Case Report: Peritoneal Dialysis in a Patient with Ascites

Dallas—During the 2019 ANNA National Symposium, Terrie Colvard, BSN, RN, and Nikeyia Davis, BSN, RN, CNN, described a procedure that enables patients with ascites requiring paracentesis who are dialysis dependent to effectively utilize peritoneal dialysis. The presentation was titled Utilization of Peritoneal Dialysis in Patients with Ascites.

Abdominal paracentesis involves surgical puncture of the peritoneal cavity with a needle or placement of a catheter for the removal of excess fluid for diagnostic or therapeutic purposes. The procedure may lead to complications, including peritonitis, bleeding, hypotension, and persistent leaking at the puncture site.

The procedure involved laparoscopic insertion of a peritoneal catheter. Ascitic fluid was drained twice weekly with use of peritoneal dialysis flushes until the start of continuous ambulatory peritoneal dialysis. Sitting and standing pre- and post-procedure blood pressure and pulse were measured.

In a case study reported in the poster, the surgeon drained 6 L of ascitic fluid at the time of insertion of the peritoneal dialysis catheter. The fluid from the peritoneal dialysis flushes were cloudy and ranged between 500 mL to 3.5 L. All cultures resulted in no growth. Gram stain showed few too many white blood cells: white blood cell count was >100 and red blood cell count was >300 consistently. The patient was asymptomatic of peritonitis and was not treated with antibiotics.

At 3 weeks after catheter insertion, continuous ambulatory peritoneal dialysis training was initiated. At the beginning of each training, the patient drained cloudy ascites fluid. Continuous ambulatory peritoneal dialysis effluent cleared with each training session. Following training, the patient’s overnight dwells at home for 3 days were described as mostly clear; ultrafiltration ranged between 800 mL to 1.4 L. All effluent was clear at day 4. The patient transitioned to automated peritoneal dialysis after 3 months. The patient did not require any further paracentesis with the start of continuous ambulatory peritoneal dialysis, and is meeting target Kt/V with no episodes of peritonitis, tunnel, or exit site infections.

“Peritoneal dialysis may be beneficial for patients with end-stage renal disease that require frequent or chronic paracentesis for ascites,” the authors said.

Source: Colvard T, Davis N. Utilization of peritoneal dialysis in patients with ascites. Abstract of a presentation at the 2019 American Nephrology Nurses Association National Symposium, April 14-17, 2019, Dallas Texas.30