• Advances in pediatric surgery
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• 제17권2호
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• pp.125-132
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• 2011

The aim of this study was to compare peritoneal dialysis catheter insertion by the open method to the laparoscopic method. Twenty four laparoscopic and 10 open peritoneal dialysis catheter placements were performed in children between 2001 and 2008. Patient characteristics, operation related data, procedural complications and clinical outcome were compared. Although there were no cases of catheter obstruction, exit site infection or bleeding in the laparoscopic group, compared to the open method, there was no statistically significant difference between the two groups. Catheter removal rate due to complication was high in the open group and catheter survival rate was high in the laparoscopic group. We concluded that laparoscopic peritoneal dialysis catheter placement is feasible in children of all age groups with at least equivalent functional results compared to the open method. An advantage of laparoscopic catheter insertion is removal of the great omentum and easy fixation of the catheter to the abdominal wall.

• 중환자간호학회지
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• 제4권2호
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• pp.47-60
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• 2011

Purpose: The purpose of this study was to develop a standardized education protocol for peritoneal dialysis patients. Methods: First, the demand for education was investigated from the 27 patients on peritoneal dialysis and 16 guardians, and later, the standardized nursing education protocol has been developed through the comprehensive literature review and the critical analysis of the related studies. Contents validity and applicability have been tested through the expert group survey. Results: The standardized peritoneal dialysis nursing education protocol with 9 areas and 20 items has been developed. The content validity for timing and duration, contents, method, and place of education proposed by the protocol were all above than 0.8. In terms of the applicability of the protocol, the experts scored between 4.20 to 4.93 for all items except one. The item on home visit education acquired the lowest applicability score, because there might exist potential restrictions in visiting patient's home. Conclusion: The standardized education protocol developed in this study turned out to be adequate by representing high content validity for all items and the applicability also was high except the item on home visit education. Further researches to test the effects of this education protocol should be done.

• Childhood Kidney Diseases
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• 제25권2호
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• pp.117-121
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• 2021

Chronic kidney disease (CKD)-mineral and bone disorder (CKD-MBD) is a common complication of CKD, often accompanied by extra-skeletal calcification in adult patients. As increased vascular calcification is predicted to increase cardiovascular mortality and morbidity, the revised Kidney Disease: Improving Global Outcomes guidelines recommend avoiding calcium-containing phosphate chelators. However, extra-skeletal calcification is less commonly noticed in pediatric patients. Here, we report our experience of such a complication in pediatric patients receiving maintenance peritoneal dialysis. Extra-skeletal calcification was noticed at the corneas, pelvic cavity, and soft tissues of the lower leg in 4 out of 32 patients on maintenance peritoneal dialysis. These patients experienced the aggravation of extra-skeletal calcifications during peritoneal dialysis, and 2 of them underwent excisional operations. It is required to monitor extra-skeletal calcifications in children on kidney replacement therapy.

• Childhood Kidney Diseases
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• 제24권2호
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• pp.63-68
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• 2020

Despite the many advantages of peritoneal dialysis (PD) in children with end-stage renal disease, there exist redoubtable complications of PD that should be overcome. To prevent and manage these complications, a multidisciplinary team should provide support highly tailored for each child and family, based on the standardized practice guidelines for the management of pediatric PD. In this review, we summarize the clinical manifestations and management of several complications of PD.

• Journal of Yeungnam Medical Science
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• 제31권1호
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• pp.25-27
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• 2014

Patients treated with peritoneal dialysis have increased intra-abdominal pressure and a high prevalence of abdominal wall complications. Hernias can lead to significant morbidity in patients on peritoneal dialysis. Hernias are clinically important because of the risk of incarceration, strangulation and subsequent bowel obstruction, rupture, and peritonitis. In this paper, a case of incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis (CAPD) patient is reported. The small bowel obstruction improved after herniorrhaphy, and the peritoneal dialysis was resumed 2 weeks after the herniorrhaphy. The patient had been undergoing CAPD without technical failure until the 2 months follow-up after the herniorrhaphy. This case shows that early detection of incarcerated umbilical hernia and herniorrhaphy can prevent resection of a strangulated small bowel so that it can remain on CAPD without post-operative technical failure. Umbilical hernias should be carefully observed and intestinal obstruction should be considered when a CAPD patient with an umbilical hernia has abdominal pain.

