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Session 5b: Concurrent 2.5
Concurrent Session
Concurrent Session
9:15 am
14 June 2024
P9
Themes
Peritoneal Dialysis
Session Description
Session Chair: Ignatius Abraham
Session Program
446Q - Research Paper
Abstract
Aim:
To provide improved wait time for PDC insertion by re-introducing insertion via Interventional Radiology (IR) alongside the surgical pathway.
Method:
Patient review for PDC insertion was included in the established, Vascular Access Nurse (VAN) led, Dialysis Access Clinic. Home Dialysis Nurses worked with the VAN coordinating patient referral and review for PDC insertion. Interventional Radiology (IR) and Surgical (Urology) were invited to participate in this Dialysis Access Clinic with the aim to streamline patient pathway for PDC insertions.
Results:
IR was successfully integrated into the Dialysis Access Clinic and IR PDC insertions recommenced in March 2023. Median time for referral to insertion via IR in 2023 was 31.5 days. IR insertion has since become the predominant pathway for referrals. The Surgical unit declined to participate in the Dialysis Access Clinic but remain an option for referral, one patient was referred in 2023 for surgical insertion.
Conclusion:
Inclusion of IR to the Dialysis Access Clinic has improved timely access to PDC insertion for our patient group. It has also provided an opportunity to build interdepartmental relationships with a view to continue to audit and improve patient outcome and experience for PDC insertion.
Abstract
Aim:
To provide improved wait time for PDC insertion by re-introducing insertion via Interventional Radiology (IR) alongside the surgical pathway.
Method:
Patient review for PDC insertion was included in the established, Vascular Access Nurse (VAN) led, Dialysis Access Clinic. Home Dialysis Nurses worked with the VAN coordinating patient referral and review for PDC insertion. Interventional Radiology (IR) and Surgical (Urology) were invited to participate in this Dialysis Access Clinic with the aim to streamline patient pathway for PDC insertions.
Results:
IR was successfully integrated into the Dialysis Access Clinic and IR PDC insertions recommenced in March 2023. Median time for referral to insertion via IR in 2023 was 31.5 days. IR insertion has since become the predominant pathway for referrals. The Surgical unit declined to participate in the Dialysis Access Clinic but remain an option for referral, one patient was referred in 2023 for surgical insertion.
Conclusion:
Inclusion of IR to the Dialysis Access Clinic has improved timely access to PDC insertion for our patient group. It has also provided an opportunity to build interdepartmental relationships with a view to continue to audit and improve patient outcome and experience for PDC insertion.
478C - Research Paper
Abstract
Case Description:
Given the portability of PD, it is not surprising that people travel to domestic locations frequently but many patients are hesitant to travel internationally due to perceived risks and challenges.Between June 2022 and February 2024, our PD unit assisted 14 PD patients to plan and successfully undertake 22 international trips, for both work and leisure related reasons. Travel destinations include North and Central America, Europe, Asia and the Middle East.
Discussion:
Our PD staff prepare patients for international travel through communication of travel plans, stock ordering and prescription management to facilitate travel, and helping to manage risk through education of different connections systems and supplies available at their destination as well as emergency management plans while overseas. Travel for all patients did not involve any adverse events with delivery of supplies and management of automated PD (APD) machines. One patient who developed peritonitis while overseas due to a disconnection contamination was managed successfully.
Conclusion:
With careful planning and support from PD staff, patients can successfully navigate arranging international travel while on PD.
Abstract
Case Description:
Given the portability of PD, it is not surprising that people travel to domestic locations frequently but many patients are hesitant to travel internationally due to perceived risks and challenges.Between June 2022 and February 2024, our PD unit assisted 14 PD patients to plan and successfully undertake 22 international trips, for both work and leisure related reasons. Travel destinations include North and Central America, Europe, Asia and the Middle East.
Discussion:
Our PD staff prepare patients for international travel through communication of travel plans, stock ordering and prescription management to facilitate travel, and helping to manage risk through education of different connections systems and supplies available at their destination as well as emergency management plans while overseas. Travel for all patients did not involve any adverse events with delivery of supplies and management of automated PD (APD) machines. One patient who developed peritonitis while overseas due to a disconnection contamination was managed successfully.
