Six-Year Experience with CAPD Catheters in Children

1985 ◽  
Vol 5 (2) ◽  
pp. 119-122 ◽  
Author(s):  
Alan R. Watson ◽  
Annette Vigneux ◽  
Brian E. Hardy ◽  
J. Williamson Balfe
Keyword(s):  
Pleural Cavity ◽  
Pediatric Population ◽  
Recent Experience ◽  
General Anesthetic ◽  
Exit Site ◽  
Catheter Survival ◽  
Catheter Obstruction ◽  
Anesthetic Complications ◽  
Catheter Function

Over a six-year period, 78 chronic peritoneal catheters were implanted in 55 patients; mean age at insertion was 9.6 years (range 0.2 to 19.1 years) and mean body weight was 28.3 kg (range 4.5 to 63 kg). Singlecuff catheters were used almost exclusively and were inserted in the midline under general anesthetic. Complications included leakage (26%) and one-way catheter obstruction (17%). Exit site and/or tunnel infections developed in 25% and hernias in 20% of 55 patients. Twenty-six catheters required replacement or removal. Actuarial catheter survival was 50% at two years. A retrospective analysis of exit-site infections suggested a significant benefit with “covered” as opposed to “uncovered” catheters (p < 0.01). Despite difficulties with catheter function only one patient was taken off CAPD because of a leak into the pleural cavity. Recent experience suggests that paramedian catheter placement and the use of catheters of an appropriate length for children will reduce the incidence of leakage and one-way obstruction. The complications associated with implantation and the long-term use of chronic peritoneal catheters have produced several modifications of the original Tenckhoff catheter (1–4). However, it remains to be established whether single or double cuff catheters result in fewer exit site, tunnel, or peritoneal complications (5). When our program started in 1978, we used double-cuff catheters but subsequently have implanted single-cuff catheters almost exclusively. Our initial experience with exit-site and tunnel infections was encouraging: only one out of 37 catheters had to be replaced because of tunnel infection (6). This paper describes our additional experience and the complications encountered with increasing duration of catheter use in our pediatric population.

scholarly journals Selective Infracolic Omentecomy and Fixation Reduces Complications after Laparoscopic Assisted Peritoneal Dialysis Catheter Placement

2018 ◽  
Vol I (1) ◽  
pp. 06-11
Author(s):  
Andries Ryckx
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Placement ◽  
P Value ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Catheter Obstruction ◽  
Infracolic Omentectomy

Introduction Peritoneal dialysis (PD) as a treatment for patients with end-stage renal disease (ESRD) provides a competitive alternative to hemodialysis (HD). Long-term catheter survival remains challenging and techniques are not standardized. Advanced laparoscopic placement with fixation and omentectomy might increase catheter survival. The goal of our study was to evaluate if selective infracolic omentectomy and fixation reduced complications after CAPD catheter placement. Materials and Methods A prospective database of patients with CAPD catheter placement from March 2004 to March 2015 was analyzed. All procedures were performed laparoscopically assisted and under general anesthesia by a single surgeon. 78 patients were included, there were no exclusion criteria. Statistical analysis was performed with SPSS. Fisher exact test and log-rank test with calculation of P-value was executed. P-value of <0.05 was considered significant. Results Of the 78 patients who underwent catheter placement, 53 (68%) were males and 25 (32%) were females. The mean age was 54 (ranged from 13 to 88 years). Selective infracolic omentectomy was performed in 32 patients if the momentum reached beyond the promontory. Non-resorbable sutures to fix the catheter were applied in 33 patients. The average duration of peritoneal dialysis was 21 months (range from ten days to 84 months). Omentectomy significantly reduced the incidence of catheter obstruction (3 vs. 11%, P=0.028) but not of catheter dislocation (19 vs. 30%, P=0.101). Omentectomy did not significantly increase the incidence of peritonitis (22 vs. 31%,P=0.133) or exit-site infection (16vs 17%, P=0.238). Catheter fixation with non-resorbable sutures reduced catheter dislocation (21 vs. 23%, P=0.226) and catheter obstruction( 12 vs.17%,P=0.223) with a significant reduction of peritonitis (15 vs. 29%, P=0.044) and no effect on exit-site infection (15 vs. 17%,P=0.251). Conclusion Laparoscopic PD catheter placement with selective omentectomy and fixation of the catheter to the abdominal wall is safe and feasible and leads to fewer complications. Key words: peritoneal, dialysis, catheter, complications, laparoscopy, omentectomy.

scholarly journals Advanced Laparoscopic Peritoneal Dialysis Catheter Insertion: Systematic Review and Meta-Analysis

