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FAQ – Peritoneal dialysis

When to consult your healthcare team

Peritoneal catheter

Equipment for peritoneal dialysis

Peritoneal dialysis sessions

General condition

Your child’s healthcare team will use your child’s regular appointments to verify the proper functioning of the catheter and peritoneal dialysis equipment and will make adjustments to the care as required.

Do not hesitate to contact your healthcare team with any specific questions concerning your child.

 

WARNING: The information in this section is meant as a general guide for parents and caregivers of children with certain problems related to peritoneal dialysis. It is not intended to replace the recommendations of your child’s healthcare team.

Discuss your child’s unique needs with the healthcare team, including WHO and WHEN to contact when problems arise.

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)

  • 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.

Dislodgement of the catheter; catheter cuff visible outside the insertion site

Possible cause(s)

  • Catheter displacement

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.

For specific advice on your child or any other questions, do not hesitate to contact your child’s healthcare team.


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