Conclusion:
With careful planning and support from PD staff, patients can successfully navigate arranging international travel while on PD.
9:45 am
419Q - Research Paper
Abstract:
Aim:
To investigate the effect of increased peritoneal dialysate flush volumes on peritonitis episodes
Method:
Clinical data was collected over a period of 11 months (February 2023-January 2024), for each episode where suspected peritonitis or sampling was indicated. These included factors such as use of Icodextrin solution, abdominal symptoms, and flush volumes prior to sampling.A change of protocol from 500ml x2 dialysate flushes to 1000ml x2 were performed prior to administration of 1L dialysate for a minimum two-hour dwell period prior to sampling. Samples were analysed for total white cell count, differential count and culture results.
Results:
A total of 26 suspected peritonitis episodes were observed of which three (12%) of these were confirmed peritonitis. There were zero episodes of culture-negative peritonitis over this time period.
Conclusion:
An increase in flush volume prior to sampling resulted in reduced peritonitis episodes and an absence of culture-negative peritonitis across the study period. This has helped our organisation to achieve the updated International Society of Peritoneal Dialysis culture negative peritonitis targets.
Abstract:
Aim:
To investigate the effect of increased peritoneal dialysate flush volumes on peritonitis episodes
Method:
Clinical data was collected over a period of 11 months (February 2023-January 2024), for each episode where suspected peritonitis or sampling was indicated. These included factors such as use of Icodextrin solution, abdominal symptoms, and flush volumes prior to sampling.A change of protocol from 500ml x2 dialysate flushes to 1000ml x2 were performed prior to administration of 1L dialysate for a minimum two-hour dwell period prior to sampling. Samples were analysed for total white cell count, differential count and culture results.
Results:
A total of 26 suspected peritonitis episodes were observed of which three (12%) of these were confirmed peritonitis. There were zero episodes of culture-negative peritonitis over this time period.
Conclusion:
An increase in flush volume prior to sampling resulted in reduced peritonitis episodes and an absence of culture-negative peritonitis across the study period. This has helped our organisation to achieve the updated International Society of Peritoneal Dialysis culture negative peritonitis targets.
439Q - Research Paper
Abstract
Aim:
To show that non-renal nurses were able to perform CAPD on admitted patients with no increase in episode of peritonitis.
Method:
Statistics were kept from 2017 – 2023 for all admitted renal patients on PD. This included length of stay, reason for admission, ward placement and movement, episodes of peritonitis as an inpatient and within 7 days of discharge. An education program was established that was aimed at the ward Clinical Nurse Educators (CNE) to ensure competency and familiarity with CAPD. The CNE’s then implemented a train the trainer program so they could educate and accredite ward staff. This was all accomplished with the oversight of the Renal Clinical Nurse Consultant and Renal CNE.
Results:
Overall, at least 50% of PD patients admitted to our hospital were not admitted to the Renal Ward. There were episodes of peritonitis recorded during admission but the episodes that were attributed to technique were minimal. Therefore it was included that this would not make us change our practice.
Conclusion:
PD patients can be admitted to non-renal wards and have their PD performed without detriment. They are able to receive quality care related to the reason for their admission without concern for their PD.
Abstract
Aim:
To show that non-renal nurses were able to perform CAPD on admitted patients with no increase in episode of peritonitis.
Method:
Statistics were kept from 2017 – 2023 for all admitted renal patients on PD. This included length of stay, reason for admission, ward placement and movement, episodes of peritonitis as an inpatient and within 7 days of discharge. An education program was established that was aimed at the ward Clinical Nurse Educators (CNE) to ensure competency and familiarity with CAPD. The CNE’s then implemented a train the trainer program so they could educate and accredite ward staff. This was all accomplished with the oversight of the Renal Clinical Nurse Consultant and Renal CNE.
Results:
Overall, at least 50% of PD patients admitted to our hospital were not admitted to the Renal Ward. There were episodes of peritonitis recorded during admission but the episodes that were attributed to technique were minimal. Therefore it was included that this would not make us change our practice.
Conclusion:
PD patients can be admitted to non-renal wards and have their PD performed without detriment. They are able to receive quality care related to the reason for their admission without concern for their PD.
