Problems related to the material
Discharge, redness, heat, swelling, bad odor and/or pain around the catheter insertion site
Possible cause(s):
- Infection or inflammation caused by:
- poor or insufficient care at the catheter insertion site,
- insufficiently frequent dressing changes,
- poor fixation of the catheter
- Chronic skin irritation
- Trauma to the site
What to do?
- Contact your healthcare team quickly.
While waiting to reach your healthcare team:
- Take a specimen of the flow at the insertion site, as taught.
- If possible, take a picture of the site.
- If you need to leave to get your smartphone or camera, cover the site with a sterile compress. After taking the photo, rewash your hands using an alcohol-based antiseptic gel (eg, Stérigel®) to the entire surface of your hands and rub until they are dry (20 to 30 seconds).
- Clean the site, change the dressing.
- Keep the skin clean and dry around the catheter insertion site.
Bump or red line near the catheter insertion site with redness, swelling, pain or tenderness and/or discharge
Possible cause(s)
- Tunnel infection (catheter pathway under the skin, from the insertion site to the peritoneal cavity) caused by:
- an infection at the catheter insertion site,
- an abscess,
- inadequate healing of the site
What to do?
- Contact your healthcare team immediately.
While waiting to reach your healthcare team:
- Take a specimen of the flow at the insertion site, as taught.
- If possible, take a picture of the site.
- If you need to leave to get your smartphone or camera, cover the site with a sterile compress. After taking the photo, rewash your hands using an alcohol-based antiseptic gel (eg, Stérigel®) to the entire surface of your hands and rub until they are dry (20 to 30 seconds).
- Clean the site, change the dressing.
- Keep the skin clean and dry around the catheter insertion site.
- Get ready to go to the hospital.
Wet dressing
Possible cause(s)
- Poor protection of the dressing while showering or swimming
- Leakage from the catheter insertion site
- Catheter breakage
- Disconnection of the extension
- Infection
- Urinary incontinence or diaper overflow
What to do?
- If the dressing was improperly protected, clean the site and change the dressing.
- If not, try to identify the cause of the discharge.
- Clamp the catheter with a dialysis clamp.
- Contact your healthcare team immediately.
While waiting to reach your healthcare team:
- Remove the wet dressing.
- Take a specimen of the flow at the insertion site, as taught.
- If possible, take a picture of the site.
- If you need to leave to get your smartphone or camera, cover the site with a sterile compress. After taking the photo, rewash your hands using an alcohol-based antiseptic gel (eg, Stérigel®) to the entire surface of your hands and rub until they are dry (20 to 30 seconds).
- Clean the site, change the dressing.
- Keep the skin clean and dry around the catheter insertion site.
- Change the dressing frequently.
Disconnection between patient line and extension during dialysis
Possible cause(s)
- Accident
- Incorrect connection technique
What to do?
- Discontinue the dialysis session.
If complete disconnection:
- Close the extension: the two half-moons of the white part and the light blue part must be well aligned and nested in each other.
- Put on a MiniCap disconnect cap.
- Contact your healthcare team immediately.
If partial disconnection:
- Close the extension: the two half-moons of the white part and the light blue part must be well aligned and nested in each other.
- Contact your healthcare team immediately.
Disconnection between MiniCap disconnecting cap and extension tubing
Possible cause(s)
- Accident
- Incorrect connection technique
What to do?
- Stay calm.
- Make sure the extension is closed.
- If the MiniCap disconnect cap is loose, screw it on completely.
- If the MiniCap has fallen off, install a new one.
- Contact your healthcare team immediately.
- Prepare to go to the hospital.
Disconnection between the extension and the catheter
Possible cause(s)
- Accident
- Damaged catheter
What to do?
- Stay calm.
- Immediately clamp the catheter with a dialysis clamp.
If complete disconnection:
- Wrap the catheter in sterile compress.
- Contact your healthcare team immediately.
If partial disconnection:
- Tighten the extension.
- Wrap it with a sterile compress.
- Contact your healthcare team immediately.
Contamination of the extension tip during dialysis connection
Possible cause(s)
- Failure to follow aseptic measures
- Accident
What to do?
- Put on a MiniCap disconnecting cap.
- Contact your healthcare team immediately.
