CAPD Catheter Research Articles

CAPD catheter obstruction by fallopian tubes

CAPD catheter obstruction by fallopian tubes

A Case of Post Traumatic Delayed CAPD Catheter Fistula with Uterus and Bowel.

A Case of Post Traumatic Delayed CAPD Catheter Fistula with Uterus and Bowel.

USAGE OF PARAMEDIAN APPROACH FOR CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CATHETER INSERTION TECHNIQUE AND COMPLICATION

Objective: This study aims to review the usage and complication of paramedian approach for CAPD catheter insertion. Material & Methods: This is a retrospective study. All ESRD patients ongoing CAPD at the Dialysis Clinic of Zainoel Abidin General Hospital in Aceh, Indonesia between January 1, 2009 and December 31, 2018 were included in the present study. Complication outcomes included mechanical and infectious complications are documented and reviewed. Results: A total of 190 ESRD patients had been performed CAPD catheter insertion using paramedian approach in this period. Out of these patients, complication occurred in 31 cases (16.32%). All the complication that occurred in this study are 5 cases of leakage (2.63%), 9 cases of infection (4.74%), 8 cases of drainage problem (4.21%), 9 cases of malposition (4.74%), and no case of bowel perforation. From total of 9 cases of infections, 1 patient had peritonitis from the catheter insertion. The other infection was exit site infection. Conclusion: CAPD catheter insertion using paramedian approach is safe with low complication rates. It could decrease post-operative complications and can be recommended for CAPD catheter insertion technique due to its safety.

Peritoneal Dialysis Catheter Placement by Open Surgical Technique: Nikdu Experience

Objective: To determine the outcome and complications of CAPD catheter implanted by open surgical technique for peritoneal dialysis. Methods: In this prospective study peritoneal dialysis catheter (PDC) for continuous ambulatory peritoneal dialysis was inserted into the abdominal cavity using an open surgical approach. We described our experience of open surgical minimal invasive technique of CAPD catheterization from July 2012 to June 2015. Total 40 catheters were inserted successfully. Patients were followed up for a variable period of 3-36 months. Results: In this study common indications of CAPD catheter insertion were CKD-5 due to diabetic nephropathy, chronic glomerulonephritis, and hypertensive nephrosclerosis. Common catheter related complications were peritonitis, hypokalaemia, exit site infection, catheter malfunction. Late peritonitis remains the major drawback of PD treatment, with the need of temporary or permanent changeover to the HD treatment in 10% of the patients. Conclusion: Enrichment of the physician’s interest and experience, along with a multidisciplinary approach to outline the optimal strategy of PD-catheter insertion and management of complications may improve technique and patients’ survival and decrease the morbidity. Bangladesh Journal of Urology, Vol. 18, No. 2, July 2015 p.62-67

P1327STATUS OF AV FISTULA AFTER SUCCESSFUL RENAL TRANSPLANT ; A SINGLE CENTRE STUDY

Abstract Background and Aims Functioning AV-Fistula is considered the Achilles hill of ESRD patients. After successful renal transplantation considering the risk of graft failure or recurrence of disease all attempts are made to preserve the functional AV fistula except few clinical situations like high output cardiac failure, steal phenomenon or large aneurysm with risk of rupture where voluntary closure of AVF is preferred. Even with care and attention a significant number of AV-Fistula closes spontaneously. In this retrospective study we analyzed the fate of AVF after successful renal transplantation. Method The medical records 800 renal transplant recipients in last 15 years were analyzed with the objective to find out the outcome of AVF after transplant. Data were systematically charted and analyzed by SPSS V.23.01 Results Out of 800 renal transplantation in last 15 years, excluding patients on CAPD or temporary catheter or AVgraft; 680 patients data were finally analyzed. Out of this 680 functioning AVF, 86 patients lost follow up and hence status of AVF could not be retrieved. Among rest 594 recipients, AV fistula was closed spontaneously in 184 cases (31.1%), and only 5 patients required planned AVF closure due to large aneurysm (2 cases), trauma and impending rupture (2 cases), cosmetic reason (1 cases). Incidence of spontaneous fistula closure was significantly higher among females than male recipients (p=0.001). Majority (62%) of the spontaneous closure occurred immediate post transplant period (within 7 days after transplant) and rest 26.4% within 1month and 9.2% in between 1 and 4 month. Only 2.4% fistula closed after 4 month of transplant. In the Tacrolimus era there is no significant difference in the rate of spontaneous closure with the patients who received cyclosporine (p=0.78). However among patient who received injectable cyclosporine the spontaneous closure was significantly higher (p=0.001). Factors which could be attributable to the rate of closure are, need of peripheral cannulation in perioperative period in the fistula arm (r2=0.89), operative time more than 2and half hr (r2=0.78), more than 2 unit of blood transfusion (r2=0.85) during operation and dialysis vintage through AVF less than 6 month (r2=0.77). There was no observed difference in rate of spontaneous closure among patients who received induction and who don’t (p=0.08). In subgroup analysis among induction with basiliximab or thymoglobulin there was no significant difference in spontaneous fistula closure (p=0.07). Conclusion Spontaneous closure of AV fistula observed in 31.1% patients with successful renal transplantation. It is more common in female recipients and 97.6% of spontaneous closure takes place within 4month of transplant. The factors which are attributable for spontaneous closure are cannulation in the fistula arm, injectable cyclosporine use, operative time more than 2and half hr, blood transfusion more than 2 units, during operation.

