scholarly journals TUNNELED LAPAROSCOPIC PERITONEAL DIALYSIS CATHETER AS A RESOURCE TECHNIQUE IN PERITONEAL DIALYSIS

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
T Díaz Vico ◽  
J L Rodicio Miravalles ◽  
A Suárez Sánchez ◽  
M García Munar ◽  
B Carrasco Aguilera ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Simple Technique ◽  
Rescue Therapy ◽  
Main Step ◽  
Peritoneal Dialysis Catheter ◽  
Safe Procedure ◽  
Suitable Candidate ◽  
Bacterial Peritonitis ◽  
Encapsulating Peritonitis ◽  
Selection Of

Abstract INTRODUCTION Surgical approach to peritoneal dialysis (PD) catheters is the main step in achieving successful PD therapy. It is important to conduct a simple and safe procedure, with adequate visualization of the path and location of the catheter, to avoid discontinuation of PD. The tunneled laparoscopic PD catheter (TLPDC) is a reliable surgical alternative in patients who are candidates for PD. MATERIAL AND METHODS This is a retrospective and descriptive study that includes all the patients in whom TLPDC was placed from October 2019 to January 2021. The objective is to know the rate of functioning and evaluate the complications derived from the procedure. RESULTS TLPDC was placed in 7 patients with a mean age of 51.4 (7.7) years and a mean BMI of 26.6 (8.0) kg/m2. Rescue therapy was considered in 6 (85.7%) patients, after removal of a previous PD catheter. There was no case (0.0%) of displacement, being the adequate functioning rate of 85.7%. One (14.3%) case of bacterial peritonitis was diagnosed, resolved with conservative management, and early TLPDC dysfunction in another (14.3%) case, requiring laparoscopic revision on the eleventh postoperative day and its repositioning, with current suspicion of encapsulating peritonitis. CONCLUSIONS The TLPDC approach is a safe and simple technique, avoiding displacement of the catheter and, thus, a higher success rate. However, as a counterpoint, it requires general anesthesia to be performed. Furthermore, an adequate selection of a suitable candidate for PD is necessary to ensure the success of the procedure.

Repair of Chronic Peritoneal Dialysis Catheter

1998 ◽  
Vol 18 (4) ◽  
pp. 419-423 ◽  
Author(s):  
Kumari Usha ◽  
Leonor Ponferrada ◽  
Barbara F. Prowant ◽  
Zbylut J. Twardowski
Keyword(s):  
Peritoneal Dialysis ◽  
Prophylactic Antibiotic ◽  
Patch Repair ◽  
Peritoneal Dialysis Catheter ◽  
Safe Procedure ◽  
Dialysis Catheter ◽  
Exit Site ◽  
Accidental Injury ◽  
Extension Tube ◽  
Catheter Replacement

Background Damage to the peritoneal dialysis catheter may be due to wear from long-term use, exposure to antibacterial agents (strong oxidants), and accidental injury from sharp objects. Repair of such catheter, if not associated with subsequent complications, would extend catheter life and reduce costs and patient inconvenience related to catheter replacement. Objective and Design Retrospective analysis of seven peritoneal catheters repaired 11 times over a 15-year period by splicing the old catheter with an extension tube using the Peri-Patch Repair Kit (Quinton Instrument Co., Bothwell, WA, U.S.A.). Results The life of these seven catheters was extended by a mean of 26 months (range 1 -87 months), without increasing infection rates after splicing. The peritonitis rate after catheter splicing was 0.40 per year, not higher than the overall rate (0.76 per year) in our center during the same time period. Exit-site infections occurred in 6 patients after catheter splicing. Only one infection was related to trauma during the procedure and resulted in chronic exit infection; the catheter was eventually removed. In this patient, damage to the catheter was less than 1.5 cm from the exit site. Conclusions and Recommendations Splicing of the damaged peritoneal catheter, if properly done, is a safe procedure and can significantly prolong catheter life. We recommend that measures to prevent catheter damage, such as avoiding the use of scissors and other sharp objects, should be emphasized during the initial patient education and training. Alcohol and iodine should not be used on silicone rubber catheters. We suggest that the patient should report catheter damage immediately and come to the clinic within a few hours for catheter splicing (if possible) and prophylactic antibiotic to prevent peritonitis. Finally, we recommend that repair of the catheter should not be attempted if the breakage is less than 2 cm from the exit site, unless done as an emergency procedure if immediate catheter replacement cannot be performed.

