A case of damage to a peritoneal dialysis tubing by a pet cockatoo and review of the literature

Naganuma et al. Renal Replacement Therapy https://doi.org/10.1186/s41100-018-0190-7 (2018) 4:47 CASE REPORT Open Access A case of damage to a peritoneal dialysis tubing by a pet cockatoo and review of the literature Toshihide Naganuma*, Yoshiaki Takemoto, Junji Uchida and Tatsuya Nakatani Abstract Background: Peritoneal dialysis (PD) access is important for patients undergoing PD. However, one of the potential complications of peritoneal dialysis access is damage to the dialysis tubing. Although most dialysis tubing damage is due to human error, there have been reports of damages attributed to pets owned by the patients. Much of the damage caused by pets has been attributable to cat biting or scratching, whereas the present case is an extremely rare case of dialysis tubing damage caused by a pet cockatoo. Case presentation: A 65-year-old male with end-stage renal disease due to diabetic nephropathy who had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for 6 years was admitted to our hospital with the chief complaint of dialysis tubing damage. While the patient was playing with his pet cockatoo on his belly after taking it out of its cage, the bird bit into his dialysis tubing of his transfer set without him realizing it, thus damaging the tube. The patient noticed that his dialysis tubing was leaking and realized that it had been damaged. He folded the end of the damaged tube, secured it with a rubber band to prevent further leakage, and made an emergency visit to our hospital. Upon inspection, we found that the dialysis tubing was completely disconnected, 28 cm from the metal connector of the connection tube. After consultation, the damaged tube was replaced. As a preventive measure for peritonitis, antibiotics were administered orally for 1 week (oral levofloxacin, 250 mg every 48 h). The patient was instructed to be careful when handling his cockatoo, and his CAPD treatment has been continued without incident to date. Conclusion: This is a rare case report of PD tubing damage caused by a cockatoo kept at home. It may be necessary to pay sufficient attention to PD equipment damage by birds in PD patients keeping large birds, such as cockatoos. Keywords: Peritoneal dialysis, Dialysis tubing, Damage, Pet, Bird, Cockatoo Background Peritoneal dialysis (PD) access is important for patients undergoing PD, just as vascular access is important for hemodialysis patients. However, one of the potential complications of peritoneal dialysis access is damage to the PD equipment including dialysis tubing. Although most dialysis tubing damage is due to human error, there have been reports of damages attributed to pets owned by the patients [1–18]. Damage to the dialysis tubing is usually discovered by dialysate leakage, but dialysis tubing damage has also been revealed after examining the * Correspondence: Department of Urology, Osaka City University Medical School, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan cause of peritonitis. As such, while many of the damages brought about by pets have been attributable to cat biting [1–10, 13, 14, 16–18], our present case was an extremely rare case of dialysis tubing damage caused by a pet cockatoo. Case presentation A 65-year-old male with end-stage renal disease due to diabetic nephropathy who had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for 6 years was admitted to our hospital with the chief complaint of dialysis tubing damage. One Sunday night, while exchanging the dialysate, the patient took his pet cockatoo out of the cage and let it play on his belly, but the bird bit and cut the dialysis tubing without this being noticed by © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Naganuma et al. Renal Replacement Therapy (2018) 4:47 Page 2 of 5 Fig. 1 Cut peritoneal dialysis tubing (entire view) the patient. He became aware of an abnormality when he noticed leakage of dialysate and then found that the tube was cut. He folded the end of the damaged tube, secured it with a rubber band to prevent further leakage, and visited the emergency room of our hospital about 30 min after the damage occurred. Upon inspection, we found that the tube was completely disconnected, 28 cm from the metal connector of the connection tube (Figs. 1 and 2). At that time, his blood pressure was 130/80 mmHg, heart rate 72/min with regular rhythm, and temperature 36.8 °C. He was lucid, and his abdomen was soft and flat and had no Fig. 2 Cut surface of the tubing tenderness. Laboratory findings revealed a white blood cell count of 4700/μL, hemoglobin of 8.9 g/dl, a platelet count of 168 × 103/μl, and a C-reactive protein level of 0.21 mg/dL. After consultation, the damaged tube was replaced. Since the patient was treated at the nighttime emergency room, a blood cell count in the dialysate and a culture of the dialysate and damaged catheter were not performed. As a preventive measure for peritonitis, antibiotics were administered orally for 1 week (oral levofloxacin, 250 mg every 48 h). The patient was advised to revisit the hospital if he had fever or abdominal pain before his regular Naganuma et al. Renal Replacement Therapy (2018) 4:47 Page 3 of 5 Table 1 Reports of damage to PD equipment caused by animals Case References Year reported Age (y)/ sex PD type Animal exposure State of damage of PD equipment Peritonitis Culture results 1 1987 55/F CCPD Cat Dialysis tubing punctured + Pasteurella multocida Paul et al. [1] 2 London et al. [2] 1991 54/M CCPD Cat Dialysis tubing punctured + Pasteurella multocida 3 Makin et al. [3] 1991 39/M CAPD Cat Dialysis tubing punctured + Neisseria pharyngis 4 Makin et al. [3] 1991 58/F CAPD Cat Dialysis tubing punctured – Staphylococcus hominis 5 Makin et al. [3] 1991 73/M CAPD Cat Dialysis tubing punctured – Sterile 6 Makin et al. [3] 1991 24/F CAPD Cat Dialysis tubing punctured – Sterile 7 Kitching et al. [4] 1996 75/M CAPD Cat Dialysis tubing punctured + Pasteurella multocida 8 Uribarri et al. [5] 1996 42/F CCPD Cat Dialysis tubing punctured + Pasteurella multocida 9 Loghman et al. [6] 1997 12/F CCPD Cat Dialysis tubing punctured + Pasteurella multocida 10 Joh et al. [7] 1998 55/M CCPD Cat Dialysis tubing punctured + Pasteurella multocida 11 Chadha et al. [8] 1999 18/M CCPD Cat Dialysis tubing punctured + Capn (...truncated)