• Journal of Yeungnam Medical Science
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• 제26권1호
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• pp.49-55
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• 2009

Peritonitis is a serious problem in patients undergoing peritoneal dialysis. Rarely pneumatosis intestinalis can occur as a complication of this infectious process. Pneumatosis intestinalis is a potential life threatening condition with a challenging management. The mortality of peritoneal dialysis patients with pneumalosis intestinalis secondary to mesenteric ischemia is almost 100%. We describe a rare case of pneumatosis intestinalis in a peritoneal dialysis patient who developed Staphylococcus aureus peritonitis which was initially treated with appropriate antibiotics. Since initial response to therapy was not achieved, an abdominal computerized tomography was done which revealed a pneumatosis intestinalis. A laparotomy was performed and small bowel necrosis was seen. A segmental resection with ileostomy, jejunostomy was done. Though surgical treatment was performed, the patient died in 2 weeks after admission. Pneumocystitis intestinalis in peritoneal dialysis peritonitis is a uncommon complication which requires prompt evaluation to rule out mesenteric ischemia as it carries a high mortality and its management will be surgical.

• 대한핵의학회지
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• 제28권1호
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• pp.153-156
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• 1994

Massive hydrothorax complicating continuous ambulatory peritoneal dialysis (CAPD) is relatively rare. A 67-year-old male and a 23-year-old female patients during CAPD presented massive pleural effusion. They have been performing peritoneal dialysis due to end-stage renal disease for 8 months and 2 weeks respectively. We injected $^{99m}Tc$-labelled radiopharmaceutiral (phytate and MAA, respectively) into peritoneal cavity with the dialysate. The anterior, posterior and right lateral images were obtained. The studies reveal visible radioactivity in the right chest indicating the communication between the peritoneal and the pleural space. After sclerotherapy with tetracycline, the same studies reveal no radioactivity in the right chest suggesting successful therapy. We think nuclear imaging is a simple and noninvasive method for the differential diagnosis of pleural effusion in patients during CAPD and the evaluation of therapy.

• Journal of Chest Surgery
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• 제34권10호
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• pp.745-753
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• 2001

배경: 체외순환은 보체의 활성화와 cytokine의 유리에 의한 급성 전신성 염증반응을 일으킨다. 이 반응은 소아들에 있어 모세혈관 누출 증후군이나 여러 장기의 기능장애를 일으킬 수 있다. 유해한 cytokine들이나 보체anaphylatoxin들을 제거함으로서 이들에 의한 염증반응을 완화시킬 수 있을 것이다. 개심술 후 변형 초여과법과 복막투석이 소아 개심술 후 혈중 염증 매개체를 감소시킬 수 있는가를 알아보기 위해 이 연구를 시행하였다. 대상 및 방법: 모두 30떵의 심실중격결손증 환아(생후 1.1∼12.6개월)들을 대상으로 하여 이들을 10명씩 세 군으로 나누어 연구하였다. 10명은 변형 초여과법을 시행한 군(U군), 다른 10명은 체중이 작은 소아(5kg 이하)들로서 술 후 복막투석을 한 군(P군), 나머지 10명은 변형 초여과법이나 복막투석을 시행하지 않은 대조군(C군)으고 나누었다. 체외순환 전후, 복막투석 후 혈청 샘플을 채취하였으며 변형 초여과의 여과액과 복막투석 배액을 채취하여 C3a와 인터루킨-6(IL-6)를 각각 radioimmunoassay법과 enzyme-linked immunosorbent assay법으로 측정하였다. 결과: 각 군간에 체외순환 시간, 대동맥차단 시간, 저체온의 정도 등은 차이가 없었다. 복막투석 배액에는 상당한 농노의 C3a와 IL-6를 포함하고 있었으나 혈청 C3a, IL-6 농도의 저하는 없었다. 변형 초여과의 여과액에는 낮은 농도의 C3a가 검출되었고 혈청 C3a 농도에도 영향을 주지 못하였으며 IL-67는 검출되지 않았다. 결론: 복막투석 배액에는 높은 농도의 C3a와 IL-6를 포함하고 있었지만 이들의 혈청 농도를 감소시키는데는 효과가 없었으며 변형 초여과법 역시 혈청 C3a와 IL-6의 감소 효과는 없었다.

