Open AccessAn Unusual Case of Peritoneal Dialysis Twisted Catheter in a Child
Author(s) -
Cahyani Gita Ambarsari,
Farhan Haidar Fazlur Rahman,
Evita Karianni Bermanshah,
Agustina Kadaristiana
Publication year - 2020
Publication title -
journal of the indonesian medical association
Language(s) - English
Resource type - Journals
eISSN - 2654-3796
pISSN - 2089-1067
DOI - 10.47830/jinma-vol.70.2-2020-175
Subject(s) - medicine , catheter , peritoneal dialysis , peritonitis , surgery , continuous ambulatory peritoneal dialysis , hemodialysis
Objective: Mechanical complications of peritoneal dialysis (PD) may occur because of surgical complications when inserting a Tenckhoff catheter or non-surgical complications during chronic care of a PD catheter. We aim to highlight the latter by presenting a case report of twisted external catheter. Method: We report an 11-year-old Indonesian girl with end-stage renal disease on continuous ambulatory PD at Cipto Mangunkusumo Hospital who was hospitalized due to repeat peritonitis.Result: Upon examination, the external catheter seemed twisted without inflow, outflow, or ultrafiltration problems. Her exit score was 4 with gaping. Both abdominal X-ray and ultrasound showed that the catheter and its cuffs were properly placed. The patient frequently pulled and manipulated her PD catheter. Additionally, the catheter-site care procedure was frequently done by untrained caregivers and catheter fixation was also not performed. A retraining program for all involved caregivers was carried out. Peritonitis resolved after 14-day-treatment using intraperitoneal gentamicin. We determined that the twisted catheter and repeat peritonitis were due to a combination of mechanical trauma, poor chronic catheter-site care, and suboptimal PD catheter training. Conclusion: Maintaining compliance for chronic PD catheter exit-site care by well-trained caregivers and by patients themselves, as well as the external catheter fixation are important.