PERITONEAL-DIALYSIS FOR ACUTE-RENAL-FAILURE IN INFANTS - A COMPARISONOF 3 TYPES OF PERITONEAL ACCESS

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.