Medtronic Plc. · NYSE:MDT
Medtronic — Technical Presentation (June 2020)
24 slides from Medtronic's technical presentation, June 2020
Slide 1: Pre-Insertion Planning, Patient Selection, and Catheter Selection
PRE-INSERTION PLANNING, PATIENT SELECTION, AND CATHETER SELECTION PERITONEAL DIALYSIS TRAINING PROGRAM
Slide 2: Outline
OUTLINE ▪ Patient pathway to PD ▪ Patient selection ▪ Pre-op instructions ▪ Catheter and exit site placement ▪ Catheter selection The content of this program was developed for Medtronic to be distributed to customers for training purposes only. 2 Do not further copy or distribute.
Slide 3: Patient Pathway
PATIENT PATHWAY1 1. Identify all PD candidates 2. Assess patient for PD eligibility 3. Offer PD if eligible and obtain patient preference for PD vs HD 4. Attempt/insert PD catheter 5. Start PD therapy 1 Blake, et al. 2013. The content of this program was developed for Medtronic to be distributed to
Slide 4: Identify PD Patients
IDENTIFY PD PATIENTS1 ▪ Keep the mindset of, “PD First” ▪ Consider your potential patient population ▪ All ESRD patients (and transfers from other centers) ▪ All patients receiving outpatient dialysis ▪ All patients with >30 consecutive days of dialysis dependence (including AKI) ▪ All patients with
Slide 5: Assess for PD Eligibility
ASSESS FOR PD ELIGIBILITY1 MOST FREQUENT MOST FREQUENT CONTRAINDICATIONS TO PD BARRIERS TO PD ▪ Place of residence does not ▪ Physical barriers permit PD ▪ Insufficient strength ▪ Insufficient dexterity ▪ Prior major abdominal surgery ▪ Poor vision ▪ Untreated large abdominal ▪ Poor hearing hernias
Slide 6: Assess for PD Eligibility: Decision-Making Tools: MATCH-D
ASSESS FOR PD ELIGIBILITY DECISION-MAKING TOOLS: MATCH-D™* MATCH – D™* ▪ Method to Assess Treatment Choices for Home Dialysis ▪ Designed to assist clinicians in identifying potential barriers and candidates for home dialysis ▪ Provides separate criteria for PD and home hemodialysis ▪ Color coded: ▪
Slide 7: Assess for PD Eligibility: Decision-Making Tools: MATCH-D
ASSESS FOR PD ELIGIBILITY DECISION-MAKING TOOLS: MATCH-D™* Find the MATCH-D™* at www.homedialysis.org/match-d The content of this program was developed for Medtronic to be distributed to customers for training purposes only. 7 Do not further copy or distribute.
Slide 8: Assess for PD Eligibility: Decision Making Tools (Continued)
ASSESS FOR PD ELIGIBILITY DECISION MAKING TOOLS (CONTINUED) Available at www.homedialysis.org.au The content of this program was developed for Medtronic to be distributed to customers for training purposes only. 8 Do not further copy or distribute.
Slide 9: Assess for PD Eligibility: Decision Making Tools (Continued)
ASSESS FOR PD ELIGIBILITY DECISION MAKING TOOLS (CONTINUED) Available at https://www.kidneyresearchuk.org/DialysisDecisionAid The content of this program was developed for Medtronic to be distributed to customers for training purposes only. 9 Do not further copy or distribute.
Slide 10: Offer PD to Eligible Patients
OFFER PD TO ELIGIBLE PATIENTS ▪ Offer the choice as part of an educational process1 ▪ Multidisciplinary team approach ▪ One-on-one sessions ▪ Peer education ▪ Written materials ▪ Videos ▪ Websites ▪ Typically about 50% of patients should select PD1 ▪ Education can significantly impact the percentage
Slide 11: Pre-Insertion of PD Catheter
PRE-INSERTION OF PD CATHETER ▪ Optimal timing of insertion is at least 2 weeks prior to the expected use of the catheter3 ▪ Confirm lifestyle considerations to comply with PD3 ▪ Full medical history4 ▪ Abdominal exam, history of prior abdominal surgeries/catheter placement, hernias, any weakness of
Slide 12: Exit Site Position
EXIT SITE POSITION6 ▪ Consider patient preference ▪ Locate to maximize self-care skills ▪ Clearly visible to patient ▪ Considers patient handedness, motor skills, and strength ▪ Above or below the belt line? ▪ Direct laterally and facing downwards ▪ Avoid moist areas or those subject to pressure (co
Slide 13: Marking the Exit Site
MARKING THE EXIT SITE6 ▪ Identify belt line with patient in supine position/dressed ▪ With the patient still in supine position, mark the catheter entry at deep cuff ▪ Ensure that catheter length takes catheter coil to symphysis pubis ▪ Exit site is now located 2-3cm from the external cuff in line w
Slide 14: Pre-Op Exam Considerations for Selection of PD Catheter Type
PRE-OP EXAM CONSIDERATIONS FOR SELECTION OF PD CATHETER TYPE5,6 ▪ Some factors may require consideration of extended catheters or pre-sternal catheters: ▪ Weight/obesity ▪ Floppy skin folds ▪ Stomas ▪ Incontinence ▪ Requirement/desire for deep tub baths ▪ Colostomies 5Amici, et al. 2013. 6Crabtree.
