Guide Wire Directed Manipulation of Malfunctioning Peritoneal Dialysis Catheters: A Critical Analysis

Savader, Scott J.; Lund, Gunnar B.; Scheel, Paul J.; Prescott, Carol A.; Feeley, Nancy; Singh, Harjit; Osterman, Floyd A.

doi:10.1016/s1051-0443(97)70693-6

Cited by 52 publications

(37 citation statements)

References 11 publications

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“…The technique survival rate was also significantly lower when the access revision was performed within 3 months of PD initiation. This experience emphasizes the importance of meticulous attention to surgical technique and postoperative catheter care, which have been emphasized in pediatric guidelines and recently, by the Standardized Care to Improve Outcomes in Pediatric ESRD (SCOPE) collaborative (33,34).…”

Section: Discussionmentioning

confidence: 97%

Peritoneal Dialysis Access Revision in Children: Causes, Interventions, and Outcomes

Borzych-Dużałka¹,

Aki²,

Azócar³

et al. 2016

CJASN

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Background and objectives Little published information is available about access failure in children undergoing chronic peritoneal dialysis. Our objectives were to evaluate frequency, risk factors, interventions, and outcome of peritoneal dialysis access revision. Results In total, 452 access revisions were recorded in 321 (13%) of 2453 patients over 3134 patient-years of followup, resulting in an overall access revision rate of 0.14 per treatment year. Among 824 incident patients, 186 (22.6%) underwent 188 access revisions over 1066 patient-years, yielding an access revision rate of 0.17 per treatment year; 83% of access revisions in incident patients were reported within the first year of peritoneal dialysis treatment. Catheter survival rates in incident patients were 84%, 80%, 77%, and 73% at 12, 24, 36, and 48 months, respectively. By multivariate logistic regression analysis, risk of access revision was associated with younger age (odds ratio, 0.93; 95% confidence interval, 0.92 to 0.95; P,0.001), diagnosis of congenital anomalies of the kidney and urinary tract (odds ratio, 1.28; 95% confidence interval, 1.03 to 1.59; P=0.02), coexisting ostomies (odds ratio, 1.42; 95% confidence interval, 1.07 to 1.87; P=0.01), presence of swan neck tunnel with curled intraperitoneal portion (odds ratio, 1.30; 95% confidence interval, 1.04 to 1.63; P=0.02), and high gross national income (odds ratio, 1.10; 95% confidence interval, 1.02 to 1.19; P=0.01). Main reasons for access revisions included mechanical malfunction (60%), peritonitis (16%), exit site infection (12%), and leakage (6%). Need for access revision increased the risk of peritoneal dialysis technique failure or death (hazard ratio, 1.35; 95% confidence interval, 1.10 to 1.65; P=0.003). Access dysfunction due to mechanical causes doubled the risk of technique failure compared with infectious causes (hazard ratio, 1.95; 95% confidence interval, 1.20 to 2.30; P=0.03).Conclusions Peritoneal dialysis catheter revisions are common in pediatric patients on peritoneal dialysis and complicate provision of chronic peritoneal dialysis. Attention to potentially modifiable risk factors by pediatric nephrologists and pediatric surgeons should be encouraged.

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Section: Discussionmentioning

confidence: 97%

Peritoneal Dialysis Access Revision in Children: Causes, Interventions, and Outcomes

Borzych-Dużałka¹,

Aki²,

Azócar³

et al. 2016

CJASN

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“…Savader et al [15] reported that the success rate of guide wire directed manipulation of malfunctioning CAPD catheters was 58%. Diaz-Buxo et al [16] reported that the overall success rate of fluoroscopic manipulation of malfunctioning Tenckhoff catheters was 60.9%.…”

Section: Discussionmentioning

confidence: 99%

Use of Fluoroscopy-Guided Wire Manipulation and/or Laparoscopic Surgery in the Repair of Malfunctioning Peritoneal Dialysis Catheters

et al. 2002

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Background: Peritoneal catheter is the lifeline for the continuous ambulatory peritoneal dialysis (CAPD) patients. Over the years, obstruction or displacement of the CAPD catheter has been one of the common complications of CAPD. Fluoroscopy-guided wire manipulation or laparoscopic surgery has been developed to manage outflow obstruction. We analyzed the catheter outcome of fluoroscopy-guided wire manipulation or laparoscopic surgery to determine the ultimate benefit of these procedures. Methods: From June 1996 to August 2000, catheter complications were manipulated in 24 patients. Eleven (46%) of these patients were initially managed by guide wire under fluoroscopic control. The remaining 13 (54%) patients were manipulated by laparoscopic surgery. A successful outcome was defined as maintained normal peritoneal catheter function at 30 days after the manipulations. Among the catheters manipulated, 18 (75%) were inserted by nephrologist and 6 (25%) by surgeons at the initiation of CAPD. Tenckhoff double-cuff peritoneal catheters were inserted to all patients. Results: The time elapsed between catheter insertion and manipulation varied from 1 to 60 days with a mean of 11 days. The primary causes of catheter malfunction were kinking in 1 case, omental wrapping with adhesions in 9 cases, and catheter displacements in the remaining 14 cases. Thirty-day catheter function was achieved in 50% (12/24) of initial catheter manipulations, with guide wire under fluoroscopic control (46%, 5/11) and laparoscopic surgery (54%, 7/13). Overall success rate of repeated manipulation was 71% (17 of 24). Conclusion: The successful outcome in repairing of the malfunctioning CAPD catheters could be increased by the combination of fluoroscopy-guided wire manipulation and laparoscopic surgery.

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“…Catheter malfunction is most commonly owed to mechanical complications, e.g., kinking, malpositioned catheter tip, catheter fibrin coating, omentum deposition, obturation and secondarily to intraperitoneal adhesion or infection [2,3]. Complications frequently cause considerable problems for ESRD patients, including an increased risk of losing access to CAPD dialysis.…”

Section: Introductionmentioning

confidence: 99%

Peritoneal dialysis catheter placement—is laparoscopy an option?

Lund

Jønler

2007

Int Urol Nephrol

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Guide Wire Directed Manipulation of Malfunctioning Peritoneal Dialysis Catheters: A Critical Analysis

Cited by 52 publications

References 11 publications

Peritoneal Dialysis Access Revision in Children: Causes, Interventions, and Outcomes

Peritoneal Dialysis Access Revision in Children: Causes, Interventions, and Outcomes

Use of Fluoroscopy-Guided Wire Manipulation and/or Laparoscopic Surgery in the Repair of Malfunctioning Peritoneal Dialysis Catheters

Peritoneal dialysis catheter placement—is laparoscopy an option?

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