Incidence Of Catheter Migration Research Articles

Laparoscopic vs open surgical insertion of peritoneal dialysis catheters: A propensity score-matched cohort study

BackgroudThe optimal peritoneal dialysis (PD) catheterization method remains under debated. To minimize catheter-related complications, we developed a novel modified low-position two-port laparoscopic technique, and evaluated the efficacy and safety of traditional open and advanced laparoscopic techniques. MethodsA total of 743 patients with uremia who underwent PD catheterization were retrospectively reviewed. For the placement of PD catheters, patients underwent low-position two-port laparoscopic surgery (Lap group) or traditional open surgery (open group). To minimize confounding bias, we performed a 1-to-2 propensity-score matching adjusted for the most clinically relevant potential confounders. The baseline characteristics, perioperative conditions, complications and outcomes were compared between the two groups. ResultsAfter propensity-score matching, a well-balanced cohort comprising 148 matched pairs were identified. In the matched analysis, patients in the Lap group showed significantly shorter operative time (43.0 ± 16.6 versus 81.6 ± 19.8 minutes, P < 0.001) and lower postoperative pain score within 24 hours (0.24 ± 0.62 versus 1.00 ± 1.41, P = 0.002). The incidence of catheter migration in the Lap group was significantly lower than those in the open group (0.7% versus 6.5%, P = 0.006), while other complications, such as catheter occlusion, omentum wrapping, dialysate leakage, bloody effluent, organ injury, hernia, hydrothorax, early tunnel infection and peritonitis, showed no difference (P > 0.05). The Lap group patients had a favorable catheter survival rate compared with group B (log rank, P = 0.032). ConclusionsOur low-position two-port laparoscopic technique is a safe, simple, and fast method that can minimize patient discomfort without additional cost and offers better catheter survival with minimal risk of migration.

Comparative efficacy of Micropore™ surgical dressing, Tegaderm™ and Lockit plus® for lumbar epidural catheter fixation in children: a prospective parallel group randomized controlled trial.

Proper fixation of an epidural catheter is necessary for desired drug effect and to prevent catheter displacement. Different techniques have been used for epidural catheter fixation. The aim of the study was to compare the relative efficacy of Micropore™ surgical dressing, Tegaderm™, and Lockit plus® in preventing lumbar epidural catheter migration in children. We studied 167 patients aged 5-16 years, for up to 48 h. After the elective abdominal or lower limb surgery. Patients were randomly assigned to one of three groups: (1) Micropore™ surgical dressing (group M), (2) Tegaderm™ (group T), or (3) Lockit plus® (group L). Incidence and extent of epidural catheter migration in centimetres (cm); was compared at 24 and 48 h post epidural fixation. Correlation between epidural catheter migration and patient characteristics, and relative incidence of complications in three groups was also analysed. Incidence of catheter migration was 9.6% at 24 h (group M: 7.1%, group T: 21.1% and group L: 0%) and 45.5% at 48 h (group M: 66.1%, group T: 45.6% and group L: 24.1%). After 48 h, absolute migration (mean migration rounded off to the nearest 0.5 cm) was least in patients in group L: 0.34 cm (1.39) compared to group M 1.22 cm (SD: 1.85) group T: 0.94 cm (1.94) (p = <0.001). Up to 48 h after surgery, the Lockit plus® device demonstrated the less epidural catheter migration when compared to micropore surgical dressing or tegaderm in children undergoing elective abdominal or lower limb surgery.

