Free air on CT and the risk of peritonitis in peritoneal dialysis patients: a retrospective study

Okamoto, Takayuki; Ikenoue, Tatsuyoshi; Matsui, Kosuke; Miyazaki, Mikiko; Tsuzuku, Y; Nishizawa, Yuichiro; Kubota, Minoru

doi:10.3109/0886022x.2014.958953

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…Intraperitoneal free air is an independent risk factor for peritonitis in patients with PD [ 7 ] and is thought to be caused by inadequate PD procedures. The most likely cause of intraperitoneal free air in patients with PD is aeration due to insufficient air removal during bag replacement.…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Dialysis with Marked Pneumoperitoneum

Nakamura

Nakata

Nagawa

et al. 2020

Case Reports in Nephrology

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Pneumoperitoneum, the presence of free air within the peritoneal cavity, is often caused by the perforation of gas-containing viscus and commonly requires surgical treatment. However, in patients with peritoneal dialysis, free air is commonly seen on X-ray. We present the case of a patient with peritoneal dialysis with marked pneumoperitoneum. A 75-year-old Japanese male with end-stage renal disease due to antineutrophil cytoplasmic antigen-associated vasculitis had been receiving continuous ambulatory peritoneal dialysis for 9 years. He had a poor appetite and general malaise without abdominal pain or fever. These symptoms gradually worsened, and he was hospitalized. At the time of admission, chest X-ray revealed bilateral free air in the abdomen. Subsequent computed tomography of the abdomen revealed marked pneumoperitoneum. Peritonitis due to perforation of the digestive tract was considered; however, the absence of abdominal pain, fever, and turbidity of dialysis drainage indicated that peritonitis was unlikely. Insufficient air venting during continuous ambulatory peritoneal dialysis bag replacement was suspected. The bag was carefully changed, resulting in a gradual decrease in the free air. We encountered a patient with continuous ambulatory peritoneal dialysis who had significant free air in the abdominal cavity in the absence of peritonitis. The source of the air was determined to be the dialysis bag due to insufficient venting during replacement. This case underscores the importance of instructing patients with continuous ambulatory peritoneal dialysis on the thorough removal of air from the bag during replacement.

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Section: Discussionmentioning

confidence: 99%

Peritoneal Dialysis with Marked Pneumoperitoneum

Nakamura

Nakata

Nagawa

et al. 2020

Case Reports in Nephrology

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“…PD patients with intra-abdominal free air have indeed a higher risk of peritonitis. Okamoto suggested that this might be based on poor PD technique (e.g., the presence of air may be a risk of imperfect sterile technique) or touch contamination [23]. Also, once the risk of non-sterile air entrance is fixed, the manufacturer shall be able to determine the correct cumulated volume of air that is infused into the patient rather than detecting any tiny air bubbles.…”

Section: Change In Paradigmmentioning

confidence: 99%

Robust alarm design strategy for medical devices: Application to air-in-line detection and occlusion management

Eric Chappel

2023

Global J. Eng. Technol. Adv.

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Alarm fatigue in the hospital environment is a recurring problem that can be solved through technical, human, or organizational considerations. The use of technical factors to get a robust alarm management system is illustrated here by two case studies related to air-in-line detection in peritoneal dialysis and insulin pump occlusion management. Air-in-line sensors are usually very sensitive to the presence of small bubbles stuck on tubing and may therefore deliver false alarms. To provide a reliable estimate of the cumulated air volume pumped an IR sensor technology that is insensitive to small bubbles was implemented and tested. Another strategy was used to limit false occlusion alarms in an insulin patch pump. The piezoelectric actuator of this micropump was servo-controlled to the pressure sensor signal to allow insulin to flow into the patient despite the presence of a partial occlusion. The false alarm rate is thus reduced by using a self-adaptive occlusion detection threshold that has been evaluated using numerical simulations.

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“…If infection occurs, dialysis fluid presents an abnormal echogenicity with multiple fine echoes due to cell debris and fibrin threads 24 . The observation of gas bubbles within dialysis fluid is mostly diagnostic of infection due to perforation 25 . Based on the study of Karahan et al, every peritonitis episode should be an indication to perform US of the catheter cuffs and the tunnel segment searching for a catheter‐related origin of infection 20 …”

Section: Peritonitismentioning

confidence: 99%

The Underrated Role of Ultrasound in Peritoneal Dialysis

Basile

Rahbari

Nicolò³

et al. 2021

J of Ultrasound Medicine

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Ultrasound is very effective in performing procedures and assessment of complications in peritoneal dialysis. The ultrasound examination can be applied for preoperative assessment, during the peritoneal catheter placement, for the detection and monitoring of infection, as well as for the evaluation of the catheter malfunction. Despite being not only a cost‐ and time‐saving technique but also a bedside procedure, ultrasonography remains an underrated clinical tool in the field of peritoneal dialysis. This publication wants to explain and reinforce the clinical utility of US in PD and to expand the diagnostic equipment for the clinician.

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Free air on CT and the risk of peritonitis in peritoneal dialysis patients: a retrospective study

Abstract: Free air is an independent risk factor for peritonitis in PD patients. This suggests that bag change procedures should be re-evaluated, and patients re-educated, when necessary.

Cited by 4 publications

References 31 publications

Peritoneal Dialysis with Marked Pneumoperitoneum

Peritoneal Dialysis with Marked Pneumoperitoneum

Robust alarm design strategy for medical devices: Application to air-in-line detection and occlusion management

The Underrated Role of Ultrasound in Peritoneal Dialysis

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