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Repeated peritoneal dialysis

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Abstract

Repeated peritoneal dialysis can be a suitable alternative to hemodialysis for selected patients with end-stage renal failure. The procedure is often used for diagnostic evaluation and as a holding procedure before hemodialysis or renal transplantation or both. Percutaneous insertion of a dialysis catheter is uncomfortable and therefore is a limiting factor to patient acceptance of the procedure. Catheter insertion can be dangerous for the unconscious patient, or even for a patient with a soft, flabby abdominal wall. In inexperienced hands a major complication has been inadvertent perforation of the bladder or bowel during insertion and positioning of the catheter. To obviate some of these difficulties, we use a plastic peritoneal replacement prosthesis to make and maintain a fistulous tract in the abdominal wall between peritoneal dialyses.1, 2 The device is a semi-rigid Teflon bar connected to a mesa-shaped Teflon disc head (Fig. 1). A model presently available is a one-piece molded unit of polyethylene. A similar device of soft silastic requires a stylet to keep the silastic shaft rigid during insertion. The diameter of the bar is similar to that of commercially available No. 11 French dialysis catheters.

A peritoneal replacement prosthesis has been used to maintain easy access to the peritoneal cavity for repeated dialyses in 14 patients with chronic, end-stage renal failure. All were undergoing evaluation in preparation for renal transplantation or were awaiting home dialysis training. The prosthesis has been inserted after 371 peritoneal dialyses and left in place for a total of 2,372 days (Table 1).


 

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