Survival and Complications of 225 Catheters Used in Continuous Ambulatory Peritoneal Dialysis: One-Center Experience in Northern Greece

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 167-171 ◽  
Author(s):  
Elias V. Balaskas ◽  
Dimitrios Ikonomopoulos ◽  
Athanasios Sioulis ◽  
Nicholas Dombros ◽  
Efstratios Kassimatis ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Survival Rates ◽  
High Survival ◽  
Exit Site ◽  
Northern Greece ◽  
Actuarial Survival ◽  
Table Analysis ◽  
Paramedian Incision ◽  
Stage Renal Disease ◽  
End Stage

This study reports our experience with permanent peritoneal catheters. From July 1983 until December 1997, 225 catheters were implanted surgically in 207 patients (120 males, 87 females) with mean age of 58 ± 16 years (range: 2 -82 years), and a mean duration of continuous peritoneal dialysis (CAPD) of 21.9 ± 21.3 months (range: 1 145 months). Two hundred and seventeen catheters were used in 199 patients suffering from end-stage renal disease (ESRD), and 8 catheters in 8 patients with end-stage heart failure resistant to medical therapy. One patient used 3 catheters and 16 patients used 2 catheters. The catheters used were: Tenckhoff, 2; Oreopoulos Zellerman-1 (OZ-1), 10; OZ-2, 205; and OZ-pediatric, 8. All catheters were implanted by the same surgical team, through a paramedian incision under local anesthesia. By life table analysis, the actuarial survival rates at 1 year, 2 years, 3 years, and 5 years were 97%, 92%, 87%, and 82% respectively for all catheters. The catheter-related complications were: 5 obstructions, 2 dislodgments, 13 dialysate leaks (6 early; 7 late), 90 exit-site/tunnel infections (in 56 patients), 2 cuff extrusions, and 37 hernias (in 31 patients). Eighteen catheters were replaced for persistent peritonitis (15 cases), dislodgment (1 case), obstruction (1 case), and accidental shortening (1 case). The total observation period was 4526 patient-months. The overall incidence of peritonitis was one episode per 15 patient-months, and of exit-site/tunnel infections was one episode per 50 patient-months, with a significant improvement during the last years. We conclude that OZ catheters implanted surgically through a paramedian incision have a very high survival rate and a low complication rate.

scholarly journals A Modified Method in Laparoscopic Peritoneal Catheter Implantation: The Combination of Preperitoneal Tunneling and Pelvic Fixation

ISRN Surgery ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Mehmet Emin Gunes ◽  
Gungor Uzum ◽  
Oguz Koc ◽  
Yiğit Duzkoylu ◽  
Meltem Kucukyilmaz ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Survival Rates ◽  
Peritoneal Catheter ◽  
Catheter Survival ◽  
Pelvic Fixation ◽  
Duration Of Hospital Stay ◽  
Catheter Implantation ◽  
Stage Renal Disease ◽  
End Stage

Introduction. Continuous ambulatory peritoneal dialysis (CAPD) is widely accepted for the management of end-stage renal disease (ESRD). Although not as widely used as hemodialysis, CAPD has clear advantages, especially those related to patient satisfaction and simplicity. Peritoneal dialysis (PD) catheter insertion can be accomplished by several different techniques. In this study, we aimed to evaluate our results obtained with peritoneal dialysis catheter placement by combination of pelvic fixation plus preperitoneal tunneling. Material and Methods. Laparoscopic peritoneal catheter implantation by combining preperitoneal tunneling and pelvic fixation methods was performed in 82 consecutive patients with end-stage renal disease. Sex, age, primary disease etiology, complications, mean duration of surgery, mean duration of hospital stay, morbidity, mortality, and catheter survival rates and surgical technique used were assessed. Analysis of catheter survival was performed using the Kaplan-Meier method. Results. Mean follow-up period was 28.35 ± 14.5 months (range of 13–44 months). Mean operative time was 28 ± 6 minutes, and mean duration of hospital stay was 3 ± 1 days. There were no conversions from laparoscopy to other insertion methods. None of the patients developed serious complications during surgery or the postoperative period. No infections of the exit site or subcutaneous tunnel, hemorrhagic complications, abdominal wall hernias, or extrusion of the superficial catheter cuff was detected. No mortality occurred in this series of patients. Catheter survival was found to be 92% at 3 years followup. Conclusions. During one-year followup, we had seven patients of migrated catheters due to separation of pelvic fixation suture from peritoneal surface, but they were reimplanted and fixated again laparoscopically with success. Over a three-year followup period, catheter survival was found to be 92%. In the literature, similar catheter survival rates without combination of the two techniques are reported. As a conclusion, although laparoscopic placement of PD catheters avoids many perioperative and early complications, as well as increasing catheter free survival period and quality of life, our results comparing to other studies in the literature indicate that different laparoscopic placement methods are still in debate, and further studies are necessary to make a more accurate decision.

