Transcatheter Examination of the Peritoneal Dialysis Catheter with the SpyGlass Direct Visualization System: A New Aid in Diagnosis and Salvation of Ultrafiltration Failure from Partial Catheter Obstruction

Mechanical complications in peritoneal dialysis (PD), including intraluminal clogging of the PD catheter by fibrin, omentum, or blood clot, are major causes of outflow problems and, in rare cases, lead to technical failure. To visualize an intraluminal image of patients undergoing PD with ineffective ultrafiltration (UF), a SpyGlass fiber optic probe was inserted into the catheter, together with SpyBite biopsy forceps, should the removal of clogging materials be needed. Applying these transcatheter devices in 2 PD patients with unexplained UF failure led to the demonstration of omental plugging at the catheter tip in the first patient and demonstration of intraluminal blood clots in the second patient from whom clots were removal successfully. Both patients achieved better UF volume thereafter without procedure-related complications.

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How to Prevent Peritoneal Dialysis Catheter Tip Migration: A Japanese Perspective

Kidney and Dialysis ◽

10.3390/kidneydial1010005 ◽

2021 ◽

Vol 1 (1) ◽

pp. 29-34

Author(s):

Minoru Ito ◽

Masataka Koshika

Keyword(s):

Peritoneal Dialysis ◽

Successful Outcome ◽

Peritoneal Dialysis Catheter ◽

Common Complication ◽

Type Selection ◽

Catheter Malfunction ◽

Peritoneal Wall ◽

Catheter Tip ◽

Catheter Complications ◽

Japanese Perspective

The prevention of peritoneal dialysis (PD) catheter complications is essential to achieve a successful outcome. In recent years, nephrologists have performed more PD catheter insertion surgeries in Japan. The prevention of catheter complications is crucial for nephrologists who do not have all-around surgical skills. PD catheter tip migration is a common complication and a significant cause of catheter malfunction. Several preventive techniques have been reported for the PD catheter tip migration. This perspective described the following: (1) surgical technique in laparotomy, (2) laparoscopic surgery, (3) peritoneal wall anchor technique, and (4) catheter type selection. We hope that more effective methods of preventing catheter complications will be developed to ensure the success of PD treatment.

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Recurrent Transvaginal Leak of Dialysate as a Complication of Peritoneal Dialysis Catheter Tip Capture by Fallopian Tube after Tubal Occlusion

Arab Journal of Nephrology and Transplantation ◽

10.4314/ajnt.v3i3.63148 ◽

2011 ◽

Vol 3 (3) ◽

Author(s):

MA Hummeida ◽

SE Khalid ◽

MHA Modawi ◽

AI Mobarak ◽

A-MM Imam ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Fallopian Tube ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Tubal Occlusion ◽

Catheter Tip

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P1207ANALYSIS OF OUTCOME AND FACTORS ASSOCIATED WITH MAINTENANCE OF PERITONEAL DIALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1207 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Merita Rroji (Molla) ◽

