Different outcomes of peritoneal catheter percutaneous placement by nephrologists using a trocar versus the Seldinger technique: the experience of two Brazilian centers

Abstract

A good catheter implantation technique is important to allow effective peritoneal access function and long-term technique survival. Studies regarding results obtained by nephrologists in comparison with different techniques have been limited. The aim of this study was to investigate the rate of early catheter-related complications and catheter survival in two Brazilian centers, according to two different percutaneous methods of catheter implantation performed by nephrologist team. Adult incident patients recruited from January 2006 to July 2013 having undergone first peritoneal dialysis (PD) catheter implantation were included in the analysis. Mechanical and infectious early complication rates were defined as time to the first event occurring up to 3 months. Four hundred and forty-five consecutive Tenckhoff catheters were implanted by nephrologist team percutaneously after antibiotic prophylaxis in an operating room: trocar was used in 349 (78.4 %) and Seldinger technique (ST) in 99 (21.6 %). The ST was significantly associated with a lower rate of leak (16.3 vs 3 %, p = 0.03) and outflow failure due to tip catheter migration (22.6 vs 10.1 %, p = 0.04), while early infectious complication rates were similar between the two groups (p = 0.59). Long-term catheter survival was higher in Seldinger group (log-rank, p = 0.031). By Cox multivariate analysis, adjusted for age, sex, and diabetes, the ST remained independently associated with better catheter survival [HR 0.681 (0.462-0.910), p = 0.04]. As conclusion, our experience showed better PD outcomes with the ST than trocar method of catheter implantation by nephrologist.

Acute kidney injury: risk factors and management challenges in developing countries

“…With the increasing interest in using PD to manage patients with AKI, [35][36][37][38][39][40][41][42][43] the first question that must be asked is whether PD can provide adequate clearance in the treatment of these patients. 44,45 The optimal prescription of dialysis in AKI is hampered by our lack of understanding of the exact factors that influence survival.…”

Peritoneal Dialysis Treatment Modality Option in Acute Kidney Injury

“…With increasing interest being shown in using PD to manage patients with AKI [3,8,9,10,11,12,13,14,15,16], the first question that must be asked is whether PD can provide adequate clearance in the treatment of these patients [6,12,13]. …”

Wang's Forceps‐Assisted Percutaneous Insertion and Fixation of Peritoneal Dialysis Catheter

“…Based on our previous experiences of utilizing Wang's forceps in the procedures of open surgical catheter insertion and displaced catheter reposition , we feel the core issue of the Wang's forceps application is to establish an access across the abdominal wall, through which the fixing arm of Wang's forceps can be advanced into the peritoneal cavity . In the procedure of percutaneous catheter placement, the access to the peritoneal cavity is created either by the trocar (in trocar and cannula technique) or the split sheath (in Seldinger technique) . After comparing the diameters of the fixing arm of Wang's forceps, trocar, and split sheath, we found that both diameters of trocar and split sheath (size 24 Fr) are large enough allowing the fixing arm of Wang's forceps to pass through freely (Fig.…”

“…We then tested the practical feasibility in porcine model. Considering the superiority of the Seldinger technique over the trocar and cannula technique , we selected the Seldinger technique to converge with Wang's forceps technique. The details of the toolkits being applied in the procedure are presented in Fig.…”

“…Among these methods, percutaneous catheter placement, possessing the merits of minimal invasion, relatively simple to perform, and surgeon and operating room independent, is more preferred by nephrologists . The percutaneous catheter placement can be performed by the “trocar and cannula technique” or the “Seldinger technique.” The Seldinger technique might be superior over the trocar and cannula technique with less complications and more catheter survival . However, either using the Seldinger technique or the trocar and cannula technique, the percutaneous placement of catheter is essentially a blind approach that may not avoid the complications of catheter malposition or bowel perforation .…”