A New Technique for Insertion of the Tenckhoff Peritoneal Dialysis Catheter

Abstract

To eliminate the discomfort caused by surgical methods and the risks involved using the trocar, for 1 year we have been using a new technique for insertion of peritoneal catheters (PC). We devised a steel instrument, vaguely resembling a rhinoscope, composed of two semicones. The handles are connected by a screw to permit dilatation of the semicones. After local anesthesia, an introducer needle is inserted into the peritoneal cavity. A guide-wire is passed through the needle which is then withdrawn and our instrument is placed around the guide and gently pushed into the peritoneal cavity. The guide is now removed and squeezing the handles of the instrument we introduce the PC up to 2 cm beyond the first Dacron cuff. When the catheter is in place, the instrument is removed and a subcutaneous tunnel may be made. We have used this method for 25 patients. 14 were new cases while 11 underwent PC repositioning. For all patients this new method proved to be excellent with practically no leakage and PC were utilized immediately or after only 24 h. We emphasize the brief time for PC insertion, the minimum discomfort and the simplicity of the technique.

The Self-Locating Catheter: Clinical Experience and Follow-Up

“…Twelve grams of tungsten, a physically and chemically inert element, are sufficient for continuous self-positioning of the tip in the lowest point of the Douglas cavity, without altering catheter function, causing discomfort, or interfering with the organs it contacts. It can be inserted by the methods used for the Tenckhoff catheter or by a keyhole technique developed by us, involving the use of a specially designed steel insertion forceps, an insertion needle (16 gauge × 7 cm), a flexible steel guide (50 cm × 1 mm), a rigid round-ended mandrel, and an echo tomographic guide (24,25,27).…”

Bleeding Complications Associated with Peritoneal Dialysis Catheter Insertion

“…There is a paucity of data in the literature regarding the risk of hemorrhagic complications associated with the insertion of PDCs. Based on the available literature, the incidence of bleeding associated with PDC insertion using an open surgical approach appears to range anywhere from 1% to 8% (1,(4)(5)(6)(7)(8)(9)(10). These studies are summarized in Table 2.…”

Injury to the Inferior Epigastric Artery Complicating Percutaneous Peritoneal Dialysis Catheter Insertion

“…Initial experience with percutaneous placement of PD catheters utilized a lower abdominal midline approach. Other methods, such as surgical placement, guide-wire/ peel-away sheath, and laparoscopy-guided placement have subsequently been reported (3-10). Several variations have been described in attempts to reduce early complications and prolong catheter life.…”