Diagnostic capability of ultrasound in peritoneal catheter malfunction compared to videolaparoscopy

Background: The approach to peritoneal catheter malfunction consists usually in a diagnostic and therapeutic sequence of laxative prescription, abdominal radiography, brushing of the catheter, guide-wire manipulation or fluoroscopy and in the end of a videolaparoscopy (VLS) rescue intervention. Ultrasound (US) is able to find out major causes of peritoneal catheter malfunction, however without a clearly defined diagnostic value. The aim of the study was to validate the diagnostic capability of US in catheter malfunction compared to the diagnostic reference of VLS. Methods: US scans of the subcutaneous and intraperitoneal segment of the catheter were performed prior to a VLS intervention in 40 adult patients presenting persistent catheter malfunction within a prospective multicentre study. Laxative prescription and brushing of the catheter lumen were undertaken prior to US scan. US diagnosis was compared to the corresponding at VLS, kappa coefficient calculated and the causes of mismatch analysed. Results: In US, causes of persistent malfunction were catheter dislocation combined with omental wrapping in 21 cases, omental wrapping without dislocation in 11 cases, dislocation only in 4 cases, adherences to non-omental structures in 3 cases and entrapment in the lateral inguinal fossa in 1 case. The US diagnosis corresponded to the respective at VLS in 36 of 40 cases, resulting in a kappa coefficient of 0.89 (95% CI: 0.78–1.00). The discrepancies were due to improper visualization of the catheter between omentum and intestinal loops, resulting in an erroneous US diagnosis of omental wrapping. Conclusions: This study suggests that US might have a pivotal role in the diagnostic approach to peritoneal catheter dysfunction.

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P1147SEQUENTIAL ULTRASOUND BASED APPROACH IN PERITONEAL CATHETER MALFUNCTION: THE COMBINATION OF B-MODE AND DOPPLER ULTRASOUND

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1147 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Matthias Zeiler ◽

Antonio Federico ◽

PAOLO LENTINI ◽

Roberto Dell'Aquila ◽

Antonio Granata ◽

...

Keyword(s):

Guide Wire ◽

Abdominal Cavity ◽

Adult Patients ◽

Clinical Approach ◽

Peritoneal Catheter ◽

Omental Wrapping ◽

Doppler Us ◽

Functional Aspects ◽

Dialysis Solution ◽

Catheter Malfunction

Abstract Background and Aims The clinical approach to peritoneal catheter malfunction consists usually in laxative prescription, abdominal radiography, brushing of the catheter lumen, guide-wire manipulation or catheter fluoroscopy. Only specialized centers apply videolaparoscopy for catheter rescue interventions. Up to now, limited experience is present regarding the evaluation of the intraperitoneal tract of the peritoneal catheter in adult patients. The aim of the study was to evaluate the diagnostic capability of B-mode ultrasound (US) followed by colour Doppler US (Doppler US) in persistent peritoneal catheter malfunction. Method US followed by Doppler US of the intraperitoneal part of the catheter was performed prior to videolaparoscopy intervention in 40 adult patients presenting persistent peritoneal catheter malfunction despite non-invasive therapy such as laxative prescription and brushing of the catheter lumen. US and Doppler US diagnosis were compared to the corresponding at videolaparoscopy intervention, and the causes of mismatch analyzed. In all patients US was performed after filling of the abdominal cavity with peritoneal dialysis solution of at least one liter. Doppler US along the intraperitoneal segment of the catheter was performed by flushing with dialysis fluid. Results In US, causes of persistent malfunction were catheter dislocation combined with omental wrapping in 21 cases, omental wrapping without dislocation in 11 cases, dislocation only in 4 cases, adherences to non-omental structures in 3 cases and entrapment in the lateral inguinal fossa in one case. The correspondence of US and videolaparoscopy diagnosis was 90%, respectively in 36 of 40 cases. The discrepancies were due to improper visualization of the catheter caused by constipation and embedding of the catheter between intestinal loops, resulting in an erroneous US diagnosis of omental wrapping, whereas videolaparoscopy showed encasement of the catheter between intestinal loops in three cases and presence of adherences to tubal structures in one case. Doppler US clarified the functional aspects of the catheter, thus increasing the correspondence to videolaparoscopy up to 39 out of 40 cases (97.5%) Conclusion US combined with Doppler US is helpful in making a correct pre-operative diagnosis of persistent peritoneal catheter malfunction and in planning of the videolaparoscopy rescue intervention.

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Omental wrap: Radiographic diagnosis confirmed surgically – Report of two cases in Grenada

Peritoneal Dialysis International ◽

10.1177/0896860820982221 ◽

2021 ◽

pp. 089686082098222

Author(s):

Sanae Ogura ◽

Germaine Bristol ◽

Max Burchman ◽

Linwald Fleary ◽

Terron Hosten ◽

...

