1. Non-Infectious Complications

2. Non-infectious Catheter Complications
Inflow/outflow obstruction
Hernia
Leakage

3. Increased Intra-Abdominal Pressure
Instillation of dialysate into the peritoneal cavity leads to increased intra-abdominal pressure
The magnitude of the increase depends upon:
Volume dialysate filled
Patient age, body mass index
Coughing, lifting straining at stool
Position of the patient (sitting>standing>supine)

4. Inflow/Outflow Obstruction
Causes:
Mechanical (e.g. tip migration, kink in tubing)
Constipation
Catheter blockage
Outflow obstruction is most frequent:
- Intraluminal (clot, fibrin)
- Extraluminal
(constipation, occlusion, omental
wrapping, tip migration, incorrect
catheter placement)

5. Inflow/Outflow Obstruction - Recommendations
Establish type of obstruction
Conservative or non-invasive approaches
- body position change
- laxatives
- heparinised saline
- fibrinolytic agents
Aggressive therapies
-a) blind - fluoroscopically guided wires, stylet, whiplash
-b) direct - peritoneoscopy, surgical catheter revision
or replacement

6. Dialysate Leaks Tzamaloukas Adv PD 1990 Early (within 30 days)
- Manifest externally
- Do not require imaging
- Managed by temporary discontinuation of PD (75%) or surgery
Late (beyond 30 days)
- Manifest by poor outflow, localised oedema, subcutaneous fluid
- 30% require imaging
- Hernia cause 40% of late leaks
- Most late leaks require surgery (70%)
- Frequently lead to change of treatment
Tzamaloukas Adv PD 1990

7. Fluid Leak - CT Cannulogram

8. Abdominal Wall or Pericatheter Leak
Presentation
Abdominal swelling or bogginess
Reduced drain (effluent) output
Weight gain and abdominal wall oedema, without peripheral oedema
Pericatheter leak: wetness or swelling at exit-site

9. Abdominal Wall or Pericatheter Leak
Management
Reintroduce low pressure PD (APD) or
Temporary transfer to HD to allow healing, or
Catheter replacement if pericatheter leak,

10. Hernias and Genital Oedema
Caused by continuous elevation of intra-abdominal pressure and abdominal wall tension
Acquired or congenital defects in the abdominal wall
Inguinal > Catheter insertion site
Epigastric > Richters
Umbilical > Enterocoele
Incisional > Spigelion
Ventral > Obturator

11. Hernias – risk factors Raised intra-abdominal pressure
Female sex and multiparity (no. of pregnancies)
Older age
Previous hernia
Polycystic kidney disease

12. Hernias – clinical presentation
Painless or tender lump or swelling
Bowel incarceration or strangulation
Peritonitis (transmural leakage of bacteria)
Treatment:
1) Surgical repair
2) Reintroduce PD with low volumes, supine posture, increase volume over 2 weeks

13. Genital Oedema Occurs in up to 10% of patients Mechanism:
- fluid tracks through soft tissue plane in a hernia,
catheter insertion site, peritoneal fascial defect,
genital oedema associated with abdo wall oedema
- patent processus vaginalis
- males affected more than females
Diagnosis:
- can be difficult
- CT scan with contrast ( mls Omnipaque)

14. continued…Genital Oedema
Treatment:
- bed rest
- scrotal elevation if symptomatic
- low volume exchange/NIPD
stop PD temporarily
surgical repair if cause is hernia or patent processus vaginalis

15. Infusion or Drainage Pain
CAUSES
- constipation
- jet effect
- fluid pH related
MANAGEMENT
- laxatives slow infusion rate
- incomplete drainage Bicarbonate buffer
- 1% lignocaine IP catheter replacement