
Radiographs courtesy of John Crabtree, MD
MRI (Magnetic Resonance Imaging)
MRI showing anterior abdominal hernia. Dialysate brightly enhances in the subcutaneous tissue demonstrating a leak.
Radiograph courtesy of Brent Miller, MD