Peritoneal dialysis complicated by peritonitis

Chronic renal failure in patients with malnutrition, poor physical fitness, low resistance, dialysis treatment to be repeated to do gymnastics and the dialysate, the dialysis tube to stimulate a number of reasons, therefore, easily lead to peritonitis. The clinical cause peritonitis, a common cause of: (1) catheter cavity infection most of the catheter cavity infection occurs in the interface of accidental contamination, such as hand contact with contaminated dialysis tube mouth torn off, the bacteria into the tube. Now, with the application of the Y-shaped pipe and titanium joints, tube infection has decreased significantly. (2) infection around the catheter exit site or subcutaneous tunnel infection, bacterial infection along the catheter around the subcutaneous tissue into the abdominal cavity. (3) to wear the intestinal wall infections more common in ischemic bowel disease or intestinal interest-room patients, anaerobic bacteria or a variety of bacteria cultured in the dialysate should be suspected infection from intestinal bacteria. (4) The blood-borne infection, tuberculous peritonitis, cirrhosis with ascites in patients with spontaneous bacterial peritonitis, a very small number of patients with acute upper respiratory tract infection, bacterial peritonitis may also occur, positive blood cultures. (5), environmental infection in patients with a bath, the water from the exit into the abdominal cavity can occur peritonitis. Diagnosis of bacterial peritonitis, the following three criteria should have at least two: ① peritonitis symptoms and signs; ② dialysate turbidity, WBC> 100 / mm3, neutrophils> 50%; ③ by Gram stain or culture that abdominal through the liquid in the presence of bacteria. Fungal peritonitis, tuberculous peritonitis, you must find a fungal or tuberculosis. Peritonitis following four: ① bacterial peritonitis: meet the diagnostic criteria, antibiotic treatment is effective. ② chemical peritonitis: more than the same time seen in patients with the same batch of dialysate. Many dialysate pH is too low, the quality is too poor, or some of the chemical composition of peritoneal irritation causes antibiotic therapy. ③ fungal peritonitis: actions by the fungal contamination of the dialysate, antibiotic therapy and anti-fungal drug treatment. ④ eosinophils increased peritonitis: eosinophilic cells in the peritoneal dialysis tube of silicone allergy or heparin on peritoneal dialysis fluid, allergies due to antibiotics, and more with drug fever, eruption, increased eosinophils in the blood and dialysate increased. Antibiotic treatment is not valid. Looking for allergens, remove the allergens to be effective anti-allergy treatment. If you can avoid infection factors can prevent peritonitis. The specific measures are as follows: ① replace the dialysate in strict accordance with the rules, not any negligence. ② avoid drugs, to join in the dialysate bag if you must join, under strict sterile conditions. ③ attention to catheter care and cleaning of the mouth. (4) attention to personal hygiene to prevent catheter mouth water bath, you should take a shower, absolutely can not take a tub bath. ⑤ Once the exit of the reddening of the skin, pain and discharge, immediately actively. ⑥ usually pay attention to exercise, to prevent colds. ⑦ maintain defecate unobstructed, and prevention of intestinal infection. If improper care, the occurrence of peritonitis situation to timely and effective treatment to prevent peritoneal adhesions, hypertrophy and loss of function. The following principles: ① educate patients in the discovery of peritoneal sign, immediately peritoneal fluid drainage out of fluid drainage bag on the side, ready to the hospital for testing and training. ② immediately with 1.5% of the dialysis fluid 1 liter flushing the abdominal cavity, three consecutive times to remove inflammatory products ease the pain. The ③ immediately to the hospital, adding antibiotics and heparin, fresh dialysate bag before each exchange of dialysate. ④ the first 24 hours should replace the outside to take over and prevent re-infection of the abdominal cavity. The ⑤ antibiotics generally should be preferred to vancomycin and aminoglycosides or cephalosporins, and when dialysate inspection results out, replace the antibiotics according to culture and sensitivity results. ⑥ treatment should be until the clinical symptoms of dialysis fluid is clear, release fluid white blood cell count of less than 100 / mm3 and culture negative. ⑦ such a potent antibiotic treatment 2 weeks later still can not control peritonitis should extubation stop through. The temporary change of hemodialysis, a month later, as appropriate catheter to re-start dialysis.