10:15 am
331R - Research Paper
Abstract
Aim:
The goal of this project was to examine the available research regarding implementation of urgent-start Peritoneal Dialysis and the benefits, complications to determine if it a safe alternative to urgent-start Haemodialysis.
Method:
An integrative review was undertaken to review current research on this topic and involved analysis on a combination of ten qualitative and quantitative papers.
Results:
Urgent-start Peritoneal Dialysis is not associated with higher rates of mortality than urgent-start HD. While urgent-start Peritoneal Dialysis does have a higher risk of complications, such as dialysate leak, it ultimately works towards preservation of renal function and reduces the number of procedures and central venous line complications associated with haemodialysis.
Conclusion:
The themes of benefits, risk, the need for further research and the implications for future practice of urgent-start Peritoneal Dialysis are discussed. With the right management and knowledge, urgent-start Peritoneal Dialysis can be a practical alternative to urgent-start HD for patients requiring immediate dialysis.
Abstract
Aim:
The goal of this project was to examine the available research regarding implementation of urgent-start Peritoneal Dialysis and the benefits, complications to determine if it a safe alternative to urgent-start Haemodialysis.
Method:
An integrative review was undertaken to review current research on this topic and involved analysis on a combination of ten qualitative and quantitative papers.
Results:
Urgent-start Peritoneal Dialysis is not associated with higher rates of mortality than urgent-start HD. While urgent-start Peritoneal Dialysis does have a higher risk of complications, such as dialysate leak, it ultimately works towards preservation of renal function and reduces the number of procedures and central venous line complications associated with haemodialysis.
Conclusion:
The themes of benefits, risk, the need for further research and the implications for future practice of urgent-start Peritoneal Dialysis are discussed. With the right management and knowledge, urgent-start Peritoneal Dialysis can be a practical alternative to urgent-start HD for patients requiring immediate dialysis.
505 - Research Paper
Abstract
Case Description:
Reporting a case of a 77-year-old male patient on APD, presenting with SOB, low ultrafiltration on APD & pleural effusion. Initial investigations including imaging studies revealed bilateral pleural effusions without apparent aetiology. Further evaluation with diagnostic paracentesis confirmed the presence of pleuroperitoneal leak. The patient underwent therapeutic thoracentesis to relieve symptoms and had to go on haemodialysis temporarily for a month. Follow-up imaging confirmed the successful closure of the pleuroperitoneal communication, and the patient successfully resumed APD.
Discussion:
Pleuroperitoneal leak is a rare but important consideration in the differential diagnosis of unexplained SOB, low UF & pleural effusion. Prompt recognition and appropriate management, often involving surgical intervention, are crucial in achieving favourable outcomes. This case highlights the clinical presentation, diagnostic approach, and therapeutic management of pleuroperitoneal leak, emphasizing the importance of a multidisciplinary approach.
Conclusion:
Pleuroperitoneal leak is a rare entity that requires a high index of suspicion for diagnosis. Timely recognition and intervention are essential for effective management and favourable patient outcomes.
Abstract
Case Description:
Reporting a case of a 77-year-old male patient on APD, presenting with SOB, low ultrafiltration on APD & pleural effusion. Initial investigations including imaging studies revealed bilateral pleural effusions without apparent aetiology. Further evaluation with diagnostic paracentesis confirmed the presence of pleuroperitoneal leak. The patient underwent therapeutic thoracentesis to relieve symptoms and had to go on haemodialysis temporarily for a month. Follow-up imaging confirmed the successful closure of the pleuroperitoneal communication, and the patient successfully resumed APD.
Discussion:
Pleuroperitoneal leak is a rare but important consideration in the differential diagnosis of unexplained SOB, low UF & pleural effusion. Prompt recognition and appropriate management, often involving surgical intervention, are crucial in achieving favourable outcomes. This case highlights the clinical presentation, diagnostic approach, and therapeutic management of pleuroperitoneal leak, emphasizing the importance of a multidisciplinary approach.
Conclusion:
Pleuroperitoneal leak is a rare entity that requires a high index of suspicion for diagnosis. Timely recognition and intervention are essential for effective management and favourable patient outcomes.