Modified minimally invasive laparoscopic peritoneal dialysis catheter insertion with internal fixation

Background Laparoscopic technique is widely used in peritoneal dialysis (PD) catheter placement. We developed a modified minimally invasive laparoscopic PD catheter (PDC) insertion with internal fixation and evaluated the early results by observing the intraoperative and postoperative conditions of the novel technique with those of conventional open surgery. Methods Retrospective research was performed on 59 patients who underwent PDC insertion from June 2019 to January 2022, including 23 patients who received open surgery and 36 patients who received modified minimally invasive laparoscopic surgery. Information such as preoperative conditions, operation time, incision length, incidence of intraoperative complications, time from operation to starting PD, time from operation to discharge, and incidence of catheter-related complications were collected and analyzed. Results The incision length, intraoperative blood loss, catheter migration rates and the total incidence of complications 6 months after operation in the laparoscopic group were lower than those in the conventional group. There were no statistically significant differences between the two groups in operation time, time from operation to starting PD, time from operation to discharge and the incidence of catheter blockage, leakage, exit-site infection, peritoneal dialysis associated peritonitis and hernia. Conclusions Modified minimally invasive laparoscopic PDC insertion and internal fixation method achieved direct vision and reliable fixation of the catheter, significantly reduced incision length and blood loss. The incidence of catheter migration was significantly lower than that of open surgery. Our primary findings reveal that modified minimally invasive laparoscopic PDC insertion with internal fixation is safe, effective and beneficial for PD patients.

Reduction of leakage from insertion site during continuous femoral nerve block with catheter-through-needle versus catheter-over-needle technique for postoperative analgesia after total knee arthroplasty: a randomized controlled trial

BackgroundContinuous femoral nerve block (CFNB) is a common procedure used for postoperative analgesia in total knee arthroplasty. Continuous nerve block using a conventional needle (catheter-through-needle/CTN) is complicated by leakage of the anesthetic from the catheter insertion site. A different type of needle (catheter-over-needle/ CON) is now available, which is believed to reduce leakage as the diameter of the catheter is larger than that of the needle. The purpose of this study was to compare the incidence of leakage from the catheter insertion site during CFNB while using CTN and CON for postoperative analgesia after total knee arthroplasty (TKA).MethodsThis prospective, randomized, single-blinded controlled study included 60 patients who were scheduled for TKA at our facility between May 2016 and November 2017. Patients were randomly allocated to the CTN or CON groups. All patients in both groups received CFNB and sciatic nerve block for postoperative analgesia. The administration of 0.16% levobupivacaine mixed with 6 mg of indigo carmine (a dye added to easily identify leakage) was started at 6 ml/h at the end of surgery. The primary outcome was the incidence of leakage from the catheter insertion site. We further investigated the degree of leakage, the incidence of catheter migration, pain scores using the numerical rating scale at 48 h postoperatively, and the number of days until the operated knee could be flexed 120 degrees postoperatively in both groups.ResultsThe CON group had a significantly lower incidence and degree of leakage from the catheter insertion site. There were no significant differences in other measurement outcomes.ConclusionsUse of CON reduces the incidence of leakage from the catheter insertion site during CFNB in the use of postoperative analgesia for total knee arthroplasty. Future research is needed to determine additional benefits of using CON related to decreased leakage.Trial registrationThe study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000021537), prospectively registered on 18 March 2016.

Association between different peritoneal dialysis catheter placement methods and short\u2010term postoperative complications

BackgroundConsidering that current peritoneal dialysis has its own shortcomings, In this study, the Seldinger technique was modified to explore the relationship between different catheter placement methods of peritoneal dialysis and short-term postoperative complications.MethodsWe retrospectively analyzed the data of 157 patients who received peritoneal dialysis in the Department of Nephrology of our hospital from January 2017 to December 2019. According to different catheter placement methods, the patients were divided into three groups: 111 cases of open surgery technique, 23 cases of Seldinger technique, and 23 cases of modified Seldinger technique (ultrasound-guided Veress needle puncture). The general data, laboratory indexes, and abdominal infection and catheter-related complications within one month postoperatively were collected.ResultsThere were 48 (31.0 %) cases of complications in 157 patients within one month postoperatively, which were mainly catheter-related complications (45 cases, 29.0 %). The incidence of catheter tip peritoneal drift (catheter migration) in the three groups was 27.3 %, 39.1 %, and 9.1 %, respectively, with no significant difference between groups (P = 0.069). Univariate logistic regression analysis showed that the systolic blood pressure, history of abdominal and pelvic surgery, creatinine, and modified Seldinger technique were possible impact factors of catheter migration (P < 0.10). After fully adjusting for confounding factors, Compared with the open surgery group, the modified Seldinger method group significantly reduced the risk of catheter migration with an OR of 0.161 (95 % confidence interval: 0.027–0.961, P = 0.045); However, the difference between the Seldinger method group and the open surgery group was not significant, with an OR of 1.061 (95 % confidence interval: 0.308–3.649, P = 0.926). Curve fitting showed that the average incidence of catheter migration in the three groups was 27.3 % (95% CI: 15.9-42.7 %), 28.5 % (95% CI: 10.7-56.9 %), and 5.7 % (95% CI: 1.0-27.0 %); the modified Seldinger method has the lowest average incidence of catheter migration.ConclusionsModified Seldinger technique can significantly reduce catheter-related short-term complications after peritoneal dialysis, and it is especially effective in reducing the incidence of catheter migration. Modified Seldinger technique is a safe and feasible method for the placement of a peritoneal dialysis catheter.

