RU2740426C1 - Method for recovery of peritoneal catheter drainage function - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to nephrology, and can be used for recovery of peritoneal catheter drainage function. Method involves administering into the abdominal cavity through a peritoneal catheter a drug solution acting on tissues surrounding the lumen of the catheter. Drug solution used is mixture of 7.5% icodextrin in amount of 7-10 ml, in which a solution of alteplase 1.0-2.5 ml and atropine 0.5-1.0 ml are added. Obtained mixture is introduced into peritoneal catheter 2 to 7 times, after each introduction pulling the syringe piston without tension to obtain a solution. In the absence of preparing the solution, such administration of the mixture of solutions is repeated until obtaining a solution from the abdominal cavity, but no more than for 2 days. After preparing the solution from the abdominal cavity, mixture of 7.5% icodextrin in volume of 300-500 ml and a dexamethasone solution in amount of 2-4 ml, which is left in the abdominal cavity for 12-24 hours.

EFFECT: use of the invention enables to significantly reduce the number of surgical interventions, several times reduce the number of bed days required for correction of dysfunction, thereby preventing the deterioration of quality of life and the state of patients and reducing the effectiveness of treating peritoneal dialysis.

1 cl, 3 ex

Description

The invention relates to medicine and can be used in departments of clinics of therapeutic and surgical profiles, for example: nephrology, transplantology.

It is known that often patients receiving treatment with peritoneal dialysis complain of discomfort and varying degrees of pain severity during exchanges of dialysis fluids.

It is generally recognized in the case of impaired function of the peritoneal catheter (PC) that it is necessary to perform manipulations aimed at restoring the function of the catheter. Surgical procedures such as laparotomy and laparoscopy with catheter position correction, reimplantation, etc. are mainly used. Operations in most cases are considered necessary, but at the same time, there is a significant decrease in the quality of life of patients, interruption of dialysis treatment.

Among the conservative measures aimed at restoring the drainage of dialysis fluids, there are such as normalization of bowel function, drug prevention of PC obturation, etc. (Zemchenkov A.Yu., Gerasimchuk R.P., et al. Life with chronic kidney disease: Conversations with a patient. SPb., 2013. S. 73-74).

The disadvantages of using the proposed measures include their relatively low efficiency in cases where the omentum or fimbriae of the fallopian tubes are involved in obturation of the PC, which are the most common cause of impaired PC function, the manifestations of which are discomfort and pain during the exchange of dialysis solution.

The most effective conservative measure aimed at restoring the drainage function of the PC, especially with early detection of catheter dysfunction, is the so-called "water hammer". The essence of the manipulation is the introduction into the abdominal cavity through the peritoneal catheter of a solution of the drug, namely, in the sharp introduction into the abdominal cavity of a sterile saline solution (Abstract of the dissertation for the degree of candidate of medical sciences “Minimally invasive surgery in patients with the terminal stage of chronic renal failure, receiving peritoneal dialysis. ”Losev G.Yu. M., 2007. S. 10).

However, this manipulation is also effective in a small part of cases, including because of the iso-osmolarity of the saline solution and the absence of components, the effect of which would be aimed at arresting and preventing edema and local aseptic inflammation of tissues, as well as lytic effects on local thrombotic masses.

The objective of the present invention is to create a method that provides a more effective restoration of the drainage function of the catheter due to conservative measures that ensure the restoration of the PC function with the exclusion of unjustified conversion to hemodialysis and related manipulations to ensure vascular access.

To solve this problem, when restoring the drainage function of the peritoneal catheter, including the introduction into the abdominal cavity through the peritoneal catheter of a solution of a drug that affects the tissues obstructing the lumen of the catheter, it is proposed to use a mixture of 7.5% icodextrin in a volume of 7-10 ml, to which a solution of alteplase is added in a volume of 1.0-2.5 ml and atropine - 0.5-1.0 ml. The resulting mixture is introduced into the peritoneal catheter 2 to 7 times, after each injection, the syringe plunger is pulled without tension to obtain a solution. In the absence of a solution, such administration of a mixture of solutions is proposed to be repeated until a solution is obtained from the abdominal cavity, but not more than within 2 days. After receiving the solution from the abdominal cavity, a mixture of 7.5% solution of icodextrin in a volume of 300-500 ml and a solution of dexamethasone in a volume of 2-4 ml is injected, which is left in the abdominal cavity for 12-24 hours.

