Peritoneoscopic Placement of Swan Neck Peritoneal Dialysis Catheters

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 330-332 ◽  
Author(s):  
J. Brian Copley ◽  
Jill S. Lindberg ◽  
Sandra N. Back ◽  
Nina P. Tapia
Keyword(s):  
Peritoneal Dialysis ◽  
Direct Result ◽  
Morbidly Obese ◽  
Surgical Removal ◽  
Diabetic Patients ◽  
Peritoneal Dialysis Catheter ◽  
Catheter Survival ◽  
Catheter Migration ◽  
Table Analysis ◽  
Catheter Implantation

Peritoneoscopic placement of peritoneal dialysis catheters, although accomplished in only about 10% of dialysis centers, is a nonsurgical technique that fulfills requirements for safety and dependability. Over a 40-month period, 136 catheters were placed with the peritoneoscope, 135 of which were double-cuffed, Swan neck curled catheters, with a uniform radiopaque stripe. Patients were followed longitudinally for outcome. Catheters were placed in 44 diabetic patients, 1 human immunodeficiency virus (HIV)-positive patient, and 18 morbidly obese patients. No complications occurred as a direct result of placement. Catheters were used, on average, nine days after placement (many on days 1 to 4) usually with 1.5 to 2 L exchanges. With 1183 patient-months’ experience, complications were few: 28 patients experienced catheter-related infections, and there were five leaks that resolved with supine, low-volume dialysis for several days. Leakage did not correlate with time of usage after placement. Of ten outflow/mechanical problems that required catheter removal, nine involved catheter migration, probably due to lack of attention during placement to orientation of the radiopaque stripe. One was due to a preperitoneal placement early in this institution's experience with the peritoneoscope. Five of the migrated catheters were removed and then successfully replaced with the peritoneoscope at the same sitting. Four patients requested surgical removal and replacement. Sixteen catheters were removed because of catheter-related infections: five refractory Staphylococcus aureus, six Pseudomonas aeruginosa, two fungal, two Serratia species, and one Mycobacterium chelonei. Actuarial life table analysis showed that at the end of the 40-month follow-up, 62% of the catheters were expected to survive. Because more than 50% survived, median catheter survival could not be calculated. The adverse responses were removal because of infection or catheter migration. Peritoneal dialysis catheter implantation with the peritoneoscope represents a safe and dependable method for catheter placement. Literature review and comparison indicate that catheter-related complications are fewer and catheter longevity is better with peritoneoscopic placement than with surgical placement. Our experience with prompt postplacement utilization suggests the need for further evaluation of catheter break-in procedure with the peritoneoscope.

scholarly journals Intraperitoneal extension of the peritoneal dialysis catheter—a new technique for catheter implantation in patients with obesity

2021 ◽  
Author(s):  
Michael Sayer ◽  
Christian Thiel ◽  
Martin Schenk ◽  
Alfred Königsrainer ◽  
Nils Heyne ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Circumference ◽  
Peritoneal Dialysis Catheter ◽  
Optimal Position ◽  
Catheter Survival ◽  
Surgical Access ◽  
Catheter Implantation ◽  
A New Technique ◽  
End Stage ◽  
Upper Abdomen

Abstract Background In patients with obesity and end-stage kidney disease, implantation of the peritoneal dialysis (PD) catheter may be complicated by increased abdominal circumference or skin folds. Relocation of the implantation site to the upper abdomen could solve this problem. However, this would require an extended catheter. Methods We developed an extended PD catheter based on a swan neck Missouri PD catheter with the help of two adaptors and a straight intraperitoneal extension segment. The extended catheter was assembled intraoperatively, and its length was adjusted individually to ensure correct positioning. After the operation, PD was commenced and handled as usual. Results In the period from 2011 to 2021, we implanted 31 extended PD catheters in 29 patients (38% men) with end-stage renal failure and obesity. Median age was 53 (range 28–77) years and body mass index was 35.5 (range 26.4–46.9) kg/m2. The postoperative course was unremarkable except for seroma formation in one patient and dialysate leakage in another. Continuous ambulatory peritoneal dialysis (CAPD) was initiated in 20 and APD in 9 patients. The achieved median Kt/V was 2.10 (range 1.50–3.10). During the follow-up period lasting up to 51 months, there was one case of intraperitoneal catheter disconnection due to an avoidable handling error. The peritonitis rate was 1:40 months. The 1- and 2-year catheter survival was 92% and 67%, respectively, and paralleled patient survival. Conclusions When using a PD catheter with an intraperitoneal extension, PD catheter implantation can be relocated to the upper abdomen in patients with obesity, thus providing optimal position and easy surgical access.

