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      Percutaneous CAPD catheter insertion by a nephrologist versus surgical placement: A comparative study

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          Abstract

          Peritoneal dialysis catheter (PDC) for continuous ambulatory peritoneal dialysis is inserted into the abdominal cavity either by a surgeon, interventional radiologist or nephrologist. Various innovations have been made in the methodology adopted in the placement of the PDC. We compared the percutaneous approach for PDC insertion with the open surgical technique. From January 2006 to May 2007, 25 of the 46 catheters were successfully inserted using the percutaneous Seldinger technique. The incision size (2.6 ± 0.7 vs 7.3 ± 0.6 cm) and the length of hospital stay (11.9 ± 5.9 vs 17.3 ± 6.8 d) were considerably less in the percutaneously placed group compared to the surgically placed group. Early initiation of exchanges and reduction in the expenses were other important advantages of this method.

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          Technical survival of CAPD catheters: comparison between percutaneous and conventional surgical placement techniques.

          E Akoglu, A Bihorac, Ozener C (2001)
          Percutaneous peritoneal dialysis catheter (PDC) placement is a well-tolerated, rapidly performed bedside procedure that allows a rapid initiation of CAPD. We compared the technical survival of PDCs while comparing the mode of insertion. We retrospectively reviewed 215 PDCs inserted over a 60-month period in 191 patients on CAPD therapy. Of these, 133 were placed percutaneously by nephrology staff (group P) and 82 were placed using conventional surgical techniques by surgical staff (group S). The total experience accumulated was 4000 patient-months: 2260 patient-months in group P and 1740 patient-months in group S. The incidence of complications in PDCs did not differ between the groups (1 episode/33 patient-months in group P and 1 episode/29 patient-months in group S). Two episodes of early leakage and 9 episodes of late leakage were observed in group P compared with one early leakage and 4 episodes of late leakage in group S. Of the mechanical complications in group P, 8.86% were due to catheter malfunction, including catheter tip migration and obstruction, compared with 12.63% in group S. The incidence of catheter infections was 1 episode/73 patient-months in group P and 1 episode/62 patient-months in group S. Significantly more catheters were removed in group S compared with group P (40% vs 16%, P<0.001). One-year and 2-year technical survivals were 90% and 82% in group P, and 73% and 60% in group S (P=0.0032), respectively. Percutaneous bedside placement of PDCs by nephrologists provides a safe and reliable access for peritoneal dialysis.
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            Immediate initiation of CAPD following percutaneous catheter placement without break-in procedure.

            Young-Il Jo, Sug Kyun Shin, Jong Ho Lee … (2015)
            To evaluate the effect of a modified method of percutaneous catheter placement without a break-in procedure on the development of catheter-related complications in patients on continuous ambulatory peritoneal dialysis (CAPD). A prospective, observational clinical study. Peritoneal dialysis (PD) units of two university-based hospitals. This study included 51 consecutive patients on CAPD. A straight double-cuffed Tenckhoff catheter with a straight intraperitoneal segment was used, and all catheters were inserted using a modified percutaneous placement method under local anesthesia. The catheter was introduced directly into the deep pelvis through an intramuscular tract, which had been created by tapered dilators. Peritoneal dialysis was initiated immediately after catheter insertion without a break-in procedure. Catheter-related complications were surveyed during the 12 months after initiation of CAPD. Within the first month, only 1 pericatheter leakage (1.9%) was detected. There were no cases of visceral perforation or severe hemorrhage during catheter insertions. Catheter malfunction due to catheter tip migration, exit-site infection, and peritonitis developed in only 1.9%, 3.9%, and 3.9% of patients, respectively. After 1 month following catheter insertion, no further incidences of pericatheter leakage occurred during the follow-up period. All catheters, except one that was reinserted due to tip migration, survived throughout the study period. The rates of pericatheter leakage and other catheter-related complications are relatively low in CAPD patients using our percutaneous catheter placement method without a break-in procedure. This procedure is comparatively simple and less invasive than other catheter placement methods, and allows for immediate start of PD after catheter insertion, without a break-in procedure.
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              Complications with Permanent Peritoneal Dialysis Catheters: Experience with 154 Percutaneously Placed Catheters

              Michael Allon, Michael Soucie, Edwin J Macon (1988)
              A prospective study evaluated the complications in 154 patients in whom a permanent peritoneal dialysis catheter was inserted percutaneously from April 1982 to June 1986. Obstruction to flow and fluid leakage occurred in 9.2 and 2.6% of the catheters, respectively. Catheter survival was 64.6 and 48.6% at 1- and 2-year follow-up, respectively. The complication rates and survival of percutaneously placed catheters was comparable to those reported for surgically placed catheters. Percutaneous insertion of Tenckhoff catheters is a viable alternative to using the surgical technique.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Nephrol
                Journal ID (publisher-id): IJN
                Title: Indian Journal of Nephrology
                Publisher: Medknow Publications (India )
                ISSN (Print): 0971-4065
                ISSN (Electronic): 1998-3662
                Publication date (Print): January 2008
                Volume: 18
                Issue: 1
                Pages: 5-8
                Affiliations
                Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Lake area, Madurai - 625 107, India
                [1 ]Department of Urology, Meenakshi Mission Hospital and Research Centre, Lake area, Madurai - 625 107, India
                Author notes
                Address for correspondence: Dr. K. Sampathkumar, Department of Nephrology, Meenakshi Mission Hospital and Research Center, Madurai - 625 107, India. E-mail: drksampath@ 123456gmail.com
                Article
                Publisher ID: IJN-18-5
                DOI: 10.4103/0971-4065.41280
                PMC ID: 2847731
                PubMed ID: 20368912
                SO-VID: 51400d99-b99e-47a2-8681-851ccaf1ee82
                Copyright © © Indian Journal of Nephrology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Subject: Original Article

                ScienceOpen disciplines: Nephrology
                Keywords: percutaneous insertion,peritoneal dialysis catheter,continuous ambulatory peritoneal dialysis,interventional nephrologists
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: percutaneous insertion, peritoneal dialysis catheter, continuous ambulatory peritoneal dialysis, interventional nephrologists

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