Saimir Seferi ◽

Larisa Shehaj ◽

Myftar Barbullushi

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Residual Renal Function ◽

Good Survival ◽

First Year ◽

Technical Failure ◽

Technique Survival ◽

Ultrafiltration Failure ◽

Comorbidity Index ◽

Short Time

Abstract Background and Aims Peritoneal dialysis (PD) is generally associated with a good survival rate and with great preservation of residual renal function (RRF). The various causes of technique failure are responsible for the relative short time staying in PD. Objectives: This study aimed to analyze the outcome and factors correlated with maintenance peritoneal dialysis (PD) to guide for improving prognosis. Method In a retrospective way we examined our PD-cohort concerning mortality, technique survival, peritonitis rate, and other complications. Results From 2005 to 2019 the number of PD patients who have been treated in PD program for more than 3 months was around 199 patient, 29.1% diabetics, mean age 53.3±15.03 years old and meantime in therapy 32.39± 27.34 months. The PD was seen as an alternative for younger patients in the transplant list and elderly patients with comorbidity. Around 7.5% of the PD patients were transplanted and 8.5 % of patients were transferred from HD due to vascular access failure. Around 88.9% of patients were on PD for more than 1 year, 37.7% from 3 up to 5 years and 19.8% percent of the patients have stayed on PD for more than 5 years. Cardiovascular mortality was the main cause of mortality with 53% of the cases. Higher comorbidity index, lower albumin levels, and lower residual renal function were the main risk factors for lower survival. The technical survival of patients was 92.3% during the first year, 79.5% and 69.6% in the second and the fifth year, respectively. There was not found a difference in technical survival between diabetics and nondiabetics patients. Ultrafiltration failure followed by peritonitis was the main reason for transfer patients with more than 24 months in therapy in hemodialysis probably linked with the no availability of icodextrin. Peritonitis rate was 1:41 patient months. Conclusion PD program in our center is organized based in the concept of integrated care in RRT. The outcome of our patients was at least comparable to those reported by larger registries Although we have done good progress in the prevention of infection the nonavailability of icodextrin is an important factor for a technical failure. RRF is an important factor and we need to be more focused to maintain it longer in the future.

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The Need for a “Swan Neck” Permanentl Y Bent, Arcuate Peritoneal Dialysis Catheter

Peritoneal Dialysis International ◽

10.1177/089686088500500404 ◽

1985 ◽

Vol 5 (4) ◽

pp. 219-223 ◽

Cited By ~ 82

Author(s):

Zbylut J. Twardowski ◽

Karl D. Nolph ◽

Ramesh Khanna ◽

Barbara F. Prowant ◽

Leonor P. Ryan ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Complication Rate ◽

Rectus Muscle ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Exit Site ◽

The Past ◽

Optimal Function ◽

Catheter Tip ◽

Subcutaneous Tunnel

In 1968 to ensure optimal function of a permanent catheter during periodic peritoneal dialysis, Tenckhoff recommended that a double-cuff catheter be inserted so that a slightly arcuate subcutaneous course would give the external and intraperitoneal segment a caudal direction. During the rapid growth of CAPD over the past five years, nephrologists generally have adapted the Tenckhoff's methods of catheter insertion but have encountered numerous complications. This paper describes a retrospective analysis of the complications associated with 83 peritoneal dialysis catheters functioned for 48,325 catheter days (132 catheter years) in 63 patients on continuous ambulatory peritoneal dialysis (CAPD) at our institution. Pericatheter leaks were seen only with midline insertions. Exit-site infections were significantly more resistant to treatment with singlecuff than with double-cuff catheters as assessed by the proportion of time that the exit-site is infected. If the subcutaneous tunnels were directed downward the infections were more responsive to treatment. Significantly more frequent catheter-tip migrations were observed with subcutaneous tunnel directed left and downward. Thus, our study supports Tenckhoff's observation that we can expect the lowest complication rate with double-cuff catheters with an arcuate tunnel, convex upwards. However, frequently this shape of tunnel is associated with external-cuff extrusions due to resilience of the straight catheter. To reconcile these conflicting requirements we recommend a new catheter permanently bent between the cuffs to eliminate one of the forces responsible for cuff extrusion. Such a catheter, named the swan-neck tunnel peritoneal dialysis catheter, should be inserted surgically through the belly of the rectus muscle.

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A Simple Method to Prevent Peritoneal Dialysis Catheter Tip Migration

Peritoneal Dialysis International ◽

10.1177/089686080702700515 ◽

2007 ◽

Vol 27 (5) ◽

pp. 554-556 ◽

Cited By ~ 8

Author(s):

Wen-Ming Chen ◽

Chen-Li Cheng

Keyword(s):

