Peritoneal Dyalisis

Gompers, BSN, RN · Oct 5, 2004

We've done this on a handful of full-term babies over the past few years. None of them survived long enough for transplant. Most got peritonitis and wound up septic, no matter how sterile we kept things, or what antibiotic we gave through the baby's IV or dialysis catheter. It's just that their immune systems are so weak to begin with! Sometimes it's a comorbidity that causes the death, like if the baby also has a cardiac defect. One ended up getting severe NEC with perforation - it happened very very quickly, and the first sign was that we saw air coming through the dialysis catheter as he drained.

We only had one baby survive long enough to go home on dialysis. Her parents did a wonderful job for a year, but then she ended up getting RSV and passing away from that. Again, just such weak immune systems. It was heartbreaking because she was only months away from transplant, and they were getting it all set up - her mom was going to give her a kidney. :crying2:

BittyBabyGrower, MSN, RN · Oct 5, 2004

We've done it on several kids and only had one live to go home on dialysis. She rec'd mom's kidney and then later died of complications related to rejection.

Those kids can end up being 2:1...one for the dialysis if they are doing q1hr infusion/drain cycles and the other just to do the regular tasks.

Jolie, BSN · Oct 5, 2004

I've cared for a few kids on PD. One was a baby with severe meconium aspiration who was transported out for ECMO. His lungs healed beautifully, but he threw a clot which damaged his kidneys. He came back to us and underwent PD while awaiting a kidney transplant. He was truly a joy, bright-eyed and happy. We were thrilled when we were notified that a kidney had been located for him, and sent him out again for the transplant. Sadly, he died in surgery.

The second baby had Potter's Syndrome (hypoplastic lungs and renal agenesis). His parents wanted everything possible done, and had arranged (prenatally) to put him on ECMO at birth. When mom delivered, the ECMO center which had agreed to care for him was full, so he was transported to out unit (which did ECMO then), even though his syndrome would have otherwise made him ineligible for ECMO. He initially did pretty well. He came off of ECMO and was stable for a time on a nasal cannula, while he received PD, and we searched for a kidney for him. Unfortunately, his little lungs could not sustain him, and he began to fail, long before a transplant was possible.

The third baby was a success story. He was born to an addicted mother who overcame her addictions to care for him at home, dialysis and all. Last I knew, he was still awaiting a transplant, but growing and thriving!

iceNICUnurse · Oct 6, 2004

Thanks so much for the replies!

I did this once as I said and the baby wound up with NEC and died after about 2 months.

I was just wondering if this is something we would do again if this came up. This was so hard on the nurses and the poor baby. Fluid running in for 10 min. stay in for 30 min and running out again in 5 minutes.

We really hated this...always checking the clock all the time. We usually had another baby as well so we were quite buissy.

Thanks again

iceNICUnurse

prmenrs, RN · Oct 7, 2004

I think that the few times we had a kid sick enough for peritoneal dialysis, they warranted one-to-one care.

Now that the situation is resolved (sadly), try to broach the subject in staff meetings or with your nurse manager to establish future policy (in writing) that an infant such as this requires one-to-one care, and that should be the expected staffing.

Hard enough to take care of such a sick baby (and the family) without having another baby to keep track of. Asking for a mistake, IMO.