scholarly journals Preperitoneal Tunneling – a Novel Technique in Peritoneal Dialysis Catheter Insertion

2014 ◽  
Vol 34 (4) ◽  
pp. 443-446 ◽  
Author(s):  
Mohammad-Hadi Saeed Modaghegh ◽  
Gholamhossein Kazemzadeh ◽  
Yaser Rajabnejad ◽  
Fatemeh Nazemian
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Transplantation ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Safe Method ◽  
Catheter Survival ◽  
Catheter Migration ◽  
Novel Technique ◽  
Omental Wrapping

IntroductionThis study describes a new preperitoneal tunneling (PPT) method for inserting a peritoneal dialysis catheter (PDC), thereby lessening surgical complications and increasing the catheter's survival.MethodsThis new technique was used in 23 cases from December 2005 to January 2007 and followed up until March 2011 (63 months). The procedure was performed laparoscopically under local (16 cases) or general (7 cases) anesthesia by one surgeon. Catheter survival is reported by Kaplan-Meyer analysis.ResultsThe catheters were mechanically obstructed in 2/23 cases (8.7%); and were withdrawn due to a peritonitis in 2 cases and inadequacy of peritoneal dialysis in 1 case. Ten patients received kidney transplantation and six died before completing this follow-up period. The patients still reaped the benefits of the PDC until receiving a kidney transplant or death. The 5-year survival rate of the catheter was 89%. No incidence of catheter migration, omental wrapping, herniation or leakage was noticed.ConclusionPreperitoneal tunneling is a simple and safe method for insertion of PDC, and can effectively prevent catheter migration, dislocation and omental wrapping.

The Curled Catheter: Dependable Device for Percutaneous Peritoneal Access

1990 ◽  
Vol 10 (3) ◽  
pp. 231-235 ◽  
Author(s):  
Richard Swartz ◽  
Joseph Messana ◽  
Leslie Rocher ◽  
Janice Reynolds ◽  
Barbara Starmann ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Infectious Complications ◽  
Peritoneal Dialysis Catheter ◽  
Catheter Migration ◽  
Table Analysis ◽  
Combined Infection ◽  
One Year ◽  
Comparable Size

The curled peritoneal dialysis catheter is theoretically less prone to catheter migration and drainage failure. It also allows percutaneous placement, rather than surgical placement exclusively, whenever desired or necessary. Review of 213 curled-catheter placements, 134 (63%) percutaneous and 79 (37%) surgical, over the last 4 years, shows that the probability of continuing catheter function by life-table analysis was 88% at one year, 71% at 2 years, and 61% at three years, with no difference comparing percutaneous to surgical placement. Among the 213 total cases, nearly 50% of all catheters were still functioning at last follow up, and 38 catheters (17.8%) have been lost in total, attributed to infectious complications in 24 cases (tunnel-exit infection alone in 5, peritonitis alone in 11, combined infection in 8), refractory drain failure in 9 cases (early drain failure in 4, late drain failure in 5), recurrent late subcutaneous dialysate leaking in 3 cases, and peri-catheter hernia in 2 cases. Among other complications, the incidence of early drain failure (7.0%), and late drain failure (4.2%), compare favorably to reports describing other devices or other placement methods having comparable size of reported experience. Analyzing our own percutaneous and surgical placements separately, there were no differences in the respective frequencies of early drain failure, late drain failure, late subcutaneous dialysate leaking, outer cuff extrusion, required hernia repair, peritonitis or tunnel-exit infection. Only early external dialysate leaking was more frequent using percutaneous placement methods (21.6% vs. 10.1%; p < 0.05), although no catheters were lost due to early external leaking. In conclusion, the present experience suggests that the curled catheter is both amenable to safe and convenient percutaneous placement methods in the majority of cases, as well as dependable for long-term peritoneal dialysis in a large university program.

scholarly journals Efficiency and safety of using a peritoneal dialysis catheter weighted with a stainless steel ballast : the Limousin experience