2018 ◽  
Vol 38 (3) ◽  
pp. 163-171 ◽  
Author(s):  
Badri M. Shrestha ◽  
Donna Shrestha ◽  
Avneesh Kumar ◽  
Alice Shrestha ◽  
Simon A. Boyes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peritoneal Dialysis ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Infectious Complications ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Catheter Survival ◽  
Catheter Obstruction ◽  
Advanced Laparoscopy

BackgroundThe optimal methodology of establishing access for peritoneal dialysis (PD) remains controversial. Previously published randomized controlled trials and cohort studies do not demonstrate an advantage for 1 technique over another. Four published meta-analyses comparing outcomes of laparoscopic versus open PD catheter (PDC) insertion have given inconsistent conclusions and are flawed since they group basic and advanced laparoscopy together. The aim of this systematic review and meta-analysis is to examine whether advanced laparoscopic interventions consisting of rectus sheath tunneling and adjunctive procedures produce a better outcome than open insertion or basic laparoscopy used only to verify the catheter position.MethodsA literature search using Medline, Embase, and Cochrane Database was performed, and meta-analysis was performed using RevMan 5.3.5 software (Nordic Cochrane Centre, The Cochrane Collaboration, London, UK). Outcomes evaluated incidence of catheter obstruction, migration, pericannular leak, hernia, infectious complications (peritonitis and exit-site infection) and catheter survival.ResultsOf the 467 records identified, 7 cohort studies, including 1,045 patients, were included in the meta-analysis. When advanced laparoscopy was compared with open insertion, a significant reduction was observed in the incidence of catheter obstruction (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.03 – 0.63; p = 0.01), catheter migration (OR 0.12, 95% CI 0.06 – 0.26; p = 0.00001), pericannular leak (OR 0.27, 95% CI 0.11 – 0.64; p = 0.003), and pericannular and incisional hernias (OR 0.29, 95% CI 0.09 – 0.94; p = 0.04), as well as better 1- and 2-year catheter survival (OR 0.52, 95% CI 0.28 – 0.97; p = 0.04 and OR 0.50, 95% CI 0.28 – 0.92; p = 0.03, respectively). Compared with basic laparoscopy, catheter obstruction and migration were significantly lower in the advanced laparoscopic group, whereas catheter survival was similar in both groups. All outcomes, except catheter obstruction, were similar between the basic laparoscopy and open insertion. The infectious complications such as peritonitis and exit-site infections were similar between the 3 groups.ConclusionsAdvanced laparoscopy was associated with a significant superior outcome in comparison with open insertion and basic laparoscopy.

Venous catheter at alternate exit site in a 2-year-old requiring long-term antibiotics for osteomyelitis: A case report

2020 ◽  
pp. 112972982095475
Author(s):  
Matthew D Ostroff ◽  
David Goldberg ◽  
Greg Bauhman ◽  
and Cheri Korb
Keyword(s):  
Case Report ◽  
Vascular Access ◽  
Jugular Vein ◽  
Traditional Approach ◽  
Pediatric Population ◽  
Central Venous Access ◽  
Venous Catheter ◽  
Exit Site ◽  
Catheter Dislodgement

In the pediatric population, vascular access is often challenging to secure and to maintain, especially for long-term intravenous (IV) treatment. The traditional approach for patients who require long-term IV antibiotics is placement of a peripherally inserted central catheter (PICC). The challenge in the pediatric population is the high risk of dislodgement after PICC placement, as these patients tend to pull their line out accidentally or purposefully. Current bedside options to prevent catheter dislodgement include adhesive securement devices, subcutaneous securement devices, sutures, and wrapping the site in gauze. However, these modalities often fail, leading to delay in administration of IV therapies, including life-saving antibiotics. A novel approach to this very common and serious issue is to tunnel the catheter subcutaneously, thereby placing the exit site in a location difficult for the patient to reach. Tunneled catheters generally are placed in children for long-term vascular access and insertion has primarily been reserved for surgeons in the operating room or by interventional radiologists. The following case report describes a central venous access catheter placed in the internal jugular vein and tunneled to the medial dorsal thoracic region successfully at the bedside, using intracavitary electrocardiogram (ECG) navigation under moderate sedation. Although a novel exit site, the technique of tunneling and use of the jugular vein is no different than traditional tunneling techniques therefore it was not deemed necessary to seek internal review board approval.