• 재활간호학회지
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• 제2권1호
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• pp.7-21
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• 1999

The purpose of this study was to identify the degree of learned helplessness and self-care agency in dialysis patients and the relationship between learned helplessness and self-care agency. The subjects were 168 dialysis patients who were undergoing hemodialysis and peritoneal dialysis from 1 university hospital, 1 hospital, 1 hemodialysis center in Seoul, 1 hospital in Incheon, Korea. The data were collected with two interview questionnaires which were Learned Helplessness Scale (LHS) and Self-as-Carer Inventory (SCI). The collected data were analyzed by descriptive statistics and t-test, One-way ANOVA and Pearson Correlation with SPSSWIN program. Results were obtained as follows : 1) The mean scores of learned were 45.93(range 20-80). The mean learned helplessness scores of peritoneal dialysis patient and hemodialysis (HD) patient were not different significantly. However by the aging process, the mean scores of learned helplessness has a tendency to get higher and who had a job were likely to low score of learned helplessness. 2) The mean scores of self-care agency were 142.48 (range 33-198). The mean self-care agency scores of peritoneal dialysis (PD) patient much higher than the score of it with hemodialysis. The score of self-care agency were significantly different between peritoneal dialysis patient and hemodialysis patient. The patients who have job were likely to be higher score of self-care agency than other groups. 3) There was significant relationship between the score of learned helplessness and self-care agency. In conclusion, there was an inverse relationship between learned helplessness and self-care agency in dialysis patients. Considering this, the high level of learned helplessness of dialysis patients should be intervened by nurse with a well developed edicational program or cognitive behavioral therapy.

• Journal of Nutrition and Health
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• 제45권1호
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• pp.30-43
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• 2012

Patients undergoing peritoneal dialysis are at risk for protein-energy malnutrition because of nutrient losses during dialysis. This study determined the nutritional status of patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Forty-four patients receiving CAPD were divided into two groups according to dialysis period. We investigated the nutritional status of the patients by measuring anthropometric and biochemical parameters, as well as food intake, self-appetite, dietary habits, a subjective global assessment, and a total nutritional status assessment. Group I subjects (7 males, 13 females) had received dialysis for < 2 years, whereas the group II subjects (18 males, 6 females) received dialysis for ${\geq}$ 2 years. Energy intake with added dextrose in the dialysate per kg of body weight was $30.3{\pm}5.8$ kcal in group I and $29.0{\pm}8.1$ kcal in group II. The average protein intake per kg of weight was $1.0{\pm}0.3$ g in group I and $1.0{\pm}0.4$ g in group II, which were less than the recommended protein intake for patients undergoing CAPD (1.2-1.5 g/kg). Mean serum albumin level was significantly lower in group II than that in group I (p < 0.05). A recent self-appetite score was significantly higher in group II than that in group I (p < 0.01). The dietary habits score was significantly lower in group II than that in group I (p < 0.05). The subjective global assessment was significantly higher in group I (85.0%) than that in group II (54.2%) under normal nutrition status (p < 0.05). The dialysis period was significantly and negatively correlated with the subjective global assessment (r = -0.502, p < 0.01) and the total nutritional status assessment (r = -0.575, p < 0.01). These results demonstrated that patients undergoing CAPD for ${\geq}$ 2 years had worse nutritional status than those who had been undergoing dialysis for < 2 years. Good nutritional status can predict the long-term survival of patients undergoing peritoneal dialysis. Additionally, the exact evaluation of nutritional status before 2 years will be important to maintain long-term dialysis therapy in patients undergoing CAPD.