An Unusual Case of Peritoneal Dialysis Twisted Catheter in a Child

  • Cahyani Gita Ambarsari Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
  • Farhan Haidar Fazlur Rahman Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
  • Evita Karianni Bermanshah Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
  • Agustina Kadaristiana Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
Keywords: Renal replacement therapy, continuous ambulatory, malposition, chronic renal insufficiency

Abstract

Objective: Mechanical complications of peritoneal dialysis (PD) may occur because of surgical complications when inserting a Tenckhoff catheter or non-surgical complications during chronic care of a PD catheter. We aim to highlight the latter by presenting a case report of twisted external catheter.
Method: We report an 11-year-old Indonesian girl with end-stage renal disease on continuous ambulatory PD at Cipto Mangunkusumo Hospital who was hospitalized due to repeat peritonitis.
Result: Upon examination, the external catheter seemed twisted without inflow, outflow, or ultrafiltration problems. Her exit score was 4 with gaping. Both abdominal X-ray and ultrasound showed that the catheter and its cuffs were properly placed. The patient frequently pulled and manipulated her PD catheter. Additionally, the catheter-site care procedure was frequently done by untrained caregivers and catheter fixation was also not performed. A retraining program for all involved caregivers was carried out. Peritonitis resolved after 14-day-treatment using intraperitoneal gentamicin. We determined that the twisted catheter and repeat peritonitis were due to a combination of mechanical trauma, poor chronic catheter-site care, and suboptimal PD catheter training.
Conclusion: Maintaining compliance for chronic PD catheter exit-site care by well-trained caregivers and by patients themselves, as well as the external catheter fixation are important.

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Published
2020-03-14
How to Cite
Cahyani Gita Ambarsari, Farhan Haidar Fazlur Rahman, Evita Karianni Bermanshah, & Agustina Kadaristiana. (2020). An Unusual Case of Peritoneal Dialysis Twisted Catheter in a Child. Journal Of The Indonesian Medical Association, 70(2), 27-31. https://doi.org/10.47830/jinma-vol.70.2-2020-175