ENDOSCOPIC TREATMENT OF CHRONIC PANCREATITIS IN PEDIATRIC POPULATION: LONG-TERM EFFICACY AND SAFETY

2019 ◽  
Author(s):  
D Kohoutova ◽  
A Tringali ◽  
G Paparella ◽  
V Perri ◽  
I Boškoski ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Endoscopic Treatment ◽  
Pediatric Population ◽  
Efficacy And Safety ◽  
Term Efficacy

Skull base aneurysmal bone cyst presenting with hydrocephalus: progressive residuum obliterated by Gamma Knife stereotactic radiosurgery in a pediatric patient

2020 ◽  
Vol 26 (1) ◽  
pp. 76-81
Author(s):  
George H. Tse ◽  
Feng Y. Jiang ◽  
Matthias W. R. Radatz ◽  
Saurabh Sinha ◽  
Hesham Zaki
Keyword(s):  
Skull Base ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Pediatric Population ◽  
Bone Cyst ◽  
Disease Free Survival ◽  
Long Term Follow Up ◽  
Aneurysmal Bone Cysts ◽  
Gamma Knife Stereotactic Radiosurgery

Aneurysmal bone cysts (ABCs) are an uncommon entity predominantly encountered in the pediatric population. The skull is rarely involved, but these cysts have been reported to arise in the skull base. Traditional treatment has been with surgery alone; however, there is a gathering body of literature that reports alternative treatments that can achieve long-term disease-free survival. However, these therapies are predominantly directed at peripheral skeletal lesions. To the authors’ knowledge, this report is the first to describe long-term follow-up of the efficacy of Gamma Knife stereotactic radiosurgery for treatment of ABC residuum in the skull base that resulted in long-term patient stability and likely ABC obliteration.

scholarly journals Arrow-Shot Injury to Pediatric Spinal Cord

2021 ◽  
Author(s):  
Vijayveer Singh ◽  
Sharad Thanvi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Pediatric Population ◽  
Cervical Region ◽  
Cervical Cord ◽  
Cord Injury ◽  
Dural Suturing ◽  
Stab Injuries ◽  
Early Surgical Intervention

AbstractPenetrating spinal cord injuries (PSCI) in cervical region are extremely rare in pediatric population. Most injuries in pediatric population are accidental due to gunshot or a stab injury with a sharp or pointed object. Gun shots may result into a severe wound which is usually fatal and may result in death, quadriplegia, or serious long-term disability. Stab injuries are less severe and may result in neurological sequalae. In this paper, an unusual case of pediatric arrow shot partial cervical cord injury is reported which was managed by aggressive neurosurgical management. The arrow lodged in the cervical cord was very near to the vertebral artery leading to parapariesis which recovered well without any complications. Diagnostic imaging at admission included radiographs, computed tomography (CT), and CT angiography of the cervical region. The patient underwent early surgical intervention with removal of foreign body from the cord and subsequent dural suturing.

Pierwotna małopłytkowość immunologiczna u dzieci

2018 ◽  
Vol 22 (4) ◽  
Author(s):  
Anna Dusza ◽  
Michał Matysiak
Keyword(s):  
Immune Thrombocytopenia ◽  
Clinical Symptoms ◽  
Pediatric Population ◽  
Current Data ◽  
Current Investigation ◽  
Surgical Interventions ◽  
Hematological Disorders ◽  
Primary Immune Thrombocytopenia

In this article we present current investigation on primary immune thrombocytopenia in children. There are described pathomorphology, clinical symptoms, diagnosis and treatment. We also present current data from literature about genetic tests and latest data on treating options in children. Primary immune thrombocytopenia (ITP) is one of the most frequent hematological disorders in pediatric population. Although the majority of children have a self-limited and short duration of the disease. However, approximately 20-30% of those patients can develop chronic ITP, which can cause significant complications and higher mortality and reduced quality of life. Especially regarding to long-term immunosupression or surgical interventions, such like splenectomy and restrictions on daily activities to avoid trauma. Over the past decades a lot of informations has been reported about pathogenic features of ITP. Nowdays, we know that it is not only caused by increased platet destruction and decreased platet production, but also complex, multifactorial immune dysregulation, like loss of immune tolerance and generation of platelet autoantibodies. In this article we present current investigation on ITP including clinical symptoms, diagnosis, pathomorphology and latests options on treatment in children. We also present current data about genetic biomarker, such as Vanin-1 (VNN-1) which has been suggested as one of predictors of chronic disease and potentially can offer early prognosis estimation.

Specificity and Sensitivity of Hemosiderin-Laden Macrophages in Routine Bronchoalveolar Lavage in Children

2006 ◽  
Vol 130 (11) ◽  
pp. 1684-1686 ◽  
Author(s):  
Zeynep N. Salih ◽  
Afreen Akhter ◽  
Javeed Akhter
Keyword(s):  
Bronchoalveolar Lavage ◽  
Sensitivity And Specificity ◽  
Pediatric Population ◽  
Strong Association ◽  
Clinical Findings ◽  
Clinical Syndrome ◽  
Pulmonary Hemosiderosis ◽  
Specificity And Sensitivity ◽  
Long Term Prognosis

