The main complications after peritoneal dialysis implantation include bloody drainage fluid, wound hematoma, abdominal pain, early leakage of peritoneal dialysis fluid, poor drainage of peritoneal dialysis fluid, incomplete bowel obstruction, abdominal organ damage, perforation and wound infection.
The causes of postoperative bloody drainage fluid, wound hematoma or bleeding include the use of perioperative anticoagulants, abnormal coagulation mechanisms, incomplete intraoperative hemostasis, premature start of postoperative peritoneal dialysis, and injury to small vessels in the subcutaneous tunnel. Generally, lap band with pressure bandage is used to suspend abdominal dialysis treatment, and bleeding stops on its own after several days of rest. Try to start abdominal dialysis treatment only two weeks after the implantation, which can significantly reduce the incidence of bloody drainage fluid and wound bleeding. In addition, female patients may have bloody drainage fluid during menstruation, which becomes clear when the menstruation clears and is caused by menstrual blood draining into the abdominal cavity through the umbilical end of the fallopian tube.
Pain in the perineum and perianal area can occur in about 3% to 4% of patients after surgery, especially when the infusion of peritoneal dialysis fluid or drainage of peritoneal dialysis fluid is about to end, mainly due to local peritoneal irritation at the end of the catheter, which usually disappears automatically one to two weeks after implantation. The pain can be reduced by slowing down the rate of infusion or drainage of peritoneal dialysis fluid. In addition, the temperature of dialysis fluid is too high or too low, and the dialysis fluid is acidic, etc. may also cause abdominal pain.
Poor drainage of abdominal dialysis fluid can manifest as unidirectional or bidirectional obstruction. Unidirectional obstruction is the most common and is mainly manifested by the unobstructed infusion of peritoneal dialysis fluid into the abdominal cavity and difficulty in drainage. The treatment methods include asking the patient to pass stool to release the compression, changing the position to restore the catheter to its original position, and injecting urokinase intraperitoneally to dissolve the fibrin clot.
The incidence of early post-implantation leakage of peritoneal dialysis is about 6.5%, and the risk factors include early start of post-operative peritoneal dialysis, obesity, diabetes mellitus, age >60 years, multiple mothers, long-term hormone application, severe malnutrition, and multiple previous implants. Most of the leaks can be resolved with pressure bandaging of the abdominal wall and cessation of abdominal dialysis for 2 to 4 weeks.