scholarly journals Comparing the Incidence of Catheter-Related Complications with Straight and Coiled Tenckhoff Catheters in Peritoneal Dialysis Patients—a Single-Center Prospective Randomized Trial

2015 ◽  
Vol 35 (4) ◽  
pp. 443-449 ◽  
Author(s):  
Chu-Jun Ouyang ◽  
Feng-Xian Huang ◽  
Qiong-Qiong Yang ◽  
Zong-Pei Jiang ◽  
Wei Chen ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Randomized Trial ◽  
Survival Rates ◽  
Prospective Randomized Trial ◽  
Primary Study ◽  
Catheter Survival ◽  
Catheter Dysfunction ◽  
Catheter Tip ◽  
Stage Renal Disease ◽  
End Stage

♦ObjectivesWe aimed to prospectively compare the incidence of catheter-related complications and catheter survival for straight (SCs) and coiled (CCs) Tenckhoff catheters in peritoneal dialysis (PD) patients.♦MethodsThis open prospective randomized trial recruited 189 PD patients with end-stage renal disease from the department of nephrology, The First Affiliated Hospital of Sun Yat-sen University from 6 November 2007 to 27 August 2008. The patients were randomized to a SC ( n = 99) or a CC ( n = 90) and were then followed for 2 years. All catheter placements were performed by two designated experienced nephrologists who used a standardized institutional placement protocol. The primary study outcomes were catheter-related complications and catheter survival at 1 and 2 years.♦ResultsWe observed no significant differences in clinical and demographic characteristics between the groups at baseline. The overall incidence of catheter dysfunction was higher in the CC group than in the SC group (17.8% vs 7.1%, p = 0.03), and most of the events occurred 4 weeks or more after the catheters were implanted. Catheter tip migration and omental wrapping were the most common causes of catheter dysfunction. Surgical catheter rescue was more common in patients with CCs than in patients with SCs (9 vs 3 patients respectively, p = 0.05). No significant differences were observed in other catheter-related complications, including dialysate leaks, hernias, and PD-related infections (peritonitis, exit-site, and tunnel infections). Catheter survival rates in the SC and CC groups were similar at 1 year (96.7% ± 1.9% vs 96.5% ± 2.0%, p = 0.98) and at 2 years (95.3% ± 2.3% vs 92.4% ± 3.6%, p = 0.76).♦ConclusionsThe incidence of PD catheter–related complications is probably higher with CCs than with SCs. The results of our study suggest that a SC is the better option to reduce subsequent catheter complications.

scholarly journals Urgent-Start Peritoneal Dialysis: The First Year of Brazilian Experience

2017 ◽  
Vol 44 (4) ◽  
pp. 283-287 ◽  
Author(s):  
Dayana Bitencourt Dias ◽  
Marcela Lara Mendes ◽  
Vanessa Burgugi Banin ◽  
Pasqual Barretti ◽  
Daniela Ponce
Keyword(s):  
Peritoneal Dialysis ◽  
Survival Rates ◽  
High Volume ◽  
Infectious Complications ◽  
Chronic Patients ◽  
Safe Alternative ◽  
Dialysis Unit ◽  
Technique Survival ◽  
Stage Renal Disease ◽  
End Stage

Background: This study aimed to evaluate mechanical and infectious complications associated with urgent-start peritoneal dialysis (PD) and patients and technique survival in the first 180 days. Methods: It was a prospective study that evaluated chronic patients who started unplanned PD using high-volume PD (HVPD) right after (<72 h) PD catheter placement. After hospital discharge, patients were treated with intermittent PD on alternate days in a dialysis unit until family training was provided. Results: Fifty-one patients fulfilling the following criteria were included: age was 62.1 ± 15 years, with diabetes as the main etiology of end-stage renal disease (39%), and uremia as the main dialysis indication (76%). Metabolic and fluid controls were achieved after 3 sessions of HVPD, and patients remained in intermittent PD for 23.2 ± 7.2 days. Mechanical complications occurred in 25.7% and peritonitis rate was 0.5 episode/patient-year. In the first 6 months, technique and patients survival rates were 86 and 82.4% respectively. Conclusion: The PD modality was a feasible and safe alternative to hemodialysis in the urgent-start dialysis.

