Pediatric Continuous Ambulatory Peritoneal Dialysis

[Kaybee0525]

Hello,

I am a PICU nurse, and also the renal coordinator at a children's hospital. When pediatric patients have a new peritoneal dialysis catheter placed, they come to the PICU, and are ordered for cycles of CAPD. We call it "manual" PD, but the official termanology is continuous ambulatory peritneal dialysis. The hospital purchased a closed tubing system to do do this kind of manual dialysis, but it's designed for neonates. It is made to give the patient 100ml fill volumes. When we try it with bigger patients, it takes almost an hour to fill each cycle (>100mls), so the nephrologists end up putting the patient on the cycler much earlier than expected.

Does anyone do CAPD (manual) on pediatric patients anymore in the ICU setting? Some children's hospitals wait 2 weeks while the catheter matures, flush it with one time cycle tubing, and then put the patient on the cycler, avoiding manual cycles.

If you do CAPD on pediatric patients, what equipment do you use? I've reached out to Baxter and one other company that make supplies, but I'm coming up short with pediatric systems. Any information would be very helpful, thank you!

[meanmaryjean, DNP, RN]

We recently had a peds patient in the ICU who was on manual. She was tiny (

Our nephrologists use the PD cath right away (they sort of had to in this case) and don't use the cycler until the patient can tolerate volumes of 100 mL.

[Kaybee0525]

Thank you meanmaryjean for your reply. We are all set with the babies, and use the set we have that can do small fills, but it's the kids that are a problem. If the baby that came to your unit was 10 years old, say 30kg, would you use the same system? What is the "warming tubing"? Is it made by Baxter? I suggested we just spike the dialysate bags and control the volumes with the buretrol, so your system may work for us. Thanks again!

[meanmaryjean, DNP, RN]

I think the 'warming tubing' is what goes in a blood warmer- loops and loops and loops of tubing all sort of attached to each other. (The dialysis nurses set it up- so I don't know exactly what to call it- but it resemble tubing for a blood warmer)

For a bigger kid- they would be on the cycler. Honestly, it's not something we do very often. I think we've had three or four kids on PD in the last four years. We've done a couple of hemodialysis (CRRT) and of course, we hemofiltrate ECMO kids.