Peripherally inserted central cathether migration in neonates: Incidence, timing and risk factors

PICC line use is a common practice in neonatal units, but it is associated with various complications. Catheter migration is the most common complication in neonates. Periodic imaging is recommended to monitor the tip position of the PICCs, but the optimal frequency is undetermined. The incidence, timing and risk factors that are associated with PICC migration have not been fully investigated beyond 24 hrs in neonates. The aim of the study was to determine the incidence, timing and risk factors that are associated with peripherally inserted central venous catheter (PICC) migration in neonates. This was a single center, retrospective study of 168 PICCs placed in 141 neonates in the neonatal intensive care unit (NICU) between 2015 and 2016. The incidence of catheter migration was determined radiographically at 12-24 hrs and every third day after insertion until it was removed. Overall incidence of PICC migration was 28%and most commonly was detected within the first three days after PICC placement (83%). The incidence of PICC migration was higher in males. The PICC migration was associated with difficulty advancing the PICC at the time of insertion and PICC dressing change. Serial evaluation of PICC placement in neonates is required to maintain proper position. Based on our experience in our unit, we recommend periodic imaging at 12-24 hrs and on the third day after PICC placement as most migration occurred within three days after insertion.

Application of the "3Y" shape Multipore tape combined with transparent dressing in the maintenance of double lumen Power PICC

Objective To observe the effect of the application of the 3Y shape Multipore tape combined with transparent dressing in the maintenance of double lumen PowerPICC. Methods Totally150 patients inserted double lumen powerPICC were randomly assigned to experimental group and control group, each group included 75 patients. when maintaining PICC, the 3Y shape Multipore tape combined with transparent dressing were used for experimental group, while traditional method were used for control group. The endpoints were: the time for dressing change,the incidence of catheter migration,the incidence of dressing rolling or loosing,the incidence of PICC related complications. Results The time for dressing change of experimental group (13.14±0.23) min was significant longer than control group (12.99±0.24) min (t=4.025, P<0.05) ; incidence of catheter migration of experimental group (5.3%,4/75) was significant lower than control group (18.7%, 14/75) (χ2=6.424, P=0.04). Incidence of dressing rolling or loosing of experimental group (9.3%,7/75) was significant lower than control group (22.7%,17/75)(χ2=7.028, P=0.03). Incidence of complication of experimental (1.3%, 1/75) was significant lower than control group (9.3%, 7/75) (χ2=4.754, P=0.03) . Conclusions Application of the 3Y shape Multipore tape combined with transparent dressing in the maintenance of double lumen PowerPICC cost a little bite more time,while reduce the incidence of catheter migration and related complications, improve patients′degree of comfort, worth to be widely used. Key words: Nursing care; Double lumen Power PICC; 3Y shape Multipore tape

Wang's Forceps-Assisted Catheter Reposition and Fixation: An Easy and Reliable Rescue Method

