FAQ – Peritoneal dialysis

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.

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.

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.

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.

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.

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.

Possible cause(s)

• Failure to follow aseptic measures
• Accident

What to do?

• Put on a MiniCap disconnecting cap.
• Contact your healthcare team immediately.

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.

Possible cause(s)

• Various

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.

Possible cause(s)

• Catheter displacement

What to do?

• Stay calm.
• Contact your healthcare team immediately.

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.

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.

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.

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.

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.

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.

Possible cause(s)

• Constipation
• Peritonitis
• Presence of fibrin
• Change in the state of the peritoneal membrane

What to do?

• Contact your healthcare team.

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.

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.

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.

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.

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.

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.

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.