Abstract Context.—The presence of iron or hemosiderin in macrophages obtained in routine bronchoalveolar lavage is considered crucial in the diagnosis of the clinical syndrome of hemosiderosis. However, there do not appear to be any data on the sensitivity and specificity of the finding of hemosiderin-laden macrophages (HLMs) in bronchoalveolar lavage in children. Objective.—To review data from bronchoalveolar lavage studies done in children to correlate the presence of HLMs with pneumonia and hemosiderosis and to determine what proportion of HLMs has the optimal sensitivity and specificity for the diagnosis of hemosiderosis. Design.—One hundred ten bronchoalveolar lavage specimens obtained via flexible bronchoscopy were reviewed retrospectively. The data collected for demographics, indication for the bronchoscopy, diagnosis of pneumonia, anemia, and bronchoscopy and bronchoalveolar lavage findings were compared between patients diagnosed with hemosiderosis and those diagnosed with other diseases. Results.—Six patients were diagnosed with hemosiderosis by clinical findings, lung biopsy, or autopsy. There were no statistical differences in pneumonia (P &gt; .99), anemia (P &gt; .99), or coughing (P = .08) between patients with hemosiderosis and other patients. Hemoptysis was the only symptom that was significantly different between the 2 groups (P = .04). The mean HLM index for patients with hemosiderosis was 56% ± 16.17% and for other patients, 7.5% ± 10.74% (P &lt; .001). A HLM index of 35% gave a sensitivity of 1% and a specificity of .96%. Conclusions.—These results confirm a strong association between HLM index and diagnosis of hemosiderosis in a pediatric population. Availability of this HLM index will result in accurate and timely diagnosis of pulmonary hemosiderosis, which may influence treatment and long-term prognosis.

Peripheral Aneurysms in Children—A Link to Trauma

PEDIATRICS ◽  
1988 ◽  
Vol 82 (5) ◽  
pp. 786-788
Author(s):  
CHARLES E. BAGWELL ◽  
H. HOLLIS CAFFEE ◽  
JAMES L. TALBERT
Keyword(s):  
Soft Tissue ◽  
Axillary Artery ◽  
Pediatric Population ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Recent Experience ◽  
Common Component ◽  
History Of ◽  
Soft Tissue Masses ◽  
Axillary Mass

Evaluation of soft tissue masses is a common component of pediatric practice and usually includes adenopathy v soft tissue neoplasia in the differential diagnosis. Recent experience with a young child referred for an enlarging axillary mass, which was found to be an aneurysm of the axillary artery, illustrates the natural history ofthis uncommon lesion and its frequent association with trauma in the pediatric population. CASE REPORT A 45/12-year-old boy had a 3-month history of an enlarging right axillary mass. Although the child remained asymptomatic, gradual enlargement of the mass was described. The parents could recall no history of injury to the affected extremity (including arterial puncture for blood gas analysis) but, when questioned further, did describe transient discomfort several months previously when an adolescent sibling had grabbed him suddenly by the upper arm while running alongside and lifted him from the ground when he tripped and fell.

The Efficacy of Silver-Ion Implanted Catheters in Reducing Peritoneal Dialysis-Related Infections

2003 ◽  
Vol 23 (4) ◽  
pp. 368-374 ◽  
Author(s):  
John H. Crabtree ◽  
Raoul J. Burchette ◽  
Rukhsana A. Siddiqi ◽  
Isan T. Huen ◽  
Linda L Hadnott ◽  
...  
Keyword(s):  
Ion Beam ◽  
Controlled Trial ◽  
Silver Ion ◽  
Control Group ◽  
Site Infection ◽  
Control Groups ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
And Control

♦ Background Dialysis-related infections are the commonest cause of catheter loss and transfer to hemodialysis. Surface modifications of the catheter that reduce infections are of major importance. ♦ Objective The efficacy of silver-ion treated catheters in reducing dialysis-related infections was tested. ♦ Methods The study design was a prospective, randomized controlled trial. Patients were implanted with either a silver-treated study catheter or a control catheter. Prospective collection of data included infectious complications and catheter survival. ♦ Results The subject groups were comprised of 67 silver-treated catheters and 72 control catheters. Demographic characteristics of the study and control groups were equal. Exit-site infection rates for the study group and control group (0.52 and 0.45 episodes/patient-year of dialysis respectively) were not different by Poisson regression analysis ( p > 0.4). Peritonitis rates were identical for the two groups (0.37 episodes/patient-year) and were not different by Poisson analysis ( p > 0.9). Antibiotic-free intervals between infections for the study and control groups were not significantly different for exit-site infections ( p = 0.58), peritonitis ( p = 0.44), or both infections combined ( p = 0.47). Actuarial analyses showed no differences between the groups in the probability of remaining free of exit-site infection ( p> 0.2) or peritonitis ( p > 0.7). Similarly, catheter survival was not significantly different between the groups ( p > 0.6). ♦ Conclusion Surface modification of catheters with ion beam implantation of silver produced no clinical effect with respect to reducing dialysis-related infections.

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