Drainage from the bag during the dialysis session
Possible cause(s)
- Incorrect cannula breakage technique during bag preparation
- Bag manufacturing defect
- Perforation of the bag during the injection of the medication through the injection port
What to do?
- Stop the dialysis session.
- Contact your healthcare team immediately.
Cycler alarms
Possible cause(s)
What to do?
- Look at the message on the screen.
- Take appropriate action.
- If necessary, refer to the instructions in the cycler’s manual or in the alarm book available to you.
- If you are still unable to resolve the problem, contact your healthcare team or the manufacturer’s technical support (eg, Baxter) whose number is displayed on the cycler.
Dislodgement of the catheter; catheter cuff visible outside the insertion site
Possible cause(s)
What to do?
- Stay calm.
- Contact your healthcare team immediately.
Problems related to the peritoneal dialysis session or the child's general condition
Cloudy effluent (as if milk had been added) with any of these symptoms: Constant pain in the belly; Chills; Fever (≥ 38⁰C rectal or ≥ 37.5⁰C oral or ≥ 37.5⁰C axilla); Nausea; Vomiting; Decreased effluent drainage; Headache; Loss of appetite; Fatigue; Abdominal muscle cramps or spasms (stiffness, pain)
Possible cause(s)
- Peritonitis (infection of the peritoneum) caused by:
- failure to follow aseptic measures during treatment
- incorrect dialysis technique
- catheter site infection
- weak immune system of the child
- untreated contamination
- Inflammatory reaction
- Appendicitis
- Invasive technique
- Movement of bacteria from the intestines to the peritoneal cavity
What to do?
- Contact your healthcare team immediately.
While waiting to reach your healthcare team:
- Discontinue dialysis session, if in progress.
- Add a specimen bag and then take a specimen of the dialysate after it has been in the peritoneal cavity for 60-90 minutes in the dwell phase.
- Take your child’s temperature, blood pressure and pulse.
Filaments (threads) or small white pieces in the effluent
Possible cause(s)
- Presence of fibrin (looks like partially cooked egg white) caused by:
- normal body reaction to the presence of a foreign body, the catheter, in the peritoneal cavity,
- infection, inflammation,
- installation of a new catheter,
- condition of the child
What to do?
- Contact your healthcare team quickly.
While waiting to reach your healthcare team:
- Continue the current dialysis session unless there are too many strands.
- Make sure you have the heparin vial available while you wait for your healthcare team’s advice.
To prevent catheter blockage by fibrin build-up:
- Check for it in the drainage bags at the beginning and end of treatment.
- If present, notify your healthcare team.
Pink or red effluent
Possible cause(s)
- Rupture of small blood vessels in the peritoneum often caused by physical exertion
- Abdominal injury or fall during a sport activity
- Menstruation or ovulation in adolescents
- Forceful manipulation of the catheter
What to do?
- If your child is unwell, contact your healthcare team immediately.
- If your child is table, don’t worry; it’s often not serious and is usually temporary.
- However, contact your healthcare team immediately and they will make the necessary assessment.
While waiting to reach your healthcare team:
- Make a 2nd exchange and compare the color with the previous cycle.
- Take your child’s blood pressure and pulse.
Slow or blocked infusion of the dialysate
Possible cause(s)
- Clamp closure
- Improperly prepared dialysate bags
- Catheter obstruction caused by the presence of fibrin (normal reaction of the body to the presence of the catheter in the peritoneal cavity)
- Internal mechanical obstruction of the catheter
- Catheter displacement
What to do?
- Make sure all clamps are open.
- Make sure the dialysate bag cannulas are broken and the seals are open.
- If the problem persists, contact your healthcare team quickly.
One and/or the other of these symptoms: Rapid increase in weight compared to your child's dry weight; Swelling of the hands, ankles, feet, around the eyes and/or face; Hypertension (high blood pressure); Difficulty breathing; Shortness of breath; Low urine output
Possible cause(s)
- Fluid overload caused by:
- too much fluid or sodium intake,
- use of the wrong dialysate,
- inadequate ultrafiltration,
- incorrect weight reading,
- insufficient or inadequate dialysis,
- catheter malfunction,
- decrease in urine production
What to do?
- Contact your healthcare team quickly.
While waiting to reach your healthcare team:
- Continue with your dialysis session.
- Limit fluids and salty foods.
- Use more concentrated dialysis solutions, as recommended by your healthcare team.
