Peritoneal Dialysis in Infants

[AliRae]

We have a baby on the unit right now who came down from the NICU because they don't do PD up there. We don't usually do it on babes this small either (DOL 15, 3120 grams dry weight), so we've been muddling through as best as we can. Among other issues that we've been having, our unit doesn't have enough supplies. We've been changing dialysates frequently, and have been jury-rigging the setups for the last few days. I'm curious to see what other units are using. We have lots of manifolds for big kids, but they're much to large to be used for this baby. We only had one neonatal manifold which was promptly used up. I've been using IV tubing with buretrols and filters, another buretrol from a neonatal foley kit for a drain and a little piece of extension tubing with a stopcock to connect to the baby. Anyone out there have a better system?

[BittyBabyGrower, MSN, RN]

We have a baby on the unit right now who came down from the NICU because they don't do PD up there. We don't usually do it on babes this small either (DOL 15, 3120 grams dry weight), so we've been muddling through as best as we can. Among other issues that we've been having, our unit doesn't have enough supplies. We've been changing dialysates frequently, and have been jury-rigging the setups for the last few days. I'm curious to see what other units are using. We have lots of manifolds for big kids, but they're much to large to be used for this baby. We only had one neonatal manifold which was promptly used up. I've been using IV tubing with buretrols and filters, another buretrol from a neonatal foley kit for a drain and a little piece of extension tubing with a stopcock to connect to the baby. Anyone out there have a better system?

That sounds about like what we do...we have consulted with our dialysis team and that is pretty much the same set up we have. We don't do it very often, but when we do it about sends us over the top. As long as you keep it sterile, all is well.

[LilPeanut, MSN, RN, NP]

We actually have two kids on PD right now on our unit. We use the stopcock/buretrol etc. setup. The older one is waiting until he gets to 150ml indwelling so he can go to mechanical PD and go home.

The dialysis team does all the setup though, we just run the dialysis.

[NotReady4PrimeTime, RN]

We do a lot of PD on kids of all ages. Most of them are post-op cardiacs. Our system sounds very much like what you described. We have a bin containing all the components for setting it up, and a nice diagram glued to the lid to show how the parts go together. We have three stopcocks at the patient end; the proximal one is a sampling port; the medial goes to the dialysate and the distal to the collection bag, a regular urometer set-up. We use a Hot-line to warm the dialysate, so that tubing is attached to the stopcock and then to the buretrol at the other end. We spike the bag with the buretrol spike and add our additives (KCl and NaHCO3) to the buretrol for wee ones with small fill volumes so that the bag and tubing will be good for 72 hours. All the connections are covered with povidone-impregnated sponge-lined covers to prevent contamination; set-up is a sterile procedure done on a sterile towel with sterile gloves. It's time consuming, in the extreme, to have a kid on PD. We usually have one hour cycles: fill for 5 minutes, dwell for 45 minutes and drain for 10. We time it so the fill finishes at the hour. We're still all paper charting so there is a lot to do at the hour, vitals, pump volumes, output volumes and so on, plus whatever meds may be due. Most of these kids have multiple drips and drains, maybe a pacemaker, intubated, etc so the time flies, even though they're always 1:1.