Bedside placement of peritoneal dialysis catheters – a single-center experience from Hungary

Ákos Pethő,Réka P Szabó,Mihály Tapolyai,László Rosivall

doi:10.1080/0886022x.2019.1614058

Ákos Pethő, Réka P Szabó + Show 2 more

Open Access

https://doi.org/10.1080/0886022x.2019.1614058

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Abstract

Objectives: The successful implantation of peritoneal dialysis (PD) catheters is a critical skill procedure with the potential to impact both the short- and long-term success of renal replacement therapy and the patients’ survival.Methods: We retrospectively reviewed our single-center experience with nephrologist-placed minimally invasive, double-cuffed PD catheters (PDCs).Results: The recruitment period was March 2014 through December 2015. The follow-up period lasted until 2016. The mean age of the subjects was 60 ± 18 years and indications for the PD were diuretic resistant acutely decompensated chronic heart failure in seven patients (47%) and end-stage renal disease in eight (53%) patients. Comorbid conditions included diabetes (27%), ischemic heart disease (47%), advanced liver failure (27%), and a history of hypertension (73%). The cohort had a high mortality with five subjects only in severe heart failure group (33%) passing away during the index hospitalization; of the rest, two (13%) had heart transplantation, three (20%) changed modality to hemodialysis, and only five (33%) continued with maintenance PD beyond 1 month. Acute technical complications within the first month were infrequent: one catheter (6%) had drainage problems and one (6%) was lost due to extrusion. There were no serious complications (e.g., organ damage, peritonitis, etc.).Conclusions: In selected cases, particularly in severe diuretic refractory heart failure, PDC placement placed by a nephrologist is feasible with a low rate of complications even in a low-volume center setting. The catheters we placed were all functioning with only minor complications and PD could be started immediately.

Highlights

Indications and techniques for peritoneal dialysis (PD) as well as the practice of modality will continue to evolve, influenced to a large degree by local needs and the availability of expertise and skills
PD catheters (PDCs) were inserted by surgeons, the need soon became apparent for a simplified procedure utilizing local anesthesia and performed outside of the operating rooms
The fluoroscopic insertion of PDC by nephrologists using the Seldinger technique can be performed in a procedure room, allowing the expeditious initiation of dialysis without involving a surgical team [3]

Summary

Introduction

Indications and techniques for peritoneal dialysis (PD) as well as the practice of modality will continue to evolve, influenced to a large degree by local needs and the availability of expertise and skills. The fluoroscopic insertion of PDC by nephrologists using the Seldinger technique can be performed in a procedure room, allowing the expeditious initiation of dialysis without involving a surgical team [3]. Those non-surgically inserted PDCs were and still are sutured to the rectus muscle or fascia [4]. The advantage of minimally invasive catheter insertions is less surgical trauma permitting an earlier start on PD fluid exchange without any waiting period [11,12,13]. Long-term retrospective clinical studies had clearly demonstrated the benefits of minimally invasive interventions [15,16,17,18] and may offer a viable alternative in resource-limited countries or when the risks of true surgical procedures impede the establishment of modality

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