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COVID19

Question Title

* The Medical Director is meeting with the Clinic Manager of the Peritoneal Dialysis (PD) program to develop guidelines for the care of the PD patients during the COVID-19 pandemic.

1. The Director and Manager discuss essential and non-essential PD clinic visits. In which of the following situations would visits be essential, requiring the patient to be seen in-person at the PD clinic?

The correct answer is c.  Suspected peritonitis, severe exit site infection, and continued training of new patients, only.

Rationale: In order to accurately diagnose and treat peritonitis or a severe exit site infection, samples must be collected, so an in-person visit is required. Likewise, training of new patients requires in-person interaction. Routine procedures, such as PET, are considered non-essential and should be rescheduled during a pandemic to avoid unnecessary patient contact. 

Reference: https://ispd.org/wp-content/uploads/ISPD-PD-management-in-COVID-19_ENG.pdf

Question Title

* 2. Since it is possible that a patient on PD may require hospitalization with COVID-19, the Director and the Manager discuss appropriate staffing. When a patient on PD is admitted to the hospital with COVID-19 symptoms, it is preferable to

The correct answer is a. have separate teams be responsible for inpatient and outpatient care.

Rationale:  In order to minimize risk for cross contamination between inpatient and outpatient settings, separate teams should be used for each setting. Designating a team member each day as a go-between would increase the risk of cross contamination. With the current pandemic restrictions, home caregivers will be required to self-isolate and not be able to do inpatient treatments. 

Reference: https://ispd.org/wp-content/uploads/ISPD-PD-management-in-COVID-19_ENG.pdf

Question Title

* 3. A patient on PD is diagnosed with COVID-19 and is in stable condition. The medical team in the Emergency Department, in consultation with the nephrologist, has determined that it is appropriate for the patient to remain at home with daily communication with the PD team. The patient is anxious about possibly infecting other family members with the drained PD solution. The patient is instructed that the most important measure to prevent infection by the drained PD solution is to

The correct answer is b. take steps to prevent accidental splash when disposing the drained dialysate.

Rationale:  There are currently a variety of opinions on how to dispose of drained dialysate from patients on PD who have COVID-19. However, it is prudent to avoid exposure to any body fluid that may contain the virus, in this case, preventing the drained dialysate from splashing. Pouring chlorine-containing solution at the same time as the spent dialysate would raise the risk of splash. Saving the drainage bags to take to the clinic would markedly increase risk of spill and require too many clinic visits. The patient would need to continue to perform the prescribed number of exchanges to maintain adequate dialysis. 

Reference: https://ispd.org/wp-content/uploads/ISPD-PD-management-in-COVID-19_ENG.pdf
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