Complications of PD
Complications of PD include peritonitis and catheter tunnel infections. Peritonitis
is more common in younger children compared to adolescents. Both Gram-
negative and Gram-positive organisms are responsible for the majority of
episodes of peritonitis. Fungal infections are responsible for less 5% of the total
infections. Approximately 50% of children had an episode of peritonitis in the first
two years of initiation of PD. [21]
Abdominal pain, cloudy fluid or elevated counts of neutrophils in the peritoneal
fluid are suggestive of peritonitis. Intraperitoneal antibiotics should be started
immediately. Typically, vancomycin and a third generation cephalosporin are the
antibiotics of choice. Peritoneal fluid cultures should be obtained prior to initiation
of antibiotics.
Catheter site infections are prevented with appropriate handling of the catheter
and the use of local mupirocin in some series.[22] Confirmed infections should be
treated with oral antibiotics and removal of the catheter done when there is no
improvement or complicated with peritonitis.
Wrapping of omentum around the intraperitoneal segment of the PD catheter is
common. In a retrospective review of 121 PD catheters, concomitant
omentectomy seemed to significantly reduce the rate of early failure. [47] Others
have proposed a more aggressive approach to catheter migration by performing
omentectomy and suturing the tip to the pelvic peritoneum. [48]
Migration of the PD catheter tip has been reported in up to 15%. [44] The
catheter should be repositioned if symptomatic or when the dialysate drainage is
compromised.
Leaks occur in up to 10% of PD catheters and tend to be less significant with
swan-neck catheters.
Other complications include bowel perforation, usually when PD catheters are