Finding the Right Position: A Three-Year, Single-Center Experience with the “Self-Locating” Catheter

2010 ◽  
Vol 30 (5) ◽  
pp. 519-523 ◽  
Author(s):  
Brigitte Bergamin ◽  
Oliver Senn ◽  
Alf Corsenca ◽  
Philipp Dutkowski ◽  
Markus Weber ◽  
...  
Keyword(s):  
Observation Time ◽  
The Self ◽  
Exit Site ◽  
Exit Site Infection ◽  
Improve Outcome ◽  
Catheter Survival ◽  
Catheter Migration ◽  
Single Center Experience ◽  
Catheter Failure ◽  
The Right

BackgroundPeritoneal dialysis (PD) catheter displacement is a major cause of dysfunction. Various catheter forms have been designed to improve outcome. One of them is based on the classical Tenckhoff catheter, but includes a small tungsten cylinder at the distal end to optimize location and to prevent dislocations.MethodsIn this retrospective study, we analyzed the functionality and complication profile of the self-locating catheter implanted at our center from November 2005 to September 2008 in our PD program.ResultsData from 27 self-locating catheters implanted in 25 patients (12 women) were obtained. Patients were followed for up to 30 months (median observation time: 13 months), resulting in a cumulative study period of 357 PD months. A total of 22 complications were identified, including 1 episode of peritonitis per 52 patient–months, 1 tunnel infection, and 1 exit-site infection. The “functional catheter failure incidence rate” was approximately 0.01 catheters per month on PD (or approximately 1 catheter loss per 100 PD months). The catheter survival was 93% at 1 year.ConclusionsThe “self-locating” PD catheter demonstrates low rates of catheter migration and dislocations, and good catheter survival.

Experience with the Toronto Western Hospital Permanent Peritoneal Catheter

1984 ◽  
Vol 4 (2) ◽  
pp. 95-98 ◽  
Author(s):  
Ramesh Khanna ◽  
Sharron Izatt ◽  
Debby Burke ◽  
Raymond Mathews ◽  
Stephen Vas ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Toronto Western Hospital ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Tenckhoff Catheter ◽  
Western Hospital ◽  
Catheter Tip ◽  
Catheter Failure

Prospective controlled trial with Tenckhoff, Toronto Western Hospital and Goldberg catheter showed a lower incidence of catheter-tip dislodgement from the pelvis with the Toronto Western Hospital catheter. A 1982 retrospective review of experiences, revealed significantly better one and two year catheter survival with the Toronto Western Hospital catheter #2 compared to the straight Tenckhoff catheter inserted at the bed side but not compared to the surgically inserted Tenckhoff catheter. Early dialysate leak was a significant compilation observed with the use of all catheters. Lateral placement of catheters has practically eliminated this complication. Catheter exit site infection now is the major cause of catheter failure.

One-Port Laparoscopic Technique for Placement of Tenckhoff Peritoneal Dialysis Catheters: Report of Seventy-Nine Procedures

2008 ◽  
Vol 28 (6) ◽  
pp. 622-625 ◽  
Author(s):  
Hossein Ashegh ◽  
Jalal Rezaii ◽  
Khalil Esfandiari ◽  
Hassan Tavakoli ◽  
Mehdi Abouzari ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Rectus Sheath ◽  
Laparoscopic Technique ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Catheter Migration ◽  
Bacterial Peritonitis ◽  
Port Site Hernia

Background Laparoscopic techniques for placement of peritoneal dialysis catheters are becoming increasingly popular. In this paper, we report the results of one-port laparoscopic placement of Tenckhoff catheters in 79 patients in our center. Method Videoscopic monitoring was performed via a port inserted in the left upper quadrant and the catheter was placed via a pull-apart sheath through an incision near the umbilicus. The tip and the deep cuff of the catheter were placed into the true pelvis (on the urinary bladder) and into the rectus sheath respectively. A subcutaneous tunnel was created and a point midway on the umbilico-crestal line was selected as the exit site of the catheter. Catheters were capped for 2 weeks before initiation of peritoneal dialysis. Mean duration of the operation was 25 minutes. Results Four patients died during the follow-up period, all due to other medical problems, and 4 patients underwent renal transplantation. During a 48-month follow-up, catheter-related complications were catheter migration (1.3%; month 1), dialysate leakage (1.3%; month 1), port-site hernia (3.8%; after 6 months), exit-site infection (2.5%; months 1 and 9), and bacterial peritonitis (2.5%; after 6 months). Catheter survival was 97.2% in our series. Conclusion We obtained a low complication rate and a high catheter survival rate with this one-port laparoscopic technique.