Development of the “Peritoneal Dialysis First” Model in Hong Kong

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 53-55 ◽  
Author(s):  
Alex Wai-Yin Yu ◽  
Ka-Foon Chau ◽  
Yiu-Wing Ho ◽  
Philip Kam-Tao Li
Keyword(s):  
Hong Kong ◽  
Peritoneal Dialysis ◽  
Survival Rates ◽  
Chronic Hemodialysis ◽  
Dialysis Unit ◽  
Number Of Patients ◽  
Maintenance Dialysis ◽  
The 1960S ◽  
Stage Renal Disease ◽  
End Stage

Maintenance dialysis is an expensive treatment modality for patients with end-stage renal-disease (ESRD). The number of patients on maintenance dialysis is rising rapidly and will reach 2.5 million globally by 2010. The predicted expenditure will be US$1 trillion. Since the 1960s, Hong Kong has faced financial restraints on the provision of dialysis. Continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis at home were found to be less expensive than in-centre chronic hemodialysis. The development of a “peritoneal dialysis first” (PD-First) policy has contributed significantly to a successful dialysis program in Hong Kong since 1960. Currently in Hong Kong, 80% of ESRD patients on maintenance dialysis are on PD, mainly CAPD; 20% are on hemodialysis. The success of the PD-First policy is a combination of accumulated experience of PD in each dialysis unit that has at least 200 CAPD patients under care and of impressive technique and patient survival rates for this modality. Concerted effort by government and charity organizations and commitment on the part of nephrologists and nursing staff to patient education are also important in making the PD program in Hong Kong a successful one.

scholarly journals Peritoneal Dialysis Exit Site Pyoderma Gangrenosum: A Case Report

2018 ◽  
Vol 8 (3) ◽  
pp. 239-245 ◽  
Author(s):  
Salman Anwar ◽  
Karen Holfeld ◽  
Bhanu Prasad
Keyword(s):  
Peritoneal Dialysis ◽  
Pyoderma Gangrenosum ◽  
Oral Prednisone ◽  
Diabetic Control ◽  
Exit Site ◽  
Chronic Inflammatory Condition ◽  
Hemorrhagic Ulcer ◽  
Painful Ulcer ◽  
Stage Renal Disease ◽  
End Stage

Background: Pyoderma gangrenosum (PG) is a rare, chronic inflammatory condition exhibiting mucopurulent or hemorrhagic exudates. The majority of cases are associated with inflammatory bowel disease, rheumatological diseases, and hematological malignancies. In the absence of typical serological markers and specific histopathological changes, the diagnosis is often clinical. Being rare, it is frequently misdiagnosed, which leads to a delay in instituting appropriate therapy. Case Presentation: We present a 53-year-old male of Aboriginal descent with end-stage renal disease due to diabetes who underwent insertion of a peritoneal dialysis (PD) catheter. Five weeks after PD catheter insertion, he started to notice a painful ulcer surrounded by a bed of erythema. The lesion eventually progressed to a purulent, hemorrhagic ulcer surrounded by a raised, irregular, violaceous border along the entirety of the PD catheter tunnel. There was no history of underlying systemic diseases commonly associated with PG. The catheter was removed, and an elliptical biopsy was taken, which ruled out infection, malignancy, and vasculitis. The changes were felt to be consistent with PG. The patient underwent treatment initially with topical corticosteroids, followed by oral prednisone, which unfortunately worsened his diabetic control; due to this, he was transitioned to cyclosporine, with complete resolution. Conclusions: Lesions at the PD catheter exit site are usually treated for infections. However, for ulcers that are painful, rapidly expanding, nonhealing, and unresponsive to antibiotics, PG should be considered as a differential diagnosis. This is the first reported case of PG occurring at the exit site of a PD catheter.

Prevention of Postoperative Peritoneal Dialysis Catheter-Related Infections

1988 ◽  
Vol 8 (3) ◽  
pp. 195-197 ◽  
Author(s):  
John B. Copley ◽  
Barbara J. Smith ◽  
Diana M. Koger ◽  
Darlene J. Rodgers ◽  
Marie Fowler
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Dialysis Catheter ◽  
Site Location ◽  
Exit Site ◽  
True Incidence ◽  
Medical Centers ◽  
Care Protocol ◽  
Stage Renal Disease ◽  
End Stage ◽  
Location Type

Catheter-related infections represent a significant complicaton of peritoneal dialysis therapy for end-stage renal disease, and may even supplant peritonitis as the Achilles’ heel. While the true incidence of all types of postoperative catheter-placement infections is unknown, it is reported that approximately 10% of exit-site infections occur in the immediate postoperative period, prior to healing and the establishment of barriers to microorganism invasion. Generally, little attention is given to this fact, and there exists no standardized procedure for the care of the operative wound and exit site. We evaluated a postoperative catheter-care protocol in 111 consecutive catheter placements. Ninety-seven were placed surgically and 14 with a peritoneoscope. Emphasizing strict aseptic technique, catheter immobilization, and avoidance of contamination, we observed no early and only two late postoperative infections. Our patients were from two different medical centers and we did not attempt to control for exit-site location, type of catheter, or technique and location of placement. Prophylactic antibiotics were utilized in 88%. We believe that our protocol was responsible for our low postoperative infection rate.

