Abstract: PUB207
Urgent Bedside PD Catheter
Session Information
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Malavade, Tushar Suryakant, University Health Network, Toronto, Ontario, Canada
- Salah, Naeim Gawad, University Health Network, Toronto, Ontario, Canada
Introduction
PD catheter for ESRD is an elective procedure is done by surgeons, interventional radiologists (IR), or nephrologists. We describe a successful bedside PD catheter insertion and immediate initiation of PD in a uremic patient, with hypoxia, and hyperkalemia with no bowel preparation.
Case Description
A 38-year-old patient with diabetic nephropathy was on 5/week HD for 5 years. He had failed multiple accesses for HD including temporary and tunneled catheters, AV grafts, trans-lumbar dialysis catheter. The accesses were complicated with CRBSIs, and central venous stenosis needing multiple interventions including angioplasties, and thrombolytics. He had inefficient HD and persistent pruritus, leading to the pulling of the HD catheter on multiple occasions. He was recently admitted with infective endocarditis, mitral regurgitation, and heart failure. His tunnelled internal jugular catheter was again dislodged. While waiting 2 days for a new HD catheter placement by IR, he developed uremia in the form of myoclonus, orthopnea, hypoxia needing Oxygen and refractory hyperkalemia. IR staff evaluated all the vascular accesses and concluded that no further HD CVC could be placed.
A decision was taken to place a bedside PD catheter on an urgent basis. The bowel prep was given 3 hours before the procedure. The patient was hypoxic needing 6 lits of O2 and with 30° head elevation. Under mild sedation, using ultrasound, a midline supraumbilical coiled double-cuffed Tenchkoff PD catheter was inserted at the bedside by the nephrology team. After confirming good inflow and outflow, we were able to start the PD on the table itself with 4.25% dextrose PD solution and continued with low volume, supine, cycler PD with 4.25% solution. His UF was 1.3 lits in 24 hours. There were no complications like leak, bleeding or perforation. After a week, the patient was on room air, with no uremic features and electrolyte imbalances. His PD was continued with low volume cycler, supine PD.
Discussion
Bedside PD catheter placement for the immediate start of PD is not commonly done. Our patient did not have any vascular access for HD and we had to do urgent PD catheter insertion and start PD immediately as life life-saving measure as he was getting uremic, hypoxic and hyperkalemic and with no bowel preparation. Fortunately, there was no PD leak in short-term follow-up.