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.

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.

Comparative Analysis of Two-Piece Extended Peritoneal Dialysis Catheters with Remote Exit-Site Locations and Conventional Abdominal Catheters

2010 ◽  
Vol 30 (1) ◽  
pp. 46-55 ◽  
Author(s):  
John H. Crabtree ◽  
Raoul J. Burchette
Keyword(s):  
Poisson Regression ◽  
Coagulase Negative Staphylococcus ◽  
Site Location ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Patient Demographics ◽  
Kaplan Meier ◽  
Included Patient ◽  
Upper Abdomen

BackgroundAn alternative peritoneal catheter exit-site location is sometimes needed in patients with obesity, floppy skin folds, intestinal stomas, urinary and fecal incontinence, and chronic yeast intertrigo. Two-piece extended catheters permit remote exit-site locations away from problematic abdominal conditions.ObjectiveThe effect on clinical outcomes by remotely locating catheter exit sites to the upper abdomen or chest was compared to conventional lower abdominal sites.MethodsIn a nonrandomized design, peritoneal access was established with 158 extended catheters and 270 conventional catheters based upon body habitus and special clinical needs. Prospective data collection included patient demographics, infectious and mechanical complications, and catheter survival.ResultsKaplan–Meier survival time until first exit-site infection was longer for extended catheters ( p = 0.03). Poisson regression showed no difference in exit site, subcutaneous tunnel, and peritonitis infection rates; however, the proportion of catheters lost during peritonitis episodes was significantly greater for extended catheters ( p = 0.007) and appeared to be due primarily to coagulase-negative staphylococcus organisms. Poisson regression showed interactions of body mass index (BMI) and diabetic status in determining catheter loss from peritonitis for both catheter types ( p = 0.02). Extended catheter patients had higher BMI and diabetes prevalence ( p < 0.0001). Overall extended catheter survival at 1, 2, and 3 years (92%, 80%, 71%) trended lower than conventional devices (93%, 87%, 80%; p = 0.0505).ConclusionsExtended catheters enable peritoneal access for patients in whom conventional catheter placement would be difficult or impossible. Certain patient and extended-catheter characteristics may contribute to loss from peritonitis.

Exit-Site Infection in Continuous Ambulatory Peritoneal Dialysis: A Review

1991 ◽  
Vol 11 (4) ◽  
pp. 333-340 ◽  
Author(s):  
Mary Anne Luzar
Keyword(s):  
Healing Process ◽  
Nasal Carriage ◽  
Epidemiological Studies ◽  
Future Research ◽  
Site Infection ◽  
Exit Site ◽  
Term Care ◽  
Exit Site Infection ◽  
Nasal Carrier ◽  
Catheter Survival

Although the ability of CAPD to successfully treat end-stage renal disease is now well established, exitsite infection (ESI) remains a serious cause of morbidity. The objective of this article is to review recent advancements relating to ESI pathogenesis and its reduction. Current definitions of ESI are reviewed, as are comparative studies of etiology. Emphasis is placed on the literature identifying Staphylococcus aureus as the primary cause of ESI in CAPD. The article reviews reported rates of ESI and discusses reasons for variations of this complication's reported frequency. The selection of catheters available in CAPD are discussed, as are studies demonstrating the threat of S. aureus to catheter survival. The pathogenesis of exit-site infection related to S. aureus nasal carriage in CAPD is reviewed in light of recent findings indicating the pre-CAPD nasal carrier as the patient at risk for subsequent ESI. Postoperative and long-term care of the catheter patient are reviewed for various literature protocols. Treatment recommendations for choice of agents are discussed. Future research should include a better understanding of the morphology of the CAPD catheter exit-site in humans and the healing process. ESI epidemiological studies should be encouraged in tandem with well -designed, controlled studies on the value of prophylactic treatment.