2019 ◽  
Vol 2 (4) ◽  
pp. 193-200
Author(s):  
Bénédicte Larivière-Durgueil ◽  
Rémi Boudet ◽  
Marie Essig ◽  
Stéphane Bouvier ◽  
Ali Abdeh ◽  
...  
Keyword(s):  
Stainless Steel ◽  
Peritoneal Dialysis ◽  
Infectious Complications ◽  
Control Group ◽  
Peritoneal Dialysis Catheter ◽  
Causal Factors ◽  
Catheter Migration ◽  
Mechanical Complications ◽  
Increased Risk ◽  
One Year

Objective: To assess the recurrence of PD catheter migration after the introduction of a walnut ballast. Materials and Methods: Retrospective study from 1999 to 2014 of PD patients followed in Limousin. Were compared two groups: ballast group (patients who benefited from the establishment of stainless steel ballast at the intraperitoneal catheter extremity) with 26 patients and control group with 204 patients. The primary endpoint was the occurrence of an episode catheter’s migration after ballast’s establishment. Secondary objectives were (i) to determine the causal factors leading to the catheter weighting, (ii) to ensure the safety of the procedure on the following criteria: infectious complications, mechanicals complications, epurations criteria, and catheter’s survival. Results: More than one year after the implementation of the ballast, no recurrent migration was observed in 86.6% of cases. It wasn’t found an increased risk of infections (OR = 0.5, 95% CI [0.22, 1.13]) or mechanical complications (OR = 1.77- 95% CI [0.77, 4.05]) between the two groups. The adequation criteria were similar: KT / V total : 2.37 in the control group and 2.28 in the ballast group (p = 0.63). The survival of the ballast catheter was comparable among the two groups (p = 0.983). Three causal factors that led to the ballast were identified: automated peritoneal dialysis (APD) (OR = 0.38, 95% CI [0.16, 0.9]), the failure from the first use of the catheter (OR = 19.48, CI 95 % [7.67, 49.48]) and the incarceration of the omentum (OR = 15.84, 95% CI [5.81, 43.21]). Conclusion: The ballast used in these study appears to prevent recurrence of migration, without any impact in terms of infectious or mechanical complications, or on the dialysis criteria or on catheter’s survival. However this catheter does currently not have an EC authorization

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.

Peritoneal Catheter Survival and Complications in end Stage Renal Disease

1985 ◽  
Vol 5 (4) ◽  
pp. 229-233 ◽  
Author(s):  
Martin H. Bierman ◽  
Jan Kasperbauer ◽  
Anthony Kusek ◽  
Michael D. Hammeke ◽  
Robert J. Fitzgibbons ◽  
...  
Keyword(s):  
End Stage Renal Disease ◽  
Diabetic Patients ◽  
Life Table Analysis ◽  
Peritoneal Catheter ◽  
Catheter Survival ◽  
Sex Type ◽  
Table Analysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Catheter Replacement

Peritoneal catheter survival and complications were determined retrospectively over an eight-year period. Two hundred and twenty-two peritoneal catheters were placed in 124 patients; the 107 failures, which required catheter replacement, were due to dislodgment (38), one-way obstruction (31), peritonitis (28), leakage (7), and tunnel infection (3). Forty per cent of all catheter failures occurred within the first week due mainly to dislodgment and obstruction. Females had significantly more leakage-related catheter failures. Diabetic patients had fewer total catheter failures and fewer failures due to peritonitis. Over a 24-month period no difference was seen in the number or types of failures between straight and curled Tenckhoff catheters. By life-table analysis cumulative per cent catheter survival was 45% at 52 weeks; this was not affected by sex, type of catheter, or use of radiography during placement. In patients with multiple peritoneal catheter placements, subsequent catheters did not have a lower survival.

A Retrospective Sequential Comparison of Topical Application of Medicated Honey and Povidone Iodine for Preventing Peritoneal Dialysis Catheter-Related Infections

2018 ◽  
Vol 38 (4) ◽  
pp. 302-305
Author(s):  
Tayler F.L. Wishart ◽  
Laraine Aw ◽  
Karen Byth ◽  
Gopala Rangan ◽  
Kamal Sud
Keyword(s):  
Peritoneal Dialysis ◽  
Cumulative Incidence ◽  
Povidone Iodine ◽  
Incidence Rates ◽  
Diabetic Patients ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Increased Risk ◽  
Multicentre Cohort Study ◽  
Nasal Mupirocin

