Piraino Beth
Pediatr Nephrol. 2004 Feb;19(2):125-7. doi: 10.1007/s00467-003-1356-1. Epub 2003 Dec 10.
Methods to prevent peritonitis are an essential component of any successful peritoneal dialysis (PD) program. Careful attention to training of the parents and child on the proper technique of PD and avoidance of manual spiking by using an assist device for the cycler, or use of the double-bag system for continuous ambulatory PD, should decrease risk of peritonitis from touch contamination. Secondly, reduction of peritonitis can be achieved through reduction of exit site infections by use of mupirocin antibiotic cream at the exit site of the PD catheter as part of routine care. If an exit site infection develops and is refractory to therapy, then the PD catheter can be successfully replaced as a single procedure, to reduce the risk of peritonitis. The third step in reducing the risk of peritonitis is to avoid repetitive episodes with the same organism. This may again involve replacing the catheter; as long as the effluent can be cleared, this again can be performed as a single procedure, thus allowing the child to avoid the trauma of hemodialysis. The focus in pediatric PD programs must always be on preserving the peritoneal membrane, and not on preservation of the catheter. With careful attention, peritonitis can become an uncommon event.
预防腹膜炎的方法是任何成功的腹膜透析（PD）方案的重要组成部分。认真关注对家长和患儿进行PD正确技术的培训，并通过使用循环器辅助装置避免人工加液，或在持续非卧床腹膜透析中使用双袋系统，应能降低因接触污染导致腹膜炎的风险。其次，作为常规护理的一部分，在PD导管出口处使用莫匹罗星抗生素软膏，通过减少出口处感染可降低腹膜炎发生率。如果发生出口处感染且治疗无效，那么可以将PD导管作为一个单独的操作成功更换，以降低腹膜炎风险。降低腹膜炎风险的第三步是避免同一病原体的反复感染。这可能同样涉及更换导管；只要能清除流出液，这也可作为一个单独的操作进行，从而使患儿避免血液透析的创伤。儿科PD方案的重点必须始终放在保护腹膜上，而不是保护导管。通过仔细关注，腹膜炎可成为罕见事件。