scholarly journals Urgent-start peritoneal dialysis after laparoscopic dialysis catheter implantation: a single-center experience

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Naohiro Toda ◽  
Motoko Yanagita ◽  
Hideki Yokoi
Keyword(s):  
Peritoneal Dialysis ◽  
Early Initiation ◽  
University Hospital ◽  
Early Group ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Single Center Experience ◽  
Catheter Malfunction ◽  
Catheter Implantation ◽  
Late Group

Abstract Background Appropriate timing of peritoneal dialysis (PD) catheter implantation and PD initiation is important. Several guidelines suggest starting PD at least 2 weeks after PD catheter implantation. Recently, urgent-start PD is widespread throughout the world. However, the ideal time to start PD after laparoscopic catheter implantation is not known. We investigated the safety and feasibility of early initiation (within 7 days) PD following laparoscopic peritoneal catheter implantation. Methods We retrospectively analyzed patients who underwent laparoscopic PD catheter implantation at the Kyoto University Hospital from January 1, 2006, to December 31, 2016. Based on when PD was initiated, the patients were divided into two groups, namely, early group, ≤ 7 days and late group, > 7 days after catheter implantation. Catheter-related complications and catheter survival were analyzed. Results We analyzed 29 and 26 patients in early and late groups, respectively. The age, sex, the incidence of diabetes and APD, and the follow-up period were not significantly different between the two groups. The interval from catheter implantation to the start of PD was 4.28 ± 1.83 and 162 ± 157.8 days in the early and late groups, respectively (P < 0.01). In a late group, 17 patients (65.4%) underwent catheter implantation using the Moncrief–Popovich technique. The use of bridge hemodialysis was higher in the early group (P < 0.01). No patients developed dialysate leakage in both groups, and no significant differences were observed for catheter malfunction (24.1% vs. 19.2%, P = 0.66), exit-site infection (ESI, 24.1% vs. 28%, P = 0.87), and peritonitis (7.14% vs. 8.0%, P = 0.91) within 6 months. Furthermore, early initiation of PD did not increase the risk of ESI, peritonitis, and PD withdrawal at 1, 2, and 5 years compared to that in the late group. Conclusions Urgent-start of PD with laparoscopic catheter implantation did not increase infection-related complications and PD withdrawal. Laparoscopic PD catheter implantation may allow the initiation of PD earlier than 7 days after implantation.

Exit-Site Infection in Children on Peritoneal Dialysis: Comparison of Two Types of Peritoneal Catheters

2003 ◽  
Vol 23 (2) ◽  
pp. 169-173 ◽  
Author(s):  
Stanislaw Warchol ◽  
Helena Ziolkowska ◽  
Maria Roszkowska–Blaim
Keyword(s):  
Clinical Investigation ◽  
Statistical Significance ◽  
Observation Time ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Large Numbers ◽  
The Mean ◽  
End Stage ◽  
Medical University

Objective To review our experience with two types of peritoneal catheters, the standard Tenckhoff catheter and the swan-neck presternal catheter (SNPC). Design A retrospective study was undertaken to compare exit-site infection (ESI) rates using two types of peritoneal catheters in children. Setting Medical University of Warsaw, Warsaw, Poland. Patients During the past 10 years, 60 peritoneal catheters were implanted in 50 children with end-stage renal failure: 46 straight, double-cuffed Tenckhoff in 37 children (mean age 11.8 ± 4.2 years, range 3.1 – 18.5 years), and 14 presternal in 13 children (mean age 10.6 ± 5 years, range 0.3 – 17.7 years). The SNPCs were used in special clinical situations such as recurrent ESI with previous abdominal peritoneal catheters, obesity, presence of ureterocutaneostomies, use of diapers, and young age. For the statistical analysis, only the first catheter placed in each child was chosen: 34 standard Tenckhoff catheters and 9 SNPCs. Intervention In all children, peritoneal catheters were implanted surgically under general anesthesia by one surgeon; uniform operative technique and perioperative management was used. Results The mean observation time for 46 standard Tenckhoff catheters was 23.8 ± 21.1 months, and for 14 SNPCs 25.1 ± 27.0 months. The ESI rate was 1/17.4 patient-months (0.69 episodes/year) for Tenckhoff catheters and 1/70.2 patient-months (0.17 episodes/year) for SNPCs. The observed differences in ESI rates between the groups reported did not achieve statistical significance. Conclusions The risk of ESI may be lower with presternal catheters. Confirmation of these findings requires further prospective clinical investigation in large numbers of patients.

