Optimal long-term management of the peritoneal dialysis (PD) patient hinges on achievement of best demonstrated practices and prevention of complications associated with peritoneal dialysis. Published recommendations enhance our understanding of how to achieve these goals and encourage focus on prevention, leading to improved management of our patients overall.
Access management is an essential element for long-term patient success with peritoneal dialysis. Proper placement of the catheter and postoperative care of the healing exit-site are key to establishing a successful permanent peritoneal access. A decrease in access-associated complications, particularly peritonitis, can be achieved if definitive focus is placed on proper catheter placement, use of advanced disconnect systems, exit-site prophylaxis, and, most importantly, the patient’s adherence to aseptic technique during the exchange procedure and to the protocol for exit-site care. Early intervention and treatment of peritoneal catheter related complications, if they do occur, are essential to maintaining the peritoneal access for prolonged successful peritoneal dialysis.
While there have been improvements made in the catheter area in both hemodialysis (HD) and peritoneal dialysis, access issues continue to be significant causes of morbidity in the dialysis patient. PD catheter-related infections and complications continue to be major reasons why patients discontinue PD.
Access Care and Complications Management was developed based on a review of the current medical literature, the recommendations of the International Society for Peritoneal Dialysis (ISPD) ad hoc advisory committee on PD-related infections, and the authors’ clinical experience. Sections include operative planning and processes, chronic catheter care, and infectious and noninfectious complications, with suggested references and additional information in the appendix. By its nature, this guide cannot be considered to be exhaustive, and users are encouraged to pursue specific issues that may not be covered herein. Therefore, this guide should not replace the independent clinical judgment of the healthcare provider.
This guide was developed as an aid to improve PD catheter management in the adult patient. It is our hope that these guidelines will assist you in improving patient care by optimizing PD catheter outcomes.
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