INFANT FEEDING TUBE - A CHEAPER ALTERNATIVE TO PERITONEAL DIALYSIS CANNULA
Amol Lohkare, Bhavana B Lakhkar
Department of Pediatrics, Sawangi, Wardha, Maharashtra, India
Address for Correspondence
Dr Bhavana Lakhkar, Department of Pediatrics, Sawangi, Wardha, Maharashtra, India.
Email
blakhkar@yahoo.co.in
Acute Renal Failure (ARF) occurs in 5% of the hospitalized adults and children and upto 30% of admissions in the intensive care. Early recognition, supportive care and treatment of the underlying cause of the ARF are crucial for prevention of associated morbidity and mortality. Dialysis is a life saving procedure and should be done immediately when indicated. Peritoneal dialysis (PD) is relatively cheaper & simpler as compared to hemodialysis. Still the cannula cost & availability are many times reasons for delay or inability to do PD. Commercially available PD fluid is quite cheap & easily available. Here we are reporting a case in which parents could not afford peritoneal dialysis cannula and infant feeding tube was successfully used as PD catheter and life of child was saved.

A 5 months old male child with large Patent Ductus Arteriosus (PDA) and pulmonary hypertension was admitted to the hospital with oliguric renal failure. Due to sepsis child's intake was significantly reduced & he did not passed urine for 36 hours. On admission child was irritable & had 2 episodes of seizures. Investigations showed blood urea of 68 mg% & creatinine of 2.1 mg%. Serum sodium was 136meq/L & potassium was 4 mEq/L. After 36 hours blood urea has reached to 250 mg% and creatinine was 7 mg%, with serum sodium of 155 mEq/L & potassium of 6 mEq/L. Ultrasound abdomen was suggestive of the renal parenchymal disease but the corticomedullary differentiation was maintained. In view of rapidly rising urea, creatinine & CNS involvement, peritoneal dialysis was planned. As parents could not afford infant size peritoneal dialysis catheter, the infant feeding tube no. 10 was used as the peritoneal dialysis catheter. Near the closed end 3-4 vents were made in the infant feeding tube to increase the number of pores to drain the fluid in the peritoneal cavity. Under all aseptic precautions and under local anesthesia, ascitis was created by introducing needle no. 22 in the left paramedian area. Normal saline 10ml/kg was introduced. The stab incision was made in the left paramedian area with the scalpel blade no. 11 and the infant feeding tube was introduced in the peritoneal cavity with the help of the curved artery forceps which was removed as the tube was confirmed in the peritoneal cavity and the infant feeding tube was advanced towards the right iliac fossa. The outer end of the feeding tube was kept open. The free outflow of the fluid was assured. The initial fluid sample was collected for the routine microscopy and culture. The infant feeding tube was properly sutured. Ultrasound abdomen confirmed the proper position of the tube and ruled out the internal injury. After fixing the infant feeding tube first inflow was initiated. Heparin was added to the peritoneal fluid to prevent the clotting. Each time amount of fluid during inflow, dwell time & out flow was recorded & cycles were continued for 3 days. Total of 60 cycles were required when the patient started passing enough amount of urine & creatinine also came down. At this time peritoneal dialysis was stopped, catheter was removed & baby was kept on antibiotics for 10 days. The hospital course was uneventful and the baby was discharged on day 11. The baby is attending regular follow-up and is doing well.

Acknowledgement: Dr Tushar Jagzape (M.D) helped in the procedure.
Funding
None
Conflict of Interest
None
References :
  1. Gaudiao KM, Sigel SJ. Pathogenesis and treatment of the renal failure. Pediatr Clin North America. 1987;34: 771-787.
  2. Srivastava RN, Bagga A, Moudigel A. ARF in north Indian children, Indian J Med Research. 1990; 92: 404-408.
  3. Ali US, Sengupta KD. ARF in critically ill children. Indian J Practical Pediatr 2000; 2:315-323.
Last Updated : Saturday, August 01, 2009 Vol 6 Issue 8 Art #44
How to Cite URL :
Lohkare A, Lakhkar B B. INFANT FEEDING TUBE - A CHEAPER ALTERNATIVE TO PERITONEAL DIALYSIS CANNULA. Pediatric Oncall [serial online] 2009[cited 2009 January 1];6. Art #44. Available From : http://www.pediatriconcall.com/Journal/Article/FullText.aspx?artid=250&type=J&tid=&imgid=&reportid=285&tbltype=
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