suspected peritonitis in peritoneal dialysis patients
DDx of cloudy effluent
ED Mx of suspected peritonitis
this is derived from Western Health Renal Medicine guideline July 20091)2)
- YOUR hospital may have it's own policy which differs!
early notification to renal unit
early Mx (within 30min of arrival to ED)
early empirical antibiotic Rx of peritonitis
not clinically compromised and no PH MRSA
clinically compromised or PH MRSA
Automated Peritoneal Dialysis (APD) Patients
For the 1st 24 hours, the patient should be changed to Continuous Ambulatory Peritoneal Dialysis (CAPD) and standard protocols as above are followed.
If there is clinical improvement after 24 hours, reversion to APD with dosing as follows:
actions once culture and sensitivities are known
S. aureus, Pseudomonas sp, multiple organisms or anaerobes:
Empiric antibiotics may be changed once the culture and/or sensitivity result is available.
If multiple organisms are present consider intra-abdominal pathology, and patients may require surgical review +/- laparotomy.
failure to respond
If effluent fails to clear after 72 hours check culture results to ensure the organism is sensitive to the current treatment protocol.
If the effluent fails to clear after 72 hours despite the organism being sensitive to the current treatment protocol, the Tenckhoff catheter should be removed and the patient temporarily transferred to haemodialysis. In general, this should NOT be delayed. Any departure from this policy should be discussed at once with the consultant in charge.
dialysis_peritonitis.txt · Last modified: 2019/04/17 09:36 by wh