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Observational Study
. 2014 Jan-Feb;34(1):12-23.
doi: 10.3747/pdi.2012.00190. Epub 2013 Jul 1.

Patient education and care for peritoneal dialysis catheter placement: a quality improvement study

Leslie P Wong  1 , Kalani T Yamamoto, Vijay Reddy, Denise Cobb, Alice Chamberlin, Hien Pham, Sumi J Sun, Madhavi Mallareddy, Miguel Saldivar
Affiliations
Observational Study

Patient education and care for peritoneal dialysis catheter placement: a quality improvement study

Leslie P Wong et al. Perit Dial Int. 2014 Jan-Feb.

Abstract

Background and objectives: Peritoneal dialysis catheter (PDC) complications are an important barrier to peritoneal dialysis (PD) utilization. Practice guidelines for PDC placement exist, but it is unknown if these recommendations are followed. We performed a quality improvement study to investigate this issue. ♢

Methods: A prospective observational study involving 46 new patients at a regional US PD center was performed in collaboration with a nephrology fellowship program. Patients completed a questionnaire derived from the International Society for Peritoneal Dialysis (ISPD) catheter guidelines and were followed for early complications. ♢

Results: Approximately 30% of patients reported not being evaluated for hernias, not being asked to visualize their exit site, or not receiving catheter location marking before placement. After insertion, 20% of patients reported not being given instructions for follow-up care, and 46% reported not being taught the warning signs of PDC infection. Directions to manage constipation (57%), immobilize the PDC (68%), or leave the dressing undisturbed (61%) after insertion were not consistently reported. Nearly 40% of patients reported that their PDC education was inadequate. In 41% of patients, a complication developed, with 30% of patients experiencing a catheter or exit-site problem, 11% developing infection, 13% needing PDC revision, and 11% requiring unplanned transfer to hemodialysis because of catheter-related problems. ♢

Conclusions: There were numerous deviations from the ISPD guidelines for PDC placement in the community. Patient satisfaction with education was suboptimal, and complications were frequent. Improving patient education and care coordination for PDC placement were identified as specific quality improvement needs.

Keywords: Complications; patient education; peritoneal dialysis catheter; practice guidelines; quality improvement.

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Figures

Figure 1 —
Figure 1 —
Flow diagram of patient selection. PD = peritoneal dialysis.
Figure 2 —
Figure 2 —
Peritoneal dialysis (PD) catheter-related complications by category [n (%) new patients]. HD = hemodialysis.
See this image and copyright information in PMC

Comment in

References

    1. Figueiredo A, Goh BL, Jenkins S, Johnson DW, Mactier R, Ramalakshmi S, et al. Clinical practice guidelines for peritoneal access. Perit Dial Int 2010; 30:424–9 - PubMed
    1. UK Renal Association. Home > Clinical > Guidelines > Peritoneal Access [Web page]. Petersfield, UK: Renal Association; 2009. [Available online at: http://www.renal.org/Clinical/GuidelinesSection/PeritonealAccess.aspx; accessed 14 May 2012]
    1. Flanigan M, Gokal R. Peritoneal catheters and exit-site practices toward optimum peritoneal access: a review of current developments. Perit Dial Int 2005; 25:132–9 - PubMed
    1. Gokal R, Alexander S, Ash S, Chen TW, Danielson A, Holmes C, et al. Peritoneal dialysis catheters and exit-site practices toward optimum peritoneal access: 1998 update. (Official report from the International Society for Peritoneal Dialysis). Perit Dial Int 1998; 18:11–33 - PubMed
    1. Dombros N, Dratwa M, Feriani M, Gokal R, Heimbürger O, Krediet R, et al. on behalf of the EBPG Expert Group on Peritoneal Dialysis. European best practice guidelines for peritoneal dialysis. 3 Peritoneal access. Nephrol Dial Transplant 2005; 20(Suppl 9):ix8–12 - PubMed

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