If you want to do acute PD you can’t do it in a little way
I went to a victory lap dinner in honor of the recent success of our peritoneal dialysis program. Our program has been growing like a weed due to our acute PD program. Patients that come to our hospital in need of chronic dialysis who are not previously engaged in the medical system are now often times started on peritoneal dialysis. Usually they never get even a single run of hemodialysis.
The patients are admitted, get a PD catheter placed the next day or so, and start low volume peritoneal exchanges the follwong day.
A day or so later they can be discharged. As outpatients they come to our PD facility 3-5 days a week for 5 hours to continue low volume, supine exchanges. Doing peritoneal exchanges with a fresh catheter breaks one of the cardnial laws of PD, do not fill the cavity for the first three weeks after the catheter is placed. By using low volumes and keeping the patients supine they are able to achieve adequate clearance, while allowing the access to mature without generating leaks.
After a coupld of weeks the patietns start to train on how to do PD and a few weeks later they are independent home dialyzors.
The key to this is a team approach. This is why you can’t do this in a little way. You have to go big and involve all of the stake holders. Dr Khairullah assembled an excellent team.
- The PD unit staffed-up and trained on how to do the low volume exchanges. He made sure they were ready for the increased time commitment for the outpatient dialysis
- We found a surgeon who was committed to doing PD placements in a timely matter and doing them really well. And then he found a second surgeon because for this to work you really need someone always available. One is not enough.
- He secured buy-in from the hospital, nurses, discharge coordinators.
- He is now adding rehabilitation facilities, and nursing homes to the team.
This has been a monumental and successful effort. Great dinner.