Comparison of Percutaneous versus Open Surgical techniques for placement of Peritoneal Dialysis Catheters

Background: Nephrologists have used percutaneous placements of peritoneal dialysis catheters (PDCs) with or without fluoroscopic guidance. PDCs are also placed using mini-laparotomy and laparoscopic techniques by surgeons. Percutaneous PDC placement by nephrologists is a simple, non-invasive technique with minimum intraoperative morbidity. We compared operative and immediate complications of PDCs using percutaneous versus open surgical mode of insertion.
 Methods: Data of all patients entering into CAPD programme in our center between July 2011 to July 2015 was collected. A total of 377 PDCs had been inserted over 48 months in 358 patients. Of 377 catheters inserted, 224 had been inserted by percutaneous method and 153 by surgical technique.
 Results: Wound hematoma developed in 3.5% of percutaneously placed catheters vs 2.6% of catheters placed by surgical technique, p-0.061. Haemorrhagic effluent was seen in 4.46% of percutaneously placed catheters vs 3.92% of surgically placed catheters, p-0.068. Bowel injury occurred in 1.33% of percutaneously placed catheters vs 0.65% of surgically placed catheters, p-0159. Dialysate leak occurred in 2.6% of catheters placed percutaneously vs 6.5% of catheters placed by surgical technique, p-0.068. Percutaneous PDC allowed a significantly shorter hospital stay, smaller wound size and less break-in period
 Conclusions: Percutaneously placed CAPD catheters by nephrologists ensues significantly less hospital stay, small sized incision, lesser break-in period and less post-surgical morbidity as compared with surgically placed catheters. Percutaneous PDC placement is minimally invasive, safe, less time consuming and dependable peritoneal access technique.

Outcomes of laparoscopic and open CAPD catheter placement: A single-center experience

BackgroundContinuous Ambulatory Peritoneal Dialysis (CAPD) catheter placement is typically a straightforward surgical procedure performed on chronically ill patients with end-stage renal disease (ESRD). Post-operative outcomes and reoperative rates vary greatly in the medical literature. We report our experience using both minimally invasive and open techniques in placing CAPD catheters and offer our surgical outcomes. MethodsThis study is an IRB-approved, retrospective review (2005–2018) of all patients undergoing CAPD catheter placement at Mayo Clinic-Rochester. Analysis focused on specific patient outcomes, including early (<30 days) versus late (≥30 days) complication and reoperation rates. ResultsA total of 173 patients with ESRD (mean ASA score = 3.1) underwent laparoscopic (n = 22) and open (n = 151) CAPD catheter placement (mean follow-up = 309 days; range: 1–3497 days). The total index operation complication rate was 41%. The total index reoperation rate was 37% and was similar in open and laparoscopic approaches. CAPD catheters malfunctioned in 19 patients (11% of total) and each underwent reoperation. CAPD catheter infections occurred in 30 patients (17% of total), and 24 required reoperation; 6 patients were treated successfully with antibiotics. CAPD catheter migrations occurred in 21 patients (12% of total) and all underwent reoperation. ConclusionAlthough CAPD catheter placements in patients with ESRD are technically easy to accomplish, the long term outcomes suggest as many as one in three patients will struggle with catheter function or infection. This study has led to changes in our technical CAPD catheter placement procedures, as well as the post-operative patient care algorithm.

Selective Infracolic Omentecomy and Fixation Reduces Complications after Laparoscopic Assisted Peritoneal Dialysis Catheter Placement

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.

Selective Infracolic Omentecomy and Fixation Reduces Complications after Laparoscopic Assisted Peritoneal Dialysis Catheter Placement

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 &lt;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.

Acinetobacter Peritonitis in CAPD

A 54 year old lady with chronic kidney disease stage 5 on CAPD presented to us with peritonitis. This was her second episode of peritonitis. The previous episode was a year before and was culture negative. The present culture grew Acinetobacter which was sensitive to aminoglycosides, fluoroquinolones, fourth generation cephalosporins and carbapenems. We treated her with Imipenem for 4 weeks and the peritonitis resolved. A month later she developed peritonitis again which was culture negative and carbapenem resistant requiring CAPD catheter removal for refractory peritonitis. Acinetobacter is an uncommon cause of gram negative peritonitis with a tendency for antibiotic resistance warranting catheter removal as highlighted by this case.

