ESPN 51th Annual Meeting

ESPN 2018


 
FIBRIN GLUE APPLICATION IN PEDIATRIC PERITONEAL DIALYSIS: THREE PATIENT EXPERIENCE
CANDAN SAGLAM 1 SERAP ARSLAN 1 NESLIHAN CICEK 1 IBRAHIM GOKCE 1 MEHTAP SAK 1 NURDAN YILDIZ 1 HALIL TUGTEPE 2 HARIKA ALPAY 1

1- MARMARA UNIVERSITY MEDICAL SCHOOL, DEPARTMENT OF PEDIATRIC NEPHROLOGY, ISTANBUL, TURKEY
2- MARMARA UNIVERSITY MEDICAL SCHOOL, DEPARTMENT OF PEDIATRIC SURGERY, ISTANBUL, TURKEY
 
Introduction:

 

The first treatment option in acute and chronic renal failure in infants and small children is peritoneal dialysis (PD). Sometimes dialysis has to be started immediately after catheter implantation especially in acute renal failure (ARF). Early dialysate leakage can be seen in these patients and complicate the effectiveness of dialysis. Fibrin glue applied to the external part of the tunnel may stop dialysate leakage and eliminate the need for surgical intervention. It shows its effect with mimicking the last step of blood clothing system. Fibrin glueis consists of a mixture of fibrinojen and thrombin and it reaches the maximum glue effect 2 hours after application. We evaluated the effect of fibrin glue as a treatment in one patient with dialysate leakage and as a prophylactic treatment to prevent PD catheter leakage in two patients with ARF.

Material and methods:

 Case Report

Results:

 

We used fibrin glue for three patients (2 months girl, 10 months boy and 3 years  girl) with ARF. The diagnosis of patients were congenital nephrotic syndrome, autosomal recessive policystic kidney disease and hemolytic uremic syndrome respectively. Double-cuff straight Tenckhoff catheters were used in all children. Fibrin glue was applied as 2 ml, 3 ml and 2 ml respectively to the external part of the subcutaneous catheter tunnel through the exit site, as close to the cuff as possible and dialysis was initiated 2 hours after fibrin glue application. PD was started with dwell volumes of 10 ml/kg. Fibrin glue was applied to the first patient after the dialysate leakage occured but it wasn’t succesfull and a second catheter replacement was needed. He died due to congenital CMV infection, influenza A sepsis and multiorgan failure and couldn’t be followed for long-term complications. Dialysate leakage didn’t occur in other two patients who had proflactic fibrin glue treatment but large necrotic tissue occured and healed with formation of granular tissue in both of them. They were treated with surgical debridement and symptomatic treatment but the lesions were healed with hypertrophic scars.

Conclusions:

 

Fibrin glue is a simple, easy to apply, effective and can be used safely for the prevention and treatment of peritoneal dialysate leakage in infants and small children with ARF treated with PD but it may cause a serious complication like tissue necrosis. Fibrin glue may be applied with decreased dosages as a thin layer in selected patients with high risk factors.