OBSERVATIONAL STUDY ON PERITONEAL DIALYSATE FLUSH VOLUMES AND ITS IMPACT ON PERITONITIS EPISODES
Dr Chau Joey Lam1
1Northern Health, Epping, Australia, 2Melbourne Health, Melbourne, Australia
Aim: To determine the impact of higher dialysate flush volumes prior to sampling on peritoneal dialysis related peritonitis episodes.
Background: Peritoneal dialysis associated peritonitis, including culture negative peritonitis, carries significant morbidity and mortality. In recent years, our organisation reported a higher than guideline recommended rate (> 20%) of culture-negative peritonitis. The International Society of Peritoneal Dialysis recommends a minimum of two flushes and a 2-hour dwell but there is no specified dialysate flush volume. We therefore implemented a specified increase of peritoneal dialysate flush volumes and investigated its effect on peritonitis episodes.
Methods: Clinical data was extracted from electronic medical records for all patients with suspected peritoneal dialysis related peritonitis from February 2023 to February 2024. A change of protocol from 500mlx2 dialysate flushes to 1000mlx2 were performed. Samples were analysed for culture and total white cell count and differential. Our primary outcomes were episodes of peritonitis, including culture-negative peritonitis episodes and recurrent presentations for suspected peritonitis.
Results: There were 21 cases of suspected peritonitis of which the majority (85.7%) had high volume dialysate flushes (1000ml x2) prior to sampling. There were two patients who required sampling in close succession who despite high volume dialysate flushes were consistent with recurrence. There were no culture- negative peritonitis episodes recorded.
Conclusions: Over a 12 month period, we have demonstrated that an increase in flush volume prior to sampling resulted in a reduction of peritonitis episodes inclusive of culture-negative peritonitis and recurrent peritonitis. This has resulted in protocol and practise change within our organisation.
Biography:
Dr Joey Lam is a current 2nd year Renal and General Medicine Advanced Physician Trainee at Northern Health. Within Renal medicine, her interests have been in exploring cardiovascular physiology in patients on haemodialysis and improving patients’ access to home therapies especially in rural, remote and indigenous communities. Joey also has an interest in clinical education and the use of simulation to support learning of junior medical doctors