Abstract
To reduce the occurrence rate of peritoneal dialysis (PD) catheter dysfunction caused by catheter displacement or plugging, this study screened all patients with peritoneal dialysis catheterization from 2002 to 2015 from the Third Xiangya Hospital of Central South University. There were 256 patients before continuous quality improvement (CQI) (from 2002 to 2007) and 813 patients after CQI (from 2008 to 2015). The occurrence rate of catheter dysfunction was 5.9% in the preCQI group: seven cases were associated with peritonitis, six cases were involved in omentum wrapping, one case was blocked by oviduct, and one case was blocked by blood clot. Through PDCA (plan-do-check-act) four-step of CQI, the following measures were adopted: (1) Preoperative: treat complications, enema and urine catheterization (2) Intraoperative: strengthen analgesia, Lower the insert position of catheter to 7.5 ∼ 8.5 cm above the pubic symphysis, extending the straight distance of catheter in rectus abdominis and decrease the times of peritoneal dialysis catheter implantation. (3) Postoperative: strengthen the training of nurses, patients and their families. (4) strengthen anticoagulation therapy during peritonitis treatment. (5) use laparoscopic technology for refractory patients, and so on. The occurrence of catheter dysfunction was 1.5% in the postCQI group (p < 0.05): two cases were associated with peritonitis, ten cases were involved in omentum wrapping. The measures we adopted in CQI reduce the occurrence rate of catheter displacement or plugging in peritoneal dialysis.
Highlights
Peritoneal dialysis is a major treatment strategy for patients with end-stage renal disease
There were seven patients combined with peritonitis, including one case with displacement of catheter, which was confirmed by X-ray film, migrating from the true pelvis, with poor treatment effectiveness, and changed to hemodialysis
The other six cases had no displacement of catheters, but one case switched to hemodialysis, and five cases were subject to recanalization after conservative therapy
Summary
Peritoneal dialysis is a major treatment strategy for patients with end-stage renal disease. Compared with hemodialysis, it has several advantages, such as simple operation, less cost as well as the protection of residual renal function. Continuous Quality Improvement (CQI) is a method of business management concept and system management, which was established and developed by American Deming in 1950s. It was originated from the development of industrialized and standardized management and is a structured and organizational process, which can allow employees to participate in the design of programs and realize the continuous improvement process, in order to provide high quality health services that can meet or exceed people’s expectations. From 1980s to 1990s, the CQI practices were widely applied in all medical institutions in Western countries, and played an important role in the management of the quality of peritonitis [2] and hypertension [3] in patients receiving peritoneal dialysis
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