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Kidney Week

Abstract: PO0996

Peritoneal Dialysis Catheter Flushing Leading to Syncope from Vagal Nerve Stimulation

Session Information

  • Peritoneal Dialysis
    November 04, 2021 | Location: On-Demand, Virtual Only
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Author

  • Barnes, Sylvester, Loyola University Health System, Maywood, Illinois, United States
Introduction

Peritoneal dialysis is the most common form of home dialysis. Complications can arise however any time the peritoneum is invaded such as during surgery. The patient is a 37-year-old male on PD secondary to developing progressive IgA nephropathy. The patient suffered from an inguinal hernia which required open repair with mesh placement. This required the patient to be subsequently bridged with HD.

Case Description

After 6 weeks the patient was in the process of beginning to transition back to PD dialysis. The patient underwent flushing of his peritoneal catheter and subsequently developed hypotension, diaphoresis and near syncope. This process continued every time the patient’s peritoneal catheter was flushed. 500 mL’s of 2.5% warm dialysate was also attempted to fill the patient resulting in the same near syncopal episode. There was no problem with aspiration of the catheter. There was no resistance involved in aspiration or flushing. KUB was obtained showing the catheter placed in the left lower pelvis as well as a significant amount of stool burden. Despite aggressive regimen of laxatives the patient continued to suffer from hypotension and near syncope with catheter flushing. The patient was referred to surgery for catheter repositioning. Operative report identified that the tip of the catheter was caught in anterior abdominal adhesions. The catheter was repositioned to the right lower pelvis. After 2 weeks the patient was able to tolerate flushing of his dialysis catheter with progressively increasing fill volumes to the point that he was able to be completely converted back to peritoneal dialysis.

Discussion

It was theroized that catheter tip was uniquely postioned leading to vagal nerve stimulation when liquid was infused though the catheter. This case illustrates a unique complication of catheter malposition and adhesions resulting in near syncope secondary to vagal nerve stimulation. With repositioning of the patient’s catheter the symptoms completely resolved.