A Novel Technique for Laparoscopic Salvage of CAPD Catheter Malfunction and Migration: The Santosh-PGI Hanging Loop Technique.

CAPD catheter malfunction is a common problem. Obstruction due to wrapping by appendices epiploicae of sigmoid colon has been rarely reported in literature. We report a case of CAPD catheter malfunction caused by catheter tip migration and obstruction by appendices epiploicae that was successfully managed by laparoscopic hanging loop technique. This case report highlights the ease with which epiplopexy can be performed and catheter tip migration can be prevented by this innovative laparoscopic procedure.

Laparoscopic Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter Placement Using a Two-Port Method in Adult End-stage Renal Disease (ESRD) Patients: Early Experience

Purpose: Laparoscopy is being widely utilized beyond the field of surgery. We report on the early experience of laparoscopic CAPD catheter placement in adult ESRD patients. In addition, we investigate the question of whether laparoscopic CAPD catheter insertion can be used as a feasible long-term procedure. Methods: Laparoscopic CAPD catheter placement was performed in 28 patients by one surgeon, between June, 2010 and October, 2013, and observed. A retrospective outcome study was conducted based on review of medical records. Results: A total of 28 laparoscopic procedures were performed. The mean age of patients who underwent laparoscopic placement of a catheter was 60.3 years old. The most common cause of ESRD was uncontrolled hypertension combined with diabetes. The procedure took 45.7 minutes. Peritoneal dialysis was introduced on postoperative day eight, after one week of daily washing and no dialysate leaks were observed. Two incidences of catheter-related complications were observed: one incidence of catheter obstruction (due to its migration and omental wrapping, which was managed with surgical removal) and one incidence of peritonitis (which was controlled with antibiotics). Conclusion: Laparoscopic CAPD catheter placement using two ports is a simple procedure with minimal complication. Laparoscopic CAPD catheter placement will gain greater acceptance as an alternative to the traditional method of CAPD catheter placement.

Phase I study of intraperitoneal irinotecan in patients with gastric adenocarcinoma with peritoneal seeding

The objectives of this phase I study were to determine the maximum-tolerated dose (MTD), dose-limiting toxicities (DLTs), and preliminary efficacy of intraperitoneally administered irinotecan (CPT-11) in gastric cancer patients with peritoneal seeding. Gastric adenocarcinoma patients with surgical biopsy proven peritoneal seeding were enrolled at the time of surgery. Prior to IP chemotherapy, patients underwent palliative gastrectomy and CAPD catheter insertion in which CPT-11 was administered on postoperative day 1. The IP CPT-11 was initiated at 50 mg/m(2), which was escalated to 100, 150, 200, 250, and 300 mg/m(2). IP CPT-11 chemotherapy was repeated every 3 weeks. Seventeen patients received a total of 56 cycles at five different CPT-11 dose levels. The DLTs were neutropenic fever, neutropenia, and diarrhea. At the dose level 2 (100 mg/m(2)), there were one DLTs in one of the first cohort of three patients, but no DLTs at the second cohort of this level. At the dose level 5 (250 mg/m(2)), two DLTs were detected in the first two patients; thus, the accrual was stopped resulting in the recommended dose of IP CPT-11 of 200 mg/m(2). Median progression-free survival was 8.6 months (95% CI, 5.9,11.2), and median overall survival was 15.6 months (95% CI, 8.4,22.8). Pharmacokinetic results of the study showed that the C (max) of peritoneal SN-38 was achieved earlier than that of plasma SN-38. Intraperitoneally administered CPT-11 was feasible and tolerable. Further, phase II study of IP CPT-11 in gastric cancer patients with peritoneal seeding is warranted.

Transcatheter arterial embolization for hemoperitoneum: unusual manifestation of iatrogenic injury to abdominal muscular arteries

To evaluate the etiology of unusual manifestation of hemoperitoneum and the efficacy of transcatheter arterial embolization (TAE). A retrospective review of patients at three hospitals was performed. A total of 12 patients (M:F = 5:7, mean age: 48) had massive hemoperitoneum without evidence of an intramuscular hematoma on CT (n = 10) or US (n = 2) after injury to the abdominal wall. The patients underwent TAE. The etiology of iatrogenic injury to the abdominal muscular arteries and the effectiveness of embolization were evaluated. Among 12 patients, 11 patients had injuries to the inferior epigastric artery (IEA) and one patient had an injury to the deep circumflex iliac artery (DCIA). The causes of the injuries were: paracentesis (n = 6), open laparotomy (n = 4), removal of a CAPD catheter (n = 1), and surgical drain (n = 1). The TAE was successfully performed in all patients. Over 10 days of follow-up after the embolization, all patients were stabilized hemodynamically. Injury to the IEA or DCIA should be considered as a possible source of hemoperitoneum even in patients with no evidence of an intramuscular hematoma after injury to the superficial arteries of the abdominal wall. In addition, such injuries can be treated successfully using TAE.

