ESPN 51th Annual Meeting

ESPN 2018


 
A SIMPLE MODIFICATION ON PERITONEAL DIALYSIS CATHETER MAKES THE PERIOPERATIVE INSERTION EASIER AFTER CARDIAC SURGERY
SERAP ARSLAN 1 CANDAN SAGLAM 1 MEHTAP SAK 1 IBRAHIM GOKCE 1 NESLIHAN CICEK 1 NURDAN YILDIZ 1 FIGEN AKALIN 2 HARIKA ALPAY 1

1- MARMARA UNIVERSITY MEDICAL SCHOOL DEPARTMENT OF PEDIATRIC NEPHROLOGY
2- MARMARA UNIVERSITY MEDICAL SCHOOL DEPARTMENT OF PEDIATRIC CARDIOLOGY
 
Introduction:

One of the early complications of peritoneal dialysis(PD) catheter insertion is bleeding, especially in patients with early perioperative coagulopathy. We report an atypical insertion and placement of a PD catheter in an infant who diagnosed as acute kidney injury(AKI) early after total correction of Tetralogy of Fallot with hemorrhagic diathesis

Material and methods:

CASE REPORT

Results:

Fifteen months old boy in the cardiovascular intensive care unit was consulted for oliguria after total correction surgery for Tetralogy of Fallot. The sternum was left open due to myocardial edema after surgical repair. Despite of the ionotropic support, he was hypotensive and physical examination revealed generalized edema. Laboratory evaluation showed acidosis, AKI(creatinine:3.16 mg/dl), elevated liver function tests and hemorrhagic diathesis. The patient was diagnosed as multiorgan failure(MOF)  and conventional supportive therapy was initiated. However, patient did not respond treatment and became anuric during follow-up and PD was planned. In order to avoid creating a second incision site in the patient with a significant hemorrhagic diathesis, it was decided to insert the PD catheter from the sternotomy incision that was used for cardiac repair. As the length of the catheter was not sufficient to insert from the lower end of the sternotomy, millimeter-scale diameter holes were opened at the tip of the Tenckhoff PD catheter, 31 cm, which should normally be outside. The catheter was inverted and then inserted from the sternal opening. The other end was cut and combined with the interconnection set. Ultrafiltration and dialysis were successfully performed but the patient died on the seventh postoperative day because of uncontrolled sepsis and MOF.

Conclusions:

A simple modification of a standard PD catheter facilitates its insertion from sternotomy in postoperative cardiac surgical patients. And also, this type of modification prevents  a new surgical intervention for the insertion of peritoneal catheter which might end up with a life-threatening bleeding complication.