Slide 15: Pre-Op Work-Up
PRE-OP WORK-UP ▪ CBC, BMP, PT, PTT, Type & Screen ▪ Consider use of mechanical bowel preparation with 1 gallon of polyethylene glycol, although this is not always necessary7,8 ▪ Patient appropriateness for administration of conscious sedation9 ▪ Examples ▪ Midazolam 1-4 mg ▪ Fentanyl 50-200 mcg 7Con
Slide 16: Infection Prophylaxis and Skin Preparation
INFECTION PROPHYLAXIS AND SKIN PREPARATION ▪ Consider screening for MRSA and nasal carrier status4,5 ▪ Morning of the operation: Shower with soap or detergent4 ▪ e.g. Chlorhexidine abdominal wash ▪ Clip/shave abdominal hair (if present)4 ▪ Pre-operative antibiotic prophylaxis4 ▪ Single i.v. dose of
Slide 17: Catheter Selection: Characteristics of Available PD Catheter Configurations
CATHETER SELECTION CHARACTERISTICS OF AVAILABLE PD CATHETER CONFIGURATIONS10 ▪ Shape of intraperitoneal segment ▪ Straight ▪ Coiled ▪ Number of cuffs ▪ Single cuff ▪ Double cuff ▪ Subcutaneous configuration ▪ Straight (Tenckoff) ▪ Prefabricated bend (Swan Neck) 10Hagen, et al. 2014. The content of t
Slide 18: Catheter Selection: Systematic Data Review of Catheter Type
CATHETER SELECTION CHARACTERISTICS OF AVAILABLE PD CATHETER CONFIGURATIONS10 Systematic Data Review of Catheter Type Intraperitoneal Segment ▪ Exit site infection Straight vs. Coiled ▪ Peritonitis ▪ Migration, leakage, removal No significant difference ▪ Wound/tunnel infection, drainage dysfunction,
Slide 19: Catheter Configuration Plays Only a Small Role in PD Outcomes
CATHETER SELECTION CHARACTERISTICS OF AVAILABLE PD CATHETER CONFIGURATIONS10 In summary, according to current evidence, catheter selection based on characteristics of catheter configurations plays only a small role in PD outcomes. 10Hagen, et al. 2014. The content of this program was developed for M
Slide 20: If Catheter Selection Does Not Impact Patient Outcomes, Then What Does?
IF CATHETER SELECTION DOES NOT IMPACT PATIENT OUTCOMES, THEN WHAT DOES?11 ▪ Choose the catheter that is a proper “fit” for the patient. ▪ Allows for pelvic location of the distal catheter ▪ Provides an appropriate exit location that is accessible for the patient and away from belt lines, skin crease
Slide 21: University of Wisconsin Hospitals and Clinics Center Experience in Selecting PD Patients
UNIVERSITY OF WISCONSIN (UW) HOSPITALS AND CLINICS CENTER EXPERIENCE IN SELECTING PD PATIENTS ▪ Multidisciplinary team ▪ Due to the expense of home set-up, training, and staff commitment, the team at UW assume patients will be dialyzing for at least 6 months ▪ Home visit will occur after initial pre
Slide 22: The UW Experience: Criteria for Acceptance for PD
THE UW EXPERIENCE CRITERIA FOR ACCEPTANCE FOR PD ▪ Pre-authorization of insurance coverage ▪ Clean home environment ▪ Running water, indoor plumbing, phone service and electricity ▪ Storage for 30-40 boxes of fluid and supplies ▪ Able and willing to come for monthly f/u visits ▪ Able and willing to
Slide 23: The UW Experience: Pre-Op Instruction for Percutaneous Insertion
THE UW EXPERIENCE PRE-OP INSTRUCTION FOR PERCUTANEOUS INSERTION OF PD CATHETER 1. Hold anticoagulants and anti-platelet medications for 5 days prior to procedure 2. Nothing to eat or drink after midnight prior to procedure 3. May take AM pills with minimal water 4. Bowel prep evening before procedur
Slide 24: References
REFERENCES 1. Blake PG, Quinn RR, Oliver MJ. Peritoneal dialysis and the process of modality selection. Perit Dial Int. 2013 May-Jun;33(3):233-41. 2. Mehrota, R., Marsh, D., Vonesh, V, Peters, V. & Nissenson, A. (2005). Patient education and access of ESRD patients to renal replacement therapies bey