One and/or the other of these symptoms: Rapid weight loss compared to your child's dry weight; Dizziness; Less saliva, dry lips; Low blood pressure; Orthostatic low blood pressure (low blood pressure and increased pulse) when the child moves from a lying to a sitting position); Increased pulse rate; Muscle cramps, especially in the legs; Weakness; Dark eyes
Possible cause(s)
- Dehydration caused by:
- use of the wrong concentration of dialysate,
- insufficient fluid intake,
- nausea,
- diarrhea,
- vomiting,
- excessive urination,
- acute illness
What to do?
- Have your child sit or lie down if feeling dizzy or weak.
- Contact your healthcare team quickly.
While waiting to reach your healthcare team:
- Discontinue dialysis session, if in progress.
- Weigh your child.
- Take your child’s blood pressure lying down and then sitting up (orthostatic blood pressure) unless your child unable to sit independently.
- Give your child more fluids to drink, especially salty fluids (eg, chicken broth).
- Use less concentrated dialysis solutions, as recommended by your healthcare team.
If your child has cramps or dizziness:
- Give him a salty liquid (eg, broth) or saltine crackers.
- Apply a warm compress or towel to cramped muscles.
- Massage the muscles.
Decrease in ultrafiltration/decreased effluent
Possible cause(s)
- Constipation
- Peritonitis
- Presence of fibrin
- Change in the state of the peritoneal membrane
What to do?
- Contact your healthcare team.
Abdominal cramps during drainage
Possible cause(s)
- Dialysate temperature too cold
- Effluent drainage too fast
- Peritonitis
- Catheter displacement
What to do?
- Ensure that the temperature setting on the cycler is appropriate for the dialysate bag.
- Give pain medication if recommended by your healthcare team.
- If the problem persists, contact your healthcare team quickly.
Constipation
Possible cause(s)
- Pressure of the dialysate on the intestines
- Certain medications (eg, antacids, calcium carbonate, iron)
- Diet low in fiber
- Decreased physical activity
- Inadequate hydration
What to do?
- Give laxative medications, if recommended by your healthcare team.
- Increase fluids, if your child’s diet allows it.
- Increase fiber-rich foods, as recommended by your healthcare team.
- Increase the amount of physical activity, if possible.
- If the problem persists, contact your healthcare team.
One and/or the other of these symptoms: Fatigue; Muscle weakness; Decreased energy; Increased sleep
Possible cause(s)
- Anemia
- Hypotension (low blood pressure)
- Dehydration
- Inadequate nutrition (eg, lack of protein)
- Lack of physical activity
What to do?
- Make sure your child is eating and hydrating well, as recommended by your healthcare team.
- Increase physical activity.
- Be sure to follow the prescription for oral and subcutaneous medications.
- If the problem persists, inform your healthcare team at your next visit.
Shoulder pain
Possible cause(s)
- Irritation of the diaphragm caused by air in the peritoneal cavity
What to do?
- Not dangerous but uncomfortable.
- If it is only a small amount of air, it will be quickly absorbed by your child’s body.
- If you see a lot of air in the patient line, drain the peritoneal cavity, as taught by your healthcare team.
- Lay your child on his or her back.
- Put pillows under his or her hips to support them.
- If the pain persists, contact your healthcare team quickly.
Itching
Possible cause(s)
- Dry skin
- Electrolyte imbalance (eg, high phosphorus level)
What to do?
- Apply a moisturizing cream or lotion to your child’s skin as recommended by your healthcare team.
- Wash your child with a soap for dry or sensitive skin.
- Use an unscented laundry soap formulated for sensitive skin.
- Contact your healthcare team for other recommendations, depending on your child’s condition.
Diarrhea
Possible cause(s)
- Viral infection
- Peritonitis (infection of the peritoneum)
- Too many laxatives
What to do?
- Contact your healthcare team quickly.
While waiting to reach your healthcare team:
- Increase fluid intake (small amounts given often) and salty foods, if recommended by your healthcare team.
- Note the frequency and consistency of bowel movements and whether blood is present.
- Take your child’s blood pressure and pulse and weigh your child.
Restless legs (need to move the legs at night or while lying down)
Possible cause(s)
- Excessive or insufficient dialysis sessions
- Lack of physical activity
What to do?
- Contact your healthcare team.
- Increase your child’s physical activity.