Peritoneal Dialysis ◽

Wound Care ◽

Fixation Method ◽

Peritoneal Dialysis Catheter ◽

Simple Method ◽

Exit Site Infection ◽

Tenckhoff Catheter ◽

Catheter Tip ◽

Stage Renal Disease

Background We report here a one-stitch fixation method that prevents catheter tip migration during implantation of the double-cuffed straight Tenckhoff catheter. Methods From July 2003 to September 2005, 38 patients with end-stage renal disease underwent implantation of the double-cuff straight Tenckhoff catheter for peritoneal dialysis by this method. Results No patient had catheter tip migration out of the true pelvis. No patient had pericatheter dialysate leakage or developed incisional hernia. Two patients (5.3%) experienced exit-site infection during the 2- and 5-month follow-up and they recovered well after wound care. Three patients (7.9%) developed peritonitis during the 3-day and 2- and 6-month follow-up; the conditions were controlled after antibiotic care. One patient (2.6%) experienced mechanical catheter obstruction during the 10-day follow-up due to omental wrapping; surgical revision was necessitated. Conclusions We believe that the method is an easy, safe, and effective technique for preventing catheter tip migration.

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Minilaparotomy Salvage of Malfunctioning Catheters in Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2011.00237 ◽

2013 ◽

Vol 33 (1) ◽

pp. 46-50 ◽

Cited By ~ 7

Author(s):

Jian-ri Li ◽

Chi-hung Cheng ◽

Kun-yuan Chiu ◽

Chen-li Cheng ◽

Chi-rei Yang ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Blood Clot ◽

Operating Time ◽

Onset Time ◽

Entry Site ◽

Significant Complication ◽

Catheter Malfunction ◽

Catheter Tip ◽

The Mean ◽

Peritoneal Entry

♦BackgroundCatheter malfunction is a common and significant complication during peritoneal dialysis (PD). We developed a minilaparotomy procedure to rescue malfunctioning catheters and to prevent recurrence of malfunction.♦MethodsFrom 2006 to 2011, 11 patients receiving PD had a malfunctioning catheter. In all patients, a 2-cm incision, 5 cm caudally to the previous peritoneal entry site was used to correct the malfunctioning catheter, with concomitant fixation of the catheter to the peritoneum.♦ResultsCatheter tip migration occurred in 7 patients, omental wrapping in 3, and blood clot obstruction in 1. The mean onset time to catheter malfunction was 197.5 days (range: 4 – 1270 days), and the mean operating time was 41 minutes (range: 35 – 56 minutes). There was no recurrence of catheter malfunction and no surgery-related peritonitis.♦ConclusionsOur minilaparotomy procedure is safe and feasible for the salvage of malfunctioning PD catheters.

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After peritoneal dialysis discontinuation: When will we remove peritoneal dialysis catheter?

The Journal of Vascular Access ◽

10.1177/1129729817751620 ◽

2018 ◽

Vol 20 (1_suppl) ◽

pp. 31-34

Author(s):

Hirotake Kasuga

Keyword(s):

Peritoneal Dialysis ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Dialysis Patients ◽

Peritoneal Equilibration Test ◽

Ultrafiltration Failure ◽

Refractory Peritonitis ◽

End Stage ◽

Peritoneal Function ◽

Dialysis Discontinuation

Most of the peritoneal dialysis patients stop their peritoneal dialysis therapy and transfer to hemodialysis or kidney transplantation. In Japan, most end-stage kidney disease patients select hemodialysis after peritoneal dialysis discontinuation. Peritoneal dialysis catheter will be removed after stopping peritoneal dialysis. If peritoneal dialysis patients suffer from refractory peritonitis or severe tunnel infection, we remove the peritoneal dialysis catheter immediately. However, the causes of peritoneal dialysis discontinuation are ultrafiltration failure or peritoneal membrane dysfunction, and we have to consider the timing of peritoneal dialysis catheter removal. Encapsulating peritoneal sclerosis is the most important adverse event of peritoneal dialysis. And encapsulating peritoneal sclerosis often develops after stopping peritoneal dialysis. Risk factors associated with encapsulating peritoneal sclerosis are high peritoneal equilibration test values, longer peritoneal dialysis period, frequent peritonitis, and so on. There is no evidence to prevent encapsulating peritoneal sclerosis completely. Therefore, we can preserve the peritoneal dialysis catheter and assess the changes of peritoneal function after peritoneal dialysis discontinuation, if patient is suspected to have high risk of encapsulating peritoneal sclerosis.

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

Case Reports in Nephrology and Dialysis ◽

10.1159/000515566 ◽

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.

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