Keyword(s):

Surgical Correction ◽

Contrast Study ◽

Peritoneal Catheter ◽

Outflow Obstruction ◽

Omental Wrapping ◽

Catheter Obstruction ◽

Catheter Malfunction ◽

Radiographic Contrast ◽

Reliable Differentiation ◽

Prompt Diagnosis

Omental wrapping is a common cause of peritoneal catheter malfunction. This diagnosis should be confirmed by radiography before proceeding with surgical omentectomy. We report two cases of peritoneal dialysis (PD) catheter outflow obstruction from our developing PD program in Grenada, in which contrast studies accurately diagnosed omental wrap, allowing for prompt surgical correction. In both cases, the contrast study indicated the presence of omental wrapping, confirmed at time of surgical correction. Radiographic features of omental wrap are distinctive, which allows for reliable differentiation from other causes of obstruction. Radiographic contrast study reliably diagnoses the cause of peritoneal catheter obstruction, permitting prompt diagnosis and treatment. This is vital for regions with limited access to haemodialysis.

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Peritoneal Dialysis Catheter Position Evaluated by Ultrasound: Can it Replace Abdomen X-Ray in Patients Presenting Catheter Misplacement?

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0043-103953 ◽

2017 ◽

Vol 38 (05) ◽

pp. 538-543

Author(s):

Matthias Zeiler ◽

Luca Zanoli ◽

Rosalia Scarfia ◽

Stefano Santarelli ◽

Antonio Granata

Keyword(s):

Peritoneal Dialysis ◽

Negative Predictive Value ◽

Predictive Value ◽

Kappa Coefficient ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Peritoneal Catheter ◽

Catheter Position ◽

X Ray ◽

Catheter Malfunction

Abstract Background Malfunction of the peritoneal dialysis catheter is frequently caused by dislocation. The diagnostic approach is classically based on abdomen X-ray together with detailed case history and physical examination. Despite being rarely applied in clinical practice to evaluate catheter misplacement, ultrasound is a noninvasive, radiation-free technique that is potentially useful also to explore reasons for catheter malfunction. Consequently, we aimed to evaluate the diagnostic accuracy of ultrasound to identify peritoneal catheter misplacement. Methods In a multicenter observational blinded study, we compared ultrasound to abdomen X-ray for catheter localization in 93 consecutive peritoneal dialysis patients with dialysate outflow problems enrolled in two nephrology and dialysis units. The position of the catheter was annotated on a standard scheme of nine abdominopelvic regions. The sensitivity, specificity, positive and negative predictive value and Kappa coefficient were calculated. Results Dislocation out of the inferior abdominopelvic regions was present in 19 patients (20 %) at X-ray and 23 patients (25 %) at ultrasound. Correct determination of the position of the catheter in the lower abdomen by ultrasound had a sensitivity of 93 % (95 % CI 84 – 97 %), specificity of 95 % (95 % CI 72 – 100 %), positive predictive value of 99 % (95 % CI 91 – 100 %), negative predictive value of 78 % (95 %CI 56 – 92 %) and Kappa coefficient of 0.82 (95 % CI 0.67 – 0.96). In 10 out of 93 patients (11 %), there was a position mismatch between X-ray and ultrasound in an adjacent abdominopelvic region. Conclusion Our results suggest that abdomen X-ray for the evaluation of peritoneal catheter position can be replaced by ultrasound in experienced hands. This bedside diagnostic procedure might reduce costs, the time necessary for diagnosis and lifetime radiation exposure.

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Problem-based learning in dentistry: Diagnostic capability of dentists in the detection of calcified carotid artery atheroma on digital panoramic radiographs

Research Society and Development ◽

10.33448/rsd-v9i11.10451 ◽

2020 ◽

Vol 9 (11) ◽

pp. e70991110451

Author(s):

Beatriz Caio Felipe ◽

Fernanda Chiguti Yamashita ◽

Amanda Lury Yamashita ◽

Ana Carolina Caio Passoni ◽

Breno Gabriel da Silva ◽

...

Keyword(s):

Carotid Artery ◽

Problem Based Learning ◽

Kappa Coefficient ◽

Operational Characteristic ◽

Panoramic Radiographs ◽

Kappa Test ◽

Experienced Radiologist ◽

Diagnostic Capability ◽

Before And After ◽

Systemic Health

Objective: The aim of this study was to evaluate the diagnostic capability of dentists in the identification of suggestive images of calcified carotid artery atheroma (CCAA) on panoramic radiographs (PRs) before and after using a problem-based learning method (PBL). Methodology: Five dentists (no specialists in oral and maxillofacial radiology) analyzed 102 digital PRs divided into: PRs with suggestive images of CCAA (n=51) and without suggestive images of CCAA (n=51). After the first analysis, the examiners attended an activity on soft tissue calcifications using the PBL method. Afterwards, they analyzed the 102 PRs again. The results of the analysis were calculated using the Cohen's Kappa Test and the Receptor Operational Characteristic Curves (ROC). Results and Discussion: Regarding examiners’ performance before and after the activity, the intra-examiner test showed reasonable Kappa coefficients (0-0.40). For inter-examiner agreement after the activity, the Kappa coefficient was almost perfect (> 0.80). When comparing examiners’ performance after the activity with a template performed by an experienced radiologist, the Kappa Coefficient was > 0.80 with significant agreement (p<0.05). Conclusion: The precision and the probability of correctly detecting suggestive images of CCAA on PRs increased when the examiners participated in the active pedagogical method. The continuing education of the dentist and how it can make a difference in the systemic health of patients should be considered.

