Background: Currently the Waikato Regional Dialysis Service supports a total of 210 peritoneal dialysis patients. It is the largest PD unit in Australasia. Due to the overwhelming increase in patients requiring dialysis, many patients come to peritoneal dialysis following late presentation, acute haemodialysis and are in a sub-optimal state of health. At least 50% of these patients have type two diabetes and sixty six percent are Maori. It has become increasingly apparent that by the time these patients are ready to start PD, constipation is a problem resulting in approximately 1/3 of patients having initial drainage problems.
Aim: To identify constipation as a cause of poor drainage
in new peritoneal dialysis patients in the Waikato Regional Dialysis Service.
Method: A thorough assessment of the patient carried out by Speciality Clinical PD nurses includes general wellness, medication, prior medical interventions, dietary and bowel habits. If drainage problems are encountered, consideration is given to fibrin, mal-positioned catheter, omental wrap and constipation as causative factors. Heparin is used routinely to combat post-operative fibrin, xylocaine for omental wrap and x-ray for diagnosis of constipation and catheter placement.
Results: Constipation results in poor drainage of peritoneal dialysis patients +/- mal-positioned catheter as confirmed by x-ray of patient’s abdomen.
Conclusion: The inclusion of appropriate bowel management pre and post theatre is essential in the management of new PD patients. If the diagnosis of constipation is made it is vital to initiate vigorous treatment to ensure good drainage of PD fluid.