Chronic Peritoneal Dialysis—A Single-Center Experience

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 188-191 ◽  
Author(s):  
Ghulam H. Malik ◽  
Ali Swaid Al-Harbi ◽  
Suleiman A. Al-Mohaya ◽  
Raed Al-Awaishe ◽  
Mohammad C. Kechrid ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Single Center Experience ◽  
Age Range

Objective In Saudi Arabia, experience with continuous ambulatory peritoneal dialysis (CAPD) as a renal replacement therapy is limited, and publications are scanty. The present study was undertaken to evaluate CAPD in the Saudi population. Patients and Methods All patients managed by CAPD from May 1993 to September 2002 were included in the study. Tenckhoff indwelling silicone-rubber double-cuff catheters were surgically implanted. Peritoneal dialysis (PD) was started 2 weeks after catheter insertion. Generally, 2-L exchanges 4 times daily were used. Our total of 91 PD patients included 50 men in the age range 13 – 80 years (mean: 48 ± 18 years), and 41 women in the age range 16 – 76 years (mean: 52 ± 18 years). Forty-nine patients performed dialysis by themselves; 42 patients needed a helper. Results Between April 2001 and September 2002, we noted, on average, 1 episode of peritonitis per 21 patient–months and 1 episode of exit-site infection per 24 patient–months. The most common causative organisms for peritonitis were Pseudomonas (16%), Staphylococcus epidermidis (16%), and Staphylococcus aureus (7%). No organisms were grown in 13% of peritonitis episodes. The organisms most commonly responsible for exit-site infection were Pseudomonas aeruginosa (50%) and Staphylococcus (31%). We removed catheters from 32 patients, 12 of those for mechanical reasons. Of the 20 patients whose catheter was removed for infection, P. aeruginosa was cultured in 11 cases. Nine of 23 patients switched to hemodialysis were switched for refractory peritonitis. By the end of the study, 38 patients were still on CAPD, 23 had been switched to hemodialysis, 10 had undergone renal transplantation, and 20 had died. The major causes of death were peritonitis with sepsis ( n = 6), cardiovascular causes ( n = 5), and sudden death at home or in other hospitals ( n = 5). Conclusion Continuous ambulatory peritoneal dialysis is a viable option of renal replacement therapy in Saudi Arabia. The main problem encountered was peritonitis.

Peritoneal Dialysis in Adult Patients with Permanent Suprapubic Catheter: A Single-Center Experience and Literature Review

2018 ◽  
Vol 38 (6) ◽  
pp. 424-429 ◽  
Author(s):  
Abdullah K. Al-Hwiesh ◽  
Ibrahiem Saeed Abdul-Rahman ◽  
Mohammad Ahmed Nasr El-Din ◽  
Amani Al-Hwiesh ◽  
Aisha Alosail ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Suprapubic Catheter ◽  
Site Infection ◽  
Single Center ◽  
Exit Site ◽  
Exit Site Infection ◽  
Single Center Experience ◽  
Number Of Patients ◽  
The Difference

Background The aim of this paper was to review the feasibility of peritoneal dialysis (PD) in the presence of a permanent supra-pubic catheter over a long follow-up period. Methods Twelve patients with automated PD and permanent suprapubic catheters were studied for complications over a period of 10 years. Results In all 12 patients, PD went smoothly. Two of our patients required removal of the PD catheter due to peritonitis. The overall rate of exit-site infection throughout the study was 41.7/patient-month and the difference between patients 60 years or older and those 25 years or younger was not significant ( p = 0.3673). The overall peritonitis rate for all patients was 38.3 episode/patient-month, and none of the patients with ventriculoperitoneal shunt (VPS) had peritonitis. All patients with episodes of infection responded well to the proper antibiotics. Conclusions The available data supported the feasibility of PD in patients with permanent suprapubic catheters; however, a greater number of patients with a longer follow-up period need to be studied to support our results.

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