A Randomized Trial Comparing Conventional Swan-Neck Straight-Tip Catheters to Straight-Tip Catheters with An Artificial Subcutaneous Swan Neck

2009 ◽  
Vol 29 (3) ◽  
pp. 278-284 ◽  
Author(s):  
Chiu-Leong Li ◽  
Tai-Gen Cui ◽  
Hong-Bing Gan ◽  
Kin Cheung ◽  
Weng-In Lio ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Controlled Trial ◽  
Good Alternative ◽  
Peritoneal Dialysis Catheter ◽  
Safe Procedure ◽  
Exit Site ◽  
Exit Site Infection ◽  
Tenckhoff Catheter ◽  
Post Surgery ◽  
The Difference

Objective To evaluate the safety and efficacy of inserting a straight-tip Tenckhoff catheter configured with a subcutaneous artificial swan neck. Design Clinical outcomes of conventional swan-neck straight-tip catheters and Tenckhoff straight-tip catheters implanted with an artificial subcutaneous swan neck were compared in a prospective randomized controlled trial in a single-center setting. Patients and Methods Patients undergoing peritoneal dialysis catheter insertion were randomized to receive either a double-cuff straight-tip Tenckhoff catheter with an artificial subcutaneous swan-neck (TC) or a conventional double-cuff straight-tip swan-neck catheter (SN). The primary outcome was catheter exit-site infection rate; the secondary outcomes were catheter-related mechanical events and surgery-related bleeding. Results A total of 39 consecutive patients were enrolled: 20 into the TC group and 19 into the SN group. More exit-site infections were observed in the SN group than in the TC group, although the difference was not statistically significant (0.97 vs 0.51 episodes per patient-year, p = 0.0657). However, there were more peritonitis episodes in the TC group than in the SN group (0.35 vs 0.15 episodes per patient-year, p = 0.0256). Exit-site and main wound bleeding post surgery were generally mild and similar in the 2 groups. No events of dialysate leakage, catheter tip migration, or subcutaneous cuff protrusion were observed in patients of either group. Outflow failure due to mechanical causes occurred in 2 patients in the TC group and in 1 patient in the SN group during the intermittent peritoneal dialysis period; all were corrected successfully by laparoscopic omentectomy. Conclusions Placement of the double-cuff straight-tip Tenckhoff catheter configured with an artificial subcutaneous swan neck appears to be an effective and safe procedure. It may be a good alternative to the conventional swan-neck catheter.

An unusual case of peritoneal dialysis-associated bacterial peritonitis caused by Weeksella virosa

2019 ◽  
pp. 1-3
Author(s):  
Tugce Unalan ◽  
Alper Karagoz ◽  
Cihangul Bayhan ◽  
Yasemin Ozsurekci ◽  
Gulsen Hazirolan
Keyword(s):  
Peritoneal Dialysis ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Empirical Therapy ◽  
Antimicrobial Susceptibility Testing ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
First Report ◽  
Bacterial Peritonitis ◽  
Fluid Culture