Hepatic and Renal Failure after Anterior Myocardial Infarction Induced Apical Ventricular Septal Defect

We report the case of a 68-year-old man suffering from incremental hepatic and renal failure one month after anterior myocardial infarction. Cardiac MRI showed a pronounced apical post-AMI aneurysm, a moderate to severe mitral and tricuspid regurgitation as well as a hemodynamically highly significant 12 mm apical ventricular septal defect with a left-to-right ventricular shunt of almost 63% as the underlying cause. Heart X-ray revealed a severe LAD in-stent restenosis. CAPD catheter drainage of hydroperitoneum due to congestive liver and renal failure was provided in combination with intensified CAPD hemodialysis. Heart surgery was performed where the apical aneurysm was excised, the mitral valve was reconstructed, the IVSD was closed and the subtotally in-stent occluded LAD was bypassed. Post-surgery, the ascites were significantly reduced, and CAPD hemodialysis therapy could be terminated since the renal function gradually improved (MDRD = 25 mL/min). To our knowledge, for the first time we report successful CAPD catheter drainage of hydroperitoneum in combination with CAPD hemodialysis.

An Animal Study of a Newly Developed Skin‐Penetrating Pad and Covering Material for Catheters to Prevent Exit‐Site Infection in Continuous Ambulatory Peritoneal Dialysis

Because currently available peritoneal dialysis catheters are not sufficiently biocompatible with the skin and subcutaneous tissue at the site of penetration, exit-site infection due to pericatheter pocket formation caused by epidermal downgrowth over a long period of time has increasingly become a problem. We developed a new, biocompatible, segmented polyurethane porous material and devised a novel skin-penetrating pad, the form and material of which we optimized for application in peritoneal dialysis catheters. For the extent of tissue ingrowth into this porous material to be examined, test materials with different pore diameters were inserted into hollow silicone tubes and implanted in the subcutaneous tissue of a goat. Four weeks later, the tubes were extracted, and, after the extent of granulation tissue ingrowth was measured, histopathological evaluation was made. Our novel skin-penetrating pad has three disklike layers of the segmented polyurethane material with different pore sizes, into the center of which a polyurethane catheter is inserted. These pads were implanted in the skin of a goat and clinically observed over a 2-year period, after which they were extracted and histopathologically analyzed. In accordance with actual clinical procedures, a commercial CAPD catheter equipped with our skin-penetrating pad was left indwelling in a goat for 4 months, and the performance of the pad was evaluated after repeated periodic infusion and drainage of the dialysate in and out of the abdominal cavity. There was no inflammation of the ingrown tissue in the pores of the segmented polyurethane material as well as the surrounding tissue, which indicated favorable tissue biocompatibility. The extent of tissue ingrowth was greater as the pore size of the material was larger, and the tissue tended to be mature, mainly consisting of collagenous fibers. The skin-penetrating pad using the porous material, of which tissue ingrowth was thus optimized, tightly adhered to the goat skin throughout the 2-year experimental period without any special wound care such as cleansing or disinfection. The performance of the skin-penetrating pad was similarly favorable when attached to a commercial continuous ambulatory peritoneal dialysis catheter. The newly developed segmented polyurethane porous material had excellent tissue biocompatibility and tissue ingrowth. The skin-penetrating pad devised by using this porous material did not cause epidermal downgrowth, suggesting that it may be effective for the prevention of exit-site infection.

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

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.

An unusual case of CAPD-related peritonitis associated with fallopian tube capture of a CAPD catheter

An unusual case of CAPD-related peritonitis associated with fallopian tube capture of a CAPD catheter

Tunnelling device for CAPD catheters.

Tunnelling device for CAPD catheters.

Early Start of CAPD with the Seldinger Technique

The ideal method for inserting continuous ambulatory peritoneal dialysis (PD) catheters remains debatable. Minimally invasive techniques are becoming more popular. The routine recommendation for starting PD is 4 - 6 weeks after catheter insertion. We planned a prospective study to evaluate whether this waiting period is necessary. From January 2003 to July 2004, 42 double-cuff Tenckhoff CAPD catheters were inserted into 41 patients. Percutaneous technique was used and PD was started on the sixth day. Only 2 pericatheter leakages (4.8%) were detected. This procedure is comparatively safe, simple, and less costly than surgical and peritoneoscopic placement. The rate of early pericatheter leakage may be lowered with this technique and PD may be started earlier.