Role of Drain and Fill Profile in automated Peritoneal Dialysis

Author(s):  
G. Amici ◽  
K. Thomaseth
2021 ◽  
Vol 4 (1) ◽  
pp. 31-43
Author(s):  
Rachel Jager ◽  
Agnes ROBLES ◽  
Philippe LAN YUE WAH

The COVID-19 pandemic has highlighted the growing role of telemedicine in home dialysis treatments. Since the appearance of a connected automated peritoneal dialysis (APD) machine (Claria Sharesource Baxter® machine), we have systematically offered this solution to our patients treated with APD. Over the past two years, we have treated 35 patients with connected APD, of which 20 are still under the technique (aged 50 to 87) and represent 54% of the patients on peritoneal dialysis. A questionnaire on five subjects (perception of switching to the connected machine, stress, safety, everyday life, and vacations) was also given to them and showed that 80% of the patients had no stress related to the telemonitoring, while 18 out of 20 patients (90%) felt safe. In 2020, we received 74 phone calls during on-call phone duty, including 42 calls for the 20 patients on connected APD, one all for a patient on normal APD, and 32 calls for 16 patients on continuous ambulatory peritoneal dialysis (CAPD). Handling errors concerned 42.85% of the calls, system errors concerned 4.76%, program validation concerned 7.14%, and connection problems concerned 9.52%. We were thus able to correct several problems remotely, such as drainage problems, weight gain, blood pressure imbalance, poor compliance, and connection problems. Thanks to the platform, we are notified daily of a possible problem. This saves the nurses time and allows them to deal with other issues. The way we educate patients and assist private nurses has not changed. Indeed, only the connection to the network as well as the entry of the weight and arterial pressure were added, and the disposables remained the same. Night or day, or in times of a health crisis, we can provide a rapid and targeted response to the patients’ questions, thanks to the platform.


2014 ◽  
Vol 34 (4) ◽  
pp. 434-442 ◽  
Author(s):  
Borut Čižman ◽  
Steve Lindo ◽  
Brian Bilionis ◽  
Ira Davis ◽  
Aaron Brown ◽  
...  

Background, objectives and methods Increased intraperitoneal volume (IIPV) can occur during automated peritoneal dialysis (APD). The contribution of factors such as cycler programming and patient/user actions to IIPV has not been previously explored. The relationship between IIPV and cycler programming, patient/user actions, and ultra-filtration over a two-year period was investigated using US data from Baxter cyclers. Drain/fill volume ratios of > 1.6 to ≤ 2.0 and > 2.0 were defined as Level I and Level II IIPV events, respectively. Results Level I IIPV events occurred in 2.39% of standard and 4.73% of small fill volume therapies, while Level II IIPV events occurred in 0.26% and 1.33% of therapies, respectively. IIPV events occurred significantly more often in association with tidal peritoneal dialysis (PD) compared to non-tidal PD therapies. In tidal therapies, IIPV events were primarily related to suboptimal programming of total ultrafiltration volume. Factors that increased the odds of IIPV events during standard therapies included programming the initial drain volume target to < 70% of the last fill, and setting minimum drain volumes to < 85% of the fill volume. Bypass of initial drain by patients/users was also associated with a significant increase in the odds of IIPV events in non-tidal, but not tidal PD. An increase in the odds for IIPV was also seen for standard therapies within the highest (> 1,245 mL) versus the lowest (< 427 mL) quartile of ultrafiltration. Similar trends were seen in small fill volume therapies. Clinical presentations associated with IIPV events were not assessed. Conclusions IIPV events are more frequent in tidal and small fill volume therapies. The greatest potential for IIPV occurred when the total ultrafiltration was set too low for the patient's UF requirements during tidal therapy. Patient/user bypass of drains without reaching the target drain volume contributes significantly to IIPV events in non-tidal PD therapies. Poorly functioning PD catheters may be central to the cycler programming and patient/user actions that lead to IIPV.


2002 ◽  
Vol 15 (6) ◽  
pp. 422-426 ◽  
Author(s):  
Wim Van Biesen ◽  
Nic Veys ◽  
Raymond Vanholder ◽  
Norbert Lameire

1999 ◽  
Vol 22 (11) ◽  
pp. 734-738 ◽  
Author(s):  
T. Liberek ◽  
M. Renke ◽  
M. Lichodziejewska-Niemierko ◽  
B. Rutkowski

2021 ◽  
Vol 41 (3) ◽  
pp. 261-272
Author(s):  
Chau Wei Ling ◽  
Kamal Sud ◽  
Connie Van ◽  
Syed Tabish Razi Zaidi ◽  
Rahul P. Patel ◽  
...  

The objectives of this study were to provide a summary of the pharmacokinetic data of some intraperitoneal (IP) antibiotics that could be used for both empirical and culture-directed therapy, as per the ISPD recommendations, and examine factors to consider when using IP antibiotics for the management of automated peritoneal dialysis (APD)-associated peritonitis. A literature search of PubMed, EMBASE, Scopus, MEDLINE and Google Scholar for articles published between 1998 and 2020 was conducted. To be eligible, articles had to describe the use of antibiotics via the IP route in adult patients ≥18 years old on APD in the context of pharmacokinetic studies or case reports/series. Articles describing the use of IP antibiotics that had been recently reviewed (cefazolin, vancomycin, gentamicin and ceftazidime) or administered for non-APD-associated peritonitis were excluded. A total of 1119 articles were identified, of which 983 abstracts were screened. Seventy-three full-text articles were assessed for eligibility. Eight records were included in the final study. Three reports had pharmacokinetic data in patients on APD without peritonitis. Each of cefepime 15 mg/kg IP, meropenem 0.5 g IP and fosfomycin 4 g IP given in single doses achieved drug plasma concentrations above the minimum inhibitory concentration for treating the susceptible organisms. The remaining five records were case series or reports in patients on APD with peritonitis. While pharmacokinetic data support intermittent cefepime 15 mg/kg IP daily, only meropenem 0.5 g IP and fosfomycin 4 g IP are likely to be effective if given in APD exchanges with dwell times of 15 h. Higher doses may be required in APD with shorter dwell times. Information on therapeutic efficacy was derived from case reports/series in individual patients and without therapeutic drug monitoring. Until more pharmacokinetic data are available on these antibiotics, it would be prudent to shift patients who develop peritonitis on APD to continuous ambulatory peritoneal dialysis, where pharmacokinetic information is more readily available.


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