Weeksella virosa is an atypical Gram-negative bacterium that does not grow on MacConkey agar. In this report, we present a 4-year-old female patient with Addison’s disease and end-stage renal failure secondary to focal sclerosing glomerulosclerosis. Continuous ambulatory peritoneal dialysis had been performed, and 3 months later, the patient developed fever, diarrhea, and vomiting. Peritoneal fluid culture and dialysis fluid culture were positive for W. virosa. It was identified with Phoenix (BD, USA) and confirmed via 16S rRNA sequencing. It cannot be identified by Maldi Biotyper (Bruker). The isolate was found to be resistant to cephalosporins, ciprofloxacin, and amikacin by gradient test. Intraperitoneal cefepime was initiated but since antimicrobial susceptibility testing revealed cephalosporin resistance, therapy was changed to intraperitoneal meropenem. Following the removal of peritoneal dialysis catheter, fever, abdominal distention, and vomiting were resolved. Piperacillin, aztreonam, and carbapenems can be used for empirical therapy. Antimicrobial susceptibility testing should be performed to guide the choice of treatment. Removal of peritoneal dialysis catheter is an important step of management of this infection. To our knowledge, this is the first report of W. virosa in a pediatric patient and first report from Turkey.

Peritoneovaginal Fistula-unusual Complication of Peritoneal Dialysis

1983 ◽  
Vol 3 (3) ◽  
pp. 142-143 ◽  
Author(s):  
Jose A. Diaz-Buxo ◽  
Patrick Burgess ◽  
Phillip J. Walker
Keyword(s):  
Peritoneal Dialysis ◽  
Young Female ◽  
Unusual Complication ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Bacterial Peritonitis ◽  
Catheter Design ◽  
Continuous Peritoneal Dialysis

The formation of a peritoneovaginal fistula was observed in a young female who had undergone continuous peritoneal dialysis for 17 months. The patient had experienced an episode of acute bacterial peritonitis two months prior to the manifestation of the fistula and showed evidence of progressive malnutrition. This case serves to illustrate the role of peritonitis and malnutrition in the development of transvisceral erosions by indwelling peritoneal catheters and emphasizes the need for modification of the traditional peritoneal dialysis catheter design.

Intraperitoneal Hyaluronan Production in Stable Continuous Ambulatory Peritoneal Dialysis Patients

1999 ◽  
Vol 19 (2) ◽  
pp. 131-137 ◽  
Author(s):  
Kunihiro Yamagata ◽  
Chie Tomida ◽  
Akio Koyama
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Morphological Changes ◽  
Stable States ◽  
Creatinine Concentration ◽  
Permeable Membrane ◽  
Bacterial Peritonitis ◽  
Marker Proteins ◽  
Ultrafiltration Failure ◽  
Encapsulating Peritonitis

Objective Several cytokines and proteins are excreted intraperitoneally during the course of peritonitis and stable states in continuous ambulatory peritoneal dialysis (CAPD) patients. Dialysate hyaluronan (HYA) is also regarded as a marker of peritoneal healing during bacterial peritonitis. We examined here, intraperitoneal HYA production in stable CAPD patients and compared the results to those of the peritoneal equilibration test (PET), the length of time on dialysis, and other marker proteins. Design We determined the concentration of HYA and other marker proteins in the 4-hour-dwell dialysate at 1-year intervals. Setting CAPD unit in Hitachi General Hospital. Patients The subjects were 46 stable CAPD patients who underwent 104 PETs. Results A correlation was found between the length of time on dialysis and the amount of HYA excretion in the 4-hr-dwell dialysate ( r = 0.403, p < 0.001). A positive but weak correlation was found between the dialysate-to-plasma ratio of the creatinine concentration and dialysate HYA excretion ( r = 0.229, p < 0.05). Seven patients were over the 90th percentile in both the concentration of HYA (>349.2 ng/mL) and the amount of HYA (>743.6 μg/4-hr dwell). Five patients exceeded 1000 μg of HYA excretion in the 4-hr-dwell dialysate, 4 of whom showed an abrupt increase of HYA excretion to more than 1000 μg/4-hr dwell, and discontinued CAPD within 6 months due to ultrafiltration failure. Two of these 4 patients were diagnosed with sclerosing encapsulating peritonitis at autopsy. Conclusion Intraperitoneal HYA production increased with both higher permeable membrane and the length of time on CAPD. Monitoring of HYA in the peritoneal dialysate may be useful as a marker to assess functional and morphological changes in the peritoneum in long-term CAPD patients.

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