Catheter migration and omental wrap are the most common causes of catheter malfunction, which usually result in catheter removal or replacement. The conventional open surgery for catheter reposition has many disadvantages. A new tunnel is needed throughout the procedure of catheter replacement causing more pain and frustration to the patients. Another drawback is that the incidence of catheter migration after conventional catheter reposition surgery is still as high as it was before the procedure. Wang's forceps, an instrument commonly used in our peritoneal dialysis center, is easy and effective in catheter insertion and fixation. Recently, we have successfully used the Wang's forceps to resolve the catheter displacement for 10 patients, including 1 patient who suffered from catheter tip migration 3 times and had undergone conventional catheter rescue by both open surgery and laparoscopy. This new technique was easy and reliable, and the original tunnel was maintained, which reduced pain and risk of infection in the patients. These advantages may grant the Wang's forceps technique favorable over the conventional surgical approach.

Preperitoneal Tunneling – a Novel Technique in Peritoneal Dialysis Catheter Insertion

This study describes a new preperitoneal tunneling (PPT) method for inserting a peritoneal dialysis catheter (PDC), thereby lessening surgical complications and increasing the catheter's survival. This new technique was used in 23 cases from December 2005 to January 2007 and followed up until March 2011 (63 months). The procedure was performed laparoscopically under local (16 cases) or general (7 cases) anesthesia by one surgeon. Catheter survival is reported by Kaplan-Meyer analysis. The catheters were mechanically obstructed in 2/23 cases (8.7%); and were withdrawn due to a peritonitis in 2 cases and inadequacy of peritoneal dialysis in 1 case. Ten patients received kidney transplantation and six died before completing this follow-up period. The patients still reaped the benefits of the PDC until receiving a kidney transplant or death. The 5-year survival rate of the catheter was 89%. No incidence of catheter migration, omental wrapping, herniation or leakage was noticed. Preperitoneal tunneling is a simple and safe method for insertion of PDC, and can effectively prevent catheter migration, dislocation and omental wrapping.

Insertion length and resistance during advancing of epidural catheter

The migration of an epidural catheter into the intravascular and subarachnoid spaces sometimes occurs. This study was designed to investigate where the resistance was felt during the advancing of the catheter into the epidural space and whether the length of catheter advanced in the epidural space affected the incidence of catheter migration. One hundred and twenty women, American Society of Anesthesiologists (ASA) 1 or 2, scheduled to undergo lower abdominal surgeries with epidural anesthesia were randomly assigned to two groups according to the length of the epidural catheter advanced; 4 cm (n = 60) or 8 cm (n = 60). The length where resistance to advancing the catheter was perceived was recorded in all patients, and the incidence of aspiration of blood or cerebrospinal fluid (CSF) was obtained. Further, the catheters removed 48 h after surgery were scrutinized for their bending sites. Resistance was felt in 83 (69.2%) patients and the mean length in the epidural space at which resistance was found was 2.5 +/- 1.2 cm. Blood was aspirated in 9 (7.5%) patients when resistance to advancing the catheter was overcome, but CSF was aspirated in no patient. A distal bend was observed 2.4 +/- 1.3 cm from the tip of the catheter, and the sites of bending were correlated with the length where resistance was encountered. An additional proximal bend was observed in 35 (58%) patients in the 8-cm group, and in 2 patients (3%) in the 4-cm group (P < 0.001), probably due to coiling of the catheter. At approximately 2.5 cm in the epidural space, advancing an epidural catheter causes resistance. Further advancing past this point may cause migration of the catheter into the vessels, or the coiling of the catheter.

Evaluating new technology to improve patient outcomes: a quality improvement approach.

The nurses in the peripherally inserted central catheter (PICC) program at the University of Washington Medical Center perform ongoing data tracking to measure team and patient outcomes. Quality improvement initiatives have included the transition to microintroducer technology and ultrasound-guided placement. Used together, this technology has allowed the PICC team to increase their bedside insertion success rate to 91%. The group has also changed PICC securement methods, and use of the Statlock anchoring device has reduced the incidence of catheter migration from 6% to 1.5% of all catheter lines placed. Catheter durability also was assessed. The Pressure Activated Safety Valve PICC was compared to the Groshong PICC and the rate of catheter repair and exchange due to breakage has been reduced from 11% to 1%.