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The Efficacy of ACH in Mitigating Serial Position Effects and Confirmation Bias in an Intelligence Analysis Scenario1

Cognitive Bias in Intelligence Analysis ◽

10.3366/edinburgh/9781474466349.003.0004 ◽

2020 ◽

pp. 107-144

Author(s):

Martha Whitesmith

Keyword(s):

Serial Position ◽

Cognitive Biases ◽

Confirmation Bias ◽

Scoring Systems ◽

Diagnostic Value ◽

Intelligence Community ◽

Intelligence Analysis ◽

Position Effects ◽

Serial Position Effects ◽

The Us

Chapter three provides details of an experimental study conducted in 2016 to provide an evaluation of the efficacy of ACH in mitigating the cognitive biases of serial position effects and confirmation bias using the scoring systems of credibility of information and diagnostic value of information. The study is based on a disguised version of the intelligence case for both the biological and nuclear weapons capabilities of Saddam Hussein’s regime that was used to support the US decision to invade Iraq in 2003. The study shows that the version of ACH taught by the PHIA to the UK’s intelligence community between 2016-2017 has no statistically significant mitigating effect on the occurrence of serial position effects or confirmation bias.

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Laparoscopic treatment strategies for peritoneal catheter malfunction by ovarian fimbriae

Saudi Journal of Laparoscopy ◽

10.4103/2542-4629.193037 ◽

2016 ◽

Vol 1 (1) ◽

pp. 3

Author(s):

Zeiler Matthias ◽

Santarelli Stefano

Keyword(s):

Treatment Strategies ◽

Laparoscopic Treatment ◽

Peritoneal Catheter ◽

Catheter Malfunction

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The Value of Peritoneoscintigraphy in the Investigation of Ultrafiltration Loss during Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089301302s17 ◽

1993 ◽

Vol 13 (2_suppl) ◽

pp. 70-74

Author(s):

Bozena Pietrzak ◽

Elzbieta Panasiuk ◽

Janusz Przedlacki ◽

Zofia Wankowicz

Keyword(s):

Peritoneal Dialysis ◽

Normal Control ◽

Peritoneal Catheter ◽

Peritoneal Equilibration Test ◽

Catheter Malfunction ◽

And Function

Perltoneoscintlgraphy (PSG) was performed In 18 patients with ultrafiltration (UF) loss during peritoneal dialysis (PD). In 9 patients PSG was abnormal after peritonitis (PT), and transfer to hemodialysis (HD) was necessary. In three cases peritoneal catheter malfunction was suspected, and PSG provided Information about the catheter's position and function. In two cases loss of UF was connected with extraperitonealleakage of the dialy818 solution (which was confirmed by PSG). In cases of UF 10.. and normal control, the peritoneal equilibration test (PET) was used, and Its result was abnormal for glucose D/Do (too high). PSG was useful for diagnosing the reasons for UF loss during PD.

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P1347A DYNAMIC ULTRASOUND-IMAGING-BASED GUIDED TECHNIQUE TO TUNNELED DIALYSIS CATHETER BY MICROBUBBLES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1347 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Erica Melo ◽

Marcelo Silveira ◽

Sérgio Souza ◽

Ana Baptista ◽

Filipe Miranda ◽

...

Keyword(s):

Ultrasound Imaging ◽

Guide Wire ◽

Accurate Method ◽

Primary Patency ◽

Hemodialysis Catheter ◽

Catheter Malfunction ◽

Dynamic Ultrasound ◽

The Right ◽

Stage Renal Disease ◽

End Stage

Abstract Background and Aims In patients with end-stage renal disease (ESRD), the use of cuffed, tunneled dialysis catheters (TDCs) for hemodialysis has become integral to treatment plans. Fluoroscopy is a widely accepted method for the insertion and positioning of cuffed dialysis catheters, because it is easy to use, accurate and reliable, and has a relatively low incidence of complications. The purpose of our study was to evaluate the feasibility of tunneled hemodialysis catheter placement without the use of fluoroscopy but with a dynamic ultrasound-imaging-based guided technique. Method From January 2015 to December 2017, we performed an observational prospective cohort study of 56 patients with ERDS who required TDC placement. Results The overall success rate for ultrasound-guided central access was 100%, with a mean number of 1.16 (± 0.4) attempts per patient. There were no incidences of guide wire coiling/kinking, carotid puncture, pneumothorax, or catheter malfunction. Catheter flow during dialysis was 286 (± 38) ml/min. The total number of catheter days was 7,451, with a mean of 133 days and a range of 46 to 322 days. Life table analysis revealed primary patency rates of 100%, 96%, and 53% at 30, 60, and 120 days, respectively. Conclusion Dynamic ultrasound-based visualization of microbubbles in the right atrium is a highly accurate method to detect percutaneous implantation of large-lumen, tunneled, central venous catheters without the need for fluoroscopic guidance technology.

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