Chapter 53 ■ Peritoneal Dialysis 381

Table 53.1 Complications of Peritoneal Dialysis

Problem (Risk) What to Do

Perforation of bladder, bowel, or major vessels

(3%–7%)

Surgical consultation

Puncture-site bleeding (3%–15%) Apply pressure gently.

Purse-string suture.

Blood-stained dialysis maintained after several

cycles

Check hematocrit frequently.

Continue heparin.

Rule out major-vessel bleeding.

Leakage from exit site (2%–20%) Reduce dwell volume until leakage stops.

Extravasation of dialysate into the anterior

abdominal wall

Replace with new catheter.

More than 10% of solution retained in each

of several consecutive cycles Reposition

infant gently. (outflow obstruction)

(15%–30%)

Reposition catheter by rotation and slight retraction. Do not

advance.

Remove if unchanged.

Replace with new catheter.

Two-way obstruction (3%–20%) Irrigate catheter with small amount of dialysate or saline

aseptically.

Reposition.

Remove if unchanged.

Dislodgment of catheter (3%) Replace with new catheter.

Hydrothorax (0%–10%) Reposition infant, head and chest above level of abdomen.

Decrease dwell volume.

Hyperglycemia (10%–60%) Avoid high concentrations of dialysate unless outflow is inadequate.

Low dose of insulin if needed.

Lactic acidosis Use bicarbonate dialysate.a

Hyponatremia Reduce fluid intake. Aim to increase outflow if secondary to

fluid overload.

Hypernatremia Increase fluid intake if secondary to excessive ultrafiltrate.

Exit site infection (4%–30%) Systemic antibiotics.

Peritonitis (0.5%–30%) Several rapid flushing exchanges.

Blood culture. Systemic vancomycin plus ceftazidime or an

aminoglycoside.

For fungal peritonitis, systemic therapy is needed and catheter

should be removed.

Hernia (inguinal or umbilical) (2%–13%) Possible need for future repair.

Small bowel herniation and gangrene at

catheter exit site (one case report)

Surgical consultation

Removal of therapeutic drugs See Appendix E.

a

1.5% bicarbonate dialysis solution: 140 mEq/L Na, 110 mEq/L Cl, 30 mEq/L HCO3, 15 g of glucose; add sterile water to

1,000 mL.