The fact that the proposed drug mixture is used in this mode makes it possible to reduce the volume of tissues involved in obturation, thereby ensuring their free removal from the catheter openings, and the lytic action of alteplase causes the removal of thrombotic masses resulting from tissue damage during obturation, which is concomitant a factor influencing the reduction of the volume of occlusive tissues. The subsequent introduction of icodextrin in combination with dexamethasone provides an anti-inflammatory effect, reduction and prevention of tissue edema, including due to the maximum hyperosmolarity of the solution.

The method is carried out as follows.

At room temperature under aseptic conditions, a solution for peritoneal dialysis is drawn into a syringe containing Icodextrin at a concentration of 7.5%, with a volume of 7 to 10 ml, after which 1-2.5 ml of alteplase solution is drawn into the syringe with the solution, and then 0 , 5-1.0 ml of atropine solution, after which the solution is injected into the peritoneal catheter, and then the syringe plunger is immediately pulled without effort to obtain the injected solution, with a tight stroke of the plunger and the absence of the injected volume of solution in it, the procedure is repeated up to 7 times per cycle ... Such cycles of mixture introduction, if necessary, are repeated 2-3 times a day for no more than 2 days. When receiving a solution from the abdominal cavity, 300-500 ml of a solution with 7.5% icodextrin and 2-4 ml of dexamethasone solution are injected, which is left for 12-24 hours.

If the proposed measures are effective, the patient resumes standard treatment with peritoneal dialysis. In the absence of the effectiveness of the procedures on the 3rd day, the patient is transferred to hemodialysis treatment, followed by preparation for the restoration of access for peritoneal dialysis by surgical methods.

Example 1.

Patient D., 62 years old, was hospitalized with a diagnosis of diabetes mellitus, type 2. Diabetic nephropathy. Chronic kidney disease, 5 E. Treatment with continuous ambulatory peritoneal dialysis. Secondary hyperparathyroidism. Anemia. Arterial hypertension. Dysfunction of the peritoneal catheter.

Violation of the drainage of the dialysate was noted during the day. An R-examination of the abdominal cavity revealed a slight displacement of the distal part of the peritoneal catheter, suggesting obstruction of the peritoneal catheter with an omentum.

To stop the catheter dysfunction, 10 ml of a 7.5% solution of icodextrin was injected with an alteplase solution in a volume of 2.5 ml and 1 ml of atropine solution, the resulting mixture was injected through a syringe into the peritoneal catheter for 1 second, 2 injections were performed in a similar way, after which with free pulling of the syringe plunger, a solution was obtained from the abdominal cavity in a volume equal to a single injection.

Then a 7.5% solution of icodextrin in a volume of 500 ml with a solution of dexamethasone in a volume of 4 ml was introduced into the abdominal cavity, the exposure of the mixture in the abdominal cavity was 12 hours. Morning trial exchanges of peritoneal dialysis solution were performed without complications.

Then the treatment with peritoneal dialysis was resumed according to the previously used scheme. The patient was followed up for 2 years, during which time no cases of peritoneal catheter dysfunction were recorded.

Example 2.

Patient I., 52 years old, was hospitalized with a diagnosis of polycystic kidney disease. Chronic pyelonephritis, Art. remission. Chronic kidney disease, 5 D. Treatment with automated peritoneal dialysis. Anemia. Secondary hyperparathyroidism. Dysfunction of the peritoneal catheter.

Disruption of dialysis fluid drainage was noted on the current day. R-graphy of the abdominal cavity revealed no abnormalities in the position of the PC. Obturation of the catheter with fimbriae of the fallopian tubes is suspected.

