Most common complication of peritoneal dialysis is?

PGIMER NO - 2020

Medical & Surgical Nursing

Easy

Appeared in: PGIMER NO - 2020

Explanation

Peritonitis, an infection of the peritoneum, is the most frequent and significant complication associated with peritoneal dialysis (PD).
It arises from a break in sterile technique during dialysate exchanges, allowing skin bacteria like Staphylococcus species to enter the peritoneal cavity via the catheter.
The hallmark clinical presentation includes cloudy dialysate effluent, diffuse abdominal pain, and fever.
Peritonitis is a primary reason for technique failure and switching patients from PD to hemodialysis.

Option B: Urinary incontinence is the involuntary leakage of urine. Peritoneal dialysis involves the abdominal cavity and does not directly affect the urinary bladder or its sphincters.
Option C: A pulmonary embolism is a blockage in one of the pulmonary arteries in the lungs, usually caused by a blood clot that travels from the legs. It is not a direct or common complication of peritoneal dialysis.
Option D: Pleurisy is the inflammation of the pleura, the membranes lining the lungs. While a rare complication called hydrothorax (dialysate leaking into the pleural space) can occur with PD, it is far less common than peritonitis.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Peritoneal Dialysis as background academic context rather than a clinical decision trigger.
The nurse's primary role is patient education, focusing on meticulous sterile technique for catheter care and exchanges to prevent infection.
Early recognition of peritonitis is critical. Nurses must teach patients to immediately report cloudy effluent or abdominal pain, as prompt antibiotic treatment can prevent hospitalization and catheter removal.
What if? If a patient reports abdominal pain but the effluent is clear, the nurse should still assess for other causes (e.g., constipation, catheter position) and instruct the patient to monitor the next effluent bag closely, as cloudiness can be a delayed sign.

How to Approach the Question

First, identify the key concepts in the question: "Most common complication" and "peritoneal dialysis".
Recall the procedure of peritoneal dialysis. It involves a permanent catheter inserted into the peritoneal cavity, creating a direct line from the outside environment into a sterile body cavity.
Analyze the inherent risks of this procedure. Any time there is a permanent indwelling catheter, the number one risk is infection.
Evaluate the given options in the context of infection risk. 'Peritonitis' is an infection of the peritoneum, which is directly accessed during PD.
Consider the other options. Urinary incontinence, pulmonary embolism, and pleurisy are not directly related to the mechanics or common infectious risks of the PD procedure.
Conclude that peritonitis is the most logical and frequent complication due to the risk of contamination via the catheter.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 1 p. 1113-1115

E6 Medicine Harrison 22e Part 2 p. 305-307