scholarly journals Analysis of outcome and factors correlated with maintenance peritoneal dialysis

2019 ◽  
Vol 47 (10) ◽  
pp. 4683-4690
Author(s):  
Min Li ◽  
Jin Yan ◽  
Hao Zhang ◽  
Qiongying Wu ◽  
Jianwen Wang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Survival Rates ◽  
Cerebrovascular Diseases ◽  
Older Age ◽  
Survival Times ◽  
Technique Survival ◽  
Female Sex ◽  
Stage Renal Disease ◽  
End Stage ◽  
To Receive

Objectives This study aimed to analyze the outcome and factors correlated with maintenance peritoneal dialysis (PD) to provide guidance for improving prognosis, and prolonging the catheterization and survival times of patients on PD with end-stage renal disease. Methods Clinical data of patients at The Third Xiangya Hospital of Central South University were retrospectively analyzed. We compared the survival and technique survival rates of patients, and analyzed relevant factors. Results A total of 510 cases of PD were included. Two hundred thirty-nine patients continued to receive PD treatment, 73 received kidney transplants, 72 transferred to hemodialysis, and 126 died. The main reasons of death were cardiovascular (27.00%) and cerebrovascular diseases (23.80%). The main reasons of transfer to HD were peritonitis and inadequate dialysis. The survival rates at 1, 2, 3, 5, and 7 years were 95.75%, 90.34%, 82.35%, 66.21%, and 54.32%, respectively. The technique survival rates at 1, 2, 3, 5, and 7 years were 93.22%, 86.76%, 77.91%, 63.16%, and 47.67%, respectively. Female sex and older age were protective factors that affected patients’ withdrawal from PD and survival time. Conclusions Death is the primary reason for withdrawal from PD. Female sex and older age affect patients’ withdrawal from PD and survival.

An Unusual Case of Peritoneal Dialysis Twisted Catheter in a Child

2020 ◽  
Vol 70 (2) ◽  
pp. 27-31 ◽  
Author(s):  
Cahyani Gita Ambarsari ◽  
Farhan Haidar Fazlur Rahman ◽  
Evita Karianni Bermanshah ◽  
Agustina Kadaristiana
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Complications ◽  
Unusual Case ◽  
Day Treatment ◽  
Mechanical Trauma ◽  
Exit Site ◽  
Catheter Site ◽  
Stage Renal Disease ◽  
End Stage ◽  
Care Procedure

Objective: Mechanical complications of peritoneal dialysis (PD) may occur because of surgical complications when inserting a Tenckhoff catheter or non-surgical complications during chronic care of a PD catheter. We aim to highlight the latter by presenting a case report of twisted external catheter. Method: We report an 11-year-old Indonesian girl with end-stage renal disease on continuous ambulatory PD at Cipto Mangunkusumo Hospital who was hospitalized due to repeat peritonitis.Result: Upon examination, the external catheter seemed twisted without inflow, outflow, or ultrafiltration problems. Her exit score was 4 with gaping. Both abdominal X-ray and ultrasound showed that the catheter and its cuffs were properly placed. The patient frequently pulled and manipulated her PD catheter. Additionally, the catheter-site care procedure was frequently done by untrained caregivers and catheter fixation was also not performed. A retraining program for all involved caregivers was carried out. Peritonitis resolved after 14-day-treatment using intraperitoneal gentamicin. We determined that the twisted catheter and repeat peritonitis were due to a combination of mechanical trauma, poor chronic catheter-site care, and suboptimal PD catheter training. Conclusion: Maintaining compliance for chronic PD catheter exit-site care by well-trained caregivers and by patients themselves, as well as the external catheter fixation are important.

scholarly journals Exteriorizing the Outer Cuff to Treat Intractable Exit Site Infection and Tunnel Infection in Peritoneal Dialysis Cases: A Single Institute Experience

2020 ◽  
pp. 1-3
Author(s):  
Tsung I Hung ◽  
Ching Shya Yong ◽  
Juiting Chang ◽  
Tsung I Hung ◽  
Wei Ting Chang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Treatment Method ◽  
Residual Renal Function ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Stage Renal Disease ◽  
End Stage

Peritoneal dialysis (PD) is an important treatment method for patients with end stage renal disease. Since its introduction in 1975, clinical studies have shown that PD can improve patient survival, retain residual renal function, and lower the risk of infection. It can also reduce financial stress in the growing population with end stage renal disease. However, PD has limitations, mainly technique failures. Of these, catheterrelated infection is a major cause of catheter failure in PD. We reviewed the medical records of 986 PD patients from 2008 to 2018 at our hospital. The patients with intractable tunnel and exit site infection received exteriorization of the outer cuff and cuff shaving. The favourable outcomes observed recommend this treatment for PD patients whose catheter infection is not well controlled.

Sign in / Sign up

Export Citation Format

Share Document