The drug mixture was introduced according to the proposed method: in 7 ml of a 7.5% solution of icodextrin, a solution of alteplase in a volume of 1 ml and 1 ml of atropine solution was introduced, the resulting mixture was introduced into the lumen of the catheter through a syringe for 1 sec., 3 injections were performed in a similar way, after which a solution from the abdominal cavity was obtained with difficulty.

Additionally, 2 cycles of 7 injections of a mixture of solutions in the same volumes were carried out, a solution was obtained from the abdominal cavity with difficulties.

Then a 7.5% solution of icodextrin in a volume of 300 ml with a solution of dexamethasone in a volume of 3 ml was introduced into the abdominal cavity, the exposure of the mixture in the abdominal cavity was 16 hours.

Result: the next day, after successful trial exchanges in manual mode, effective treatment with automated peritoneal dialysis was resumed.

The patient was followed up for 4 years, during which no clinically significant dysfunction of the peritoneal catheter was noted.

Example 3.

Patient T., 65 years old, was hospitalized with a diagnosis of chronic nephritis. Chronic kidney disease, 5 E. Treatment of CAPD. Obesity 1 tbsp. Arterial hypertension. Anemia. Secondary hyperparathyroidism. Dysfunction of the peritoneal catheter.

Disruption of dialysis fluid drainage was noted within 2 days. When R-graphy of the abdominal cavity: the shadow of the distal part of the PC in the projection of the pelvis, displacement in the cranial direction was revealed. Obturation of the catheter with an omentum is suspected.

To relieve dysfunction, a solution of alteplase in a volume of 1.5 ml and 0.5 ml of atropine solution was introduced in 8 ml of a 7.5% solution of icodextrin, the resulting mixture was injected into the lumen of the catheter through a syringe for 1 second, 3 injections per cycle were performed in a similar way , after which a solution was obtained with difficulty from the abdominal cavity.

Additionally, during the day, 2 more cycles of 5 injections of the mixture of solutions in the same volumes were carried out, after which the solution was freely obtained through the catheter from the abdominal cavity.

Then a 7.5% solution of Icodextrin in a volume of 400 ml with a solution of dexamethasone in a volume of 2 ml was introduced into the abdominal cavity, the exposure of the mixture in the abdominal cavity was 24 hours. The next day, after a trial of successful exchange of dialysis fluid, treatment with continuous ambulatory peritoneal dialysis was resumed. The patient was followed up for 1.5 years. There were no cases of peritoneal catheter dysfunction.

Using the proposed method, procedures aimed at restoring the function of the peritoneal catheter were carried out in the treatment of 25 patients. The effect of the measures taken was obtained in 23 people. 2 patients underwent surgery to restore access for peritoneal dialysis treatment.

The proposed conservative method has significantly reduced the incidence of surgical treatment of patients to restore dialysis access.

The observation period for patients treated using the proposed method averaged 28.52 dialysis months. There were no cases of repeated dysfunction in any of the patients. PD treatment was effective in all these cases.

The use of the proposed method made it possible to significantly reduce the number of surgical interventions, to several times reduce the number of bed-days required to correct dysfunction, thereby preventing a deterioration in the quality of life and condition of patients and a decrease in the effectiveness of treatment with peritoneal dialysis.

Claims (1)

A method of restoring the drainage function of a peritoneal catheter, including the introduction into the abdominal cavity through the peritoneal catheter of a solution of a drug that affects the tissues obstructing the lumen of the catheter, characterized in that a mixture of 7.5% icodextrin in a volume of 7-10 ml is used as a drug solution, to which a solution of alteplase is added in a volume of 1.0-2.5 ml and atropine - 0.5-1.0 ml, the resulting mixture is injected into the peritoneal catheter 2-7 times until a solution is obtained from the abdominal cavity, such injections are performed no more than 2 days, and after receiving the solution from the abdominal cavity, a mixture of 7.5% solution of icodextrin in a volume of 300-500 ml and a solution of dexamethasone in a volume of 2-4 ml is injected, which is left in the abdominal cavity for 12-24 hours.