Application of medicated honey (MH) to peritoneal dialysis (PD) catheter exit sites has been found to be as effective as intra-nasal mupirocin for preventing PD catheter-related infections (CRIs), but was associated with increased risk for CRIs in diabetics. The efficacy of topical MH as a prophylactic agent has not been compared with the exit-site application of povidone iodine (PI). This retrospective multicentre cohort study compared cumulative incidence rates of PD CRIs (peritonitis or exit-site infections) and the number of PD CRIs observed per patient over the study period with PD exit-site application of MH or PI, in both diabetic and non-diabetic patients. Outcomes were compared in incident patients in 2 eras: January 2011 – December 2012, when 147 received exit-site care with PI (PI group), and July 2013 – June 2015, when 171 patients applied MH (MH group). Patients were followed until technique failure, death, transplant, or end of study treatment era. Cumulative incidence of PD CRIs was higher in the PI group (hazard ratio [HR] = 1.7, 95% confidence interval [CI] 1.1 – 2.6, p = 0.019) and the benefit of MH was not modified by diabetic status (present/absent, interaction p = 0.723). A similar trend was observed in the cumulative incidence of peritonitis (HR = 1.6, 95% CI 0.99 – 2.6, p = 0.059). After adjusting for months of exposure, the rate ratio for PD CRIs was 1.58 for PI compared to MH (95% CI, 1.03 – 2.42, p = 0.035). We conclude that exit-site application of MH is more effective than PI in preventing PD CRIs, and this effect is not modified by the presence or absence of diabetes.

Fluoroscopically Guided Peritoneal Dialysis Catheter Placement: Long-Term Results from a Single Center

2008 ◽  
Vol 28 (2) ◽  
pp. 163-169 ◽  
Author(s):  
Ju-Young Moon ◽  
Sebin Song ◽  
Kyung-Hwan Jung ◽  
Mina Park ◽  
Sang-Ho Lee ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Removal ◽  
Long Term Results ◽  
Significant Prognostic Factor ◽  
Peritoneal Dialysis Catheter ◽  
Early Complications ◽  
Catheter Survival ◽  
Minimal Invasiveness ◽  
Relative Safety

Objective Despite percutaneous fluoroscopy ensuring appropriate placement of peritoneal dialysis (PD) catheters, the efficacy of this method is not well known. Therefore, we evaluated our long-term experience with fluoroscopy-assisted placement of PD catheters. Patients and Methods We retrospectively reviewed 134 PD catheters in 114 PD patients that were treated in the PD center of a university-based hospital. We evaluated complications related to PD catheters, causes for catheter removal, and catheter survival. We used the multivariate Cox proportional hazard model to identify independent factors related to PD catheter survival. Results Early complications related to insertion included 1 case of pericatheter bleeding; there were no placement failures. Early complications occurred in 8.5% of patients. Most late complications were migration and leakage, which occurred in 10.4% and 9.7% of patients respectively. The most common cause for catheter removal was intractable and recurrent peritonitis. The 12- and 24-month survival rates of the catheters were 80.0% and 74.9%. The most significant prognostic factor of percutaneous fluoroscopy-assisted PD catheter survival was late leakage ( p < 0.01). Conclusions In addition to the advantages of simplicity, minimal invasiveness, and relative safety, the survival rate of PD catheters placed using the percutaneous fluoroscopy-assisted method was comparable to that of more invasive methods. Percutaneous fluoroscopy-assisted placement of PD catheters should be considered when available, and may be preferred to other placement methods.

scholarly journals The Choice of Peritoneal Dialysis Catheter Implantation Technique by Nephrologists

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
T. Yip ◽  
S. L. Lui ◽  
W. K. Lo
Keyword(s):  
Peritoneal Dialysis ◽  
Implantation Technique ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Catheter Design ◽  
Critical Issues ◽  
Catheter Implantation ◽  
Pros And Cons ◽  
Mini Laparotomy

Peritoneal dialysis catheter (PDC) is the lifeline of peritoneal dialysis (PD) patients. One of the critical issues for successful PD is a well-functioning PDC which is timely inserted. It is the implantation technique rather than the catheter design that determines the outcome of the catheter. Dedication in acquiring the appropriate technique is vital to the success of a PD program. In this paper, we discuss the pros and cons of various techniques used for PDC implantation. A detailed description of PDC implantation by using the minilaparotomy method is presented. We strongly recommend mini-laparotomy as the method of choice for PDC implantation by nephrologists.

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