378

Kathleen A. Marinelli

Majid Rasoulpour

53 Peritoneal Dialysis

Acute Peritoneal Dialysis (1–5)

In neonates, acute peritoneal dialysis (PD) is frequently preferred over hemodialysis (HD), continuous arteriovenous

hemofiltration with or without dialysis (CAVH/D), and continuous venovenous hemofiltration with or without dialysis

(CVVH/D), because it is technically easier to perform.

Peritoneal surface area per kilogram of body weight is relatively larger in newborns and children than in adults.

Therefore, PD usually allows adequate clearance and

removal of excess fluid (6). In addition, PD avoids the need

for anticoagulation and maintenance of adequate vascular

access, which are required for the other methods (7).

A. Indications

1. Renal failure, when conservative management has

failed to adequately control any of the following conditions (8,9).

a. Hypervolemia

b. Hyperkalemia

c. Hyponatremia

d. Refractory metabolic acidosis

e. Hyperphosphatemia

f. Azotemia

g. Additional fluid space needed for delivering drugs

and/or nutrition

2. Inherited disorders of organic and amino acid metabolism when HD or CVVH/D is unavailable (10,11)

a. In hyperammonemic metabolic crisis, however, evidence suggests that ammonia is more efficiently

removed by extracorporeal techniques than by PD

(12,13).

b. In babies with imminent or current intracranial

hemorrhage, PD is considered the therapeutic

option of choice, especially in nonhyperammonemic disorders (12).

B. Relative Contraindications

1. Acute abdomen

2. Abdominal adhesions

3. Immediately after abdominal surgery (14)

4. Diaphragmatic or abdominal wall disruptions

C. Equipment (Figs. 53.1 through 53.3)

Sterile

1. Masks, drapes, gowns, and gloves

2. Povidone–iodine

3. 1% lidocaine without epinephrine

4. 3-mL syringe with 25-gauge needle

5. IV cutdown tray with no. 11 surgical blade

6. 3-0 Prolene sutures (either as part of cutdown tray or

separately)