Hs. Kohli et al., PERITONEAL-DIALYSIS FOR ACUTE-RENAL-FAILURE IN INFANTS - A COMPARISONOF 3 TYPES OF PERITONEAL ACCESS, Renal failure, 19(1), 1997, pp. 165-170
Peritoneal access for peritoneal dialysis (PD) poses a significant pro
blem in infants due to their small size and can result in considerable
morbidity and occasional mortality. This study was carried out to com
pare the complications associated with three different types of PD cat
heters for intermittent PD. A total of 79 sessions of PD were given to
51 infants with acute renal failure. Twenty-nine infants received 1,
18 received 2 and 2 infants received 3 and 4 sessions of PD, respectiv
ely. For PD access an intravenous cannula was used in 36, stylet cathe
ter in 18, and guide wire inserted femoral vein catheter in 25 procedu
res. Percentage reduction of serum creatinine per PD session was compa
rable in infants being dialysed with different types of PD access. Loc
al puncture site and intraperitoneal bleed were associated with the us
e of a stylet catheter during 4 procedures each (22.2%). Catheter bloc
kade was commonest with the intravenous cannula (22.2%), followed by g
uide wire inserted femoral vein catheter (16%), and was least with the
stylet catheter (5.5%). Total mechanical complications were lower wit
h guide wire inserted femoral vein catheter (16%) as compared to intra
venous cannula (25%) and stylet catheter (66%) (p < 0.05). There were
4 episodes of peritonitis (5.0%), 3 bacterial and 1 fungal. Although p
eritonitis was more common with intravenous cannula (8.3%) than guide
wire inserted catheter (4%) and styler catheter (nil), the difference
was not statistically significant Total complications including mechan
ical and infective were least with guide wire inserted femoral vein ca
theter (20%), followed by intravenous cannula (33%) and styler cathete
r (66%) (p < 0.05). Of 51 infants, 20 died (39.0%)). The PD procedure
per se resulted in mortality in 2 cases, 1 because of massive intraper
itoneal bleed due to styler induced injury of an intra abdominal blood
vessel and the other due to fungal peritonitis. To conclude, of the t
hree types of access for intermittent PD, complications related to the
PD procedure are the least with guide wire inserted femoral vein cath
eter.