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 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.

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 Effectiveness, safety and cost reduction of long-term tunneled central venous catheter insertion in outpatients performed by an interventional nephrologist

2020 ◽  
Vol 42 (1) ◽  
pp. 53-58
Author(s):  
Artur Quintiliano ◽  
Marcel Rodrigues Gurgel Praxedes
Keyword(s):  
Central Venous Catheter ◽  
Vascular Access ◽  
Survival Rates ◽  
Cost Savings ◽  
Venous Catheter ◽  
Central Venous ◽  
Catheter Survival ◽  
Stage Renal Disease ◽  
End Stage

Abstract Introduction: Invasive procedures performed by trained nephrologists can reduce delays in making a definitive vascular access, complications, number of procedures on the same patient, and costs for the Public Health System. Objective: to demonstrate that a long-term tunneled central venous catheter (LTCVC) implanted by a nephrologist is safe, effective, and associated with excellent results. Methods: A retrospective study analyzed 149 consecutively performed temporary-to-long-term tunneled central venous catheter conversions in the operating room (OR) from a dialysis facility from March 2014 to September 2017. The data collected consisted of the total procedures performed, demographic characteristics of the study population, rates of success, aborted procedure, failure, complications, and catheter survival, and costs. Results: the main causes of end stage renal disease (ESRD) were systemic arterial hypertension and diabetes mellitus, 37.9% each. Patients had a high number of previous arteriovenous fistula (1.72 ± 0.84) and temporary catheter (2.87 ± 1.9) attempts until a definitive vascular access was achieved, while the preferred vascular site was right internal jugular vein (80%). Success, abortion, and failure rates were 93.3%, 2.7% and 4%, respectively, with only 5.36% of complications (minors). Overall LTCVC survival rates over 1, 3, 6, and 12 months were 93.38, 71.81, 54.36, and 30.2%, respectively, with a mean of 298 ± 280 days (median 198 days). The procedure cost was around 496 dollars. Catheter dysfunction was the main reason for catheter removal (34%). Conclusion: Our analysis shows that placement of LTCVC by a nephrologist in an OR of a dialysis center is effective, safe, and results in substantial cost savings.

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.

P1193URGENT X EARLY START PERITONEAL DIALYSIS: PATIENTS´ PROFILE AND OUTCOMES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Viviane Calice-Siva ◽  
Helen Ferreira ◽  
Bruna Tonial ◽  
Izabel Ribeiro ◽  
Pedro Daudt ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Demographic Data ◽  
Dropout Rate ◽  
Catheter Insertion ◽  
Catheter Placement ◽  
Early Start ◽  
Fill Volume ◽  
Catheter Tip ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims In the last ten years, peritoneal dialysis (PD) has been considered a safe option to start renal replacement therapy (RRT) in end-stage renal disease patients in need to start dialysis urgently. The definition applied to the Urgent Start PD (US-PD) varies widely worldwide. Recently, it was proposed that US-PD definition should be according to patients’ necessity of starting dialysis, considering “urgent start” when PD started up to 72 hours of catheter placement and “early start” PD when it is starts between 3 and 14 days after catheter placement. Considering this new definition, we aimed to compare demographical and clinical characteristics of patients´ that started PD therapy as urgent and early starts as well as 30-day complications, 6-month hospitalization and dropout rate. Method All adult patients that started PD therapy up to 14 days after catheter insertion in our institution between October 2016 and February 2019 were included in the analyses. Patients were placed on urgent-start (US-PD) group if therapy started until 72-h after catheter insertion or early-start (ES-PD) group if PD initiated between 3 and 14 days. Dialysis records were reviewed to obtain clinical and demographic data, fill volume prescribed for the first PD session, 30-days complications (leakage, bleeding, catheter tip migration and peritonitis) and 6-month hospitalization and dropout rate. Results In our study, 72 patients were analyzed (US-PD=52, ES-PD=20), mean age was 53.2 ± 15.2 years old. No differences between US-PD and ES-PD regarding demographic characteristics, 30-day complications and 6-month hospitalization and dropout events were found. The most frequent short-term complication in patients who started PD urgently was leakage (US-PD 6 (11%) x ES-PD 2(10%) patients). The most common cause of patient’s dropout was transfer to HD.Only patients from the US-PD group needed to switch to that modality (5 (10%)). Conclusion Almost three-quarters of our sample started PD less than 72 hours after catheter insertion. The lack of difference in the measured outcomes compared to patients that had therapy initiated after this period encourages the use of PD when urgent dialysis is needed.

scholarly journals An Unusual Case of Recurrent Migration of the Peritoneal Dialysis Catheter into the Inguinal Hernia Sac

2021 ◽  
pp. 152-157
Author(s):  
Haruna Fukuzaki ◽  
Junichiro Nakata ◽  
Yuka Shirotani ◽  
Yuki Shimizu ◽  
Masayuki Maiguma ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Inguinal Hernia ◽  
Peritoneal Dialysis Catheter ◽  
Hernia Sac ◽  
First Case ◽  
Catheter Tip ◽  
Hernia Inguinal ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

We herein report the first case of a patient with recurrent migration of the peritoneal dialysis (PD) catheter into the inguinal hernia sac. A 58-year-old man suffered from end-stage renal disease due to polycystic kidney disease (PKD). A year before starting PD, a PD catheter was implanted with stepwise initiation of PD using the Moncrief-Popovich technique. He complained of drain failure and right inguinal swelling during the induction period and was diagnosed with right inguinal hernia. Further examination revealed that the PD catheter tip had migrated into the inguinal hernia sac. Although surgery was planned, the PD catheter tip spontaneously migrated back into the intra-peritoneal space. 14 months later, he noticed fill and drain failure again. Diagnosis was PD catheter dysfunction due to migration into the right inguinal hernia sac. PD was resumed without issues after repositioning of the PD catheter and repair of the inguinal hernia. Inguinal hernia is a frequent complication in PD patients, especially in those with PKD. Early diagnosis and treatment of hernia should be considered in PD patients.

Peritoneal Dialysis Access

2020 ◽  
Author(s):  
David Shaffer ◽  
Rachel Forbes
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Dialysis Access ◽  
Catheter Survival ◽  
Flexible Schedule ◽  
Key Words Peritoneal Dialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Laparoscopic Techniques

Currently approximately 10% of the 650,000 ESRD patients in the U.S. requiring renal replacement therapy are on peritoneal dialysis (PD).  Although equally efficacious as hemodialysis (HD), advantages of PD may include a more flexible schedule allowing greater freedom to work or travel, better tolerability in patients with cardiovascular compromise, and decreased costs.   PD requires an intact peritoneal membrane and abdominal wall and the ability to perform at home, either by the patient  or by a caregiver.  Although PD catheters can be inserted via open or laparoscopic techniques, laparoscopic insertion allows for direct visualization and placement of the tip of the catheter, as well as the ability to secure the tip of the dialysis catheter in the pelvis.  Laparoscopic insertion improves catheter survival, reduces the incidence of mechanical complications, and allows for additional procedures, such as repair of umbilical hernias, lysis of adhesions, or omentopexy. Laparoscopy is also ideal for secondary procedures for catheter salvage.  Infections remain the most frequent complication of peritoneal dialysis catheters and the most common reason for catheter removal or conversion from PD to HD.   This review contains 16 figures, 6 tables, and 40 references. Key Words: Peritoneal dialysis; End-stage renal disease; renal replacement therapy; dialysis; laparoscopy; catheter-associated peritonitis; exit site infections; catheterpexy; omental wrapping; catheter outflow obstruction.

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