Common cause of PD catheter obstruction and how addressed?

• A. Flushing with saline alone.
• B. Obstruction due to kinked catheter.
• C. Obstruction from omental wrapping or fibrin clots; addressed with flushing (often with heparin), investigation, and possibly surgical revision.
• D. Obstruction due to low dialysate flow in the cycler.

Answer: (C)

The issue being tested is that the most frequent cause of PD catheter obstruction is material around the catheter tip—often the omentum wrapping the catheter or fibrin clots forming there. This type of blockage directly prevents dialysate from flowing in or out. The best management combines restoring patency and identifying the cause: flushing with heparinized saline to help dissolve clots and prevent new ones, plus careful assessment (sometimes with imaging) to determine if the tip is encased by omentum or if there’s another mechanical problem. If these measures don’t relieve the obstruction, surgical revision—such as omentopexy or repositioning of the catheter—may be required to restore function. Flushing with saline alone is unlikely to fix clots or omental wrapping, so it isn’t enough by itself. Kinking is another possible issue but not the most common cause, and low dialysate flow in the cycler points more to flow settings than to a true catheter obstruction.