Immediate Initiation of CAPD following Percutaneous Catheter Placement without Break-in Procedure

Abstract

Objective To evaluate the effect of a modified method of percutaneous catheter placement without a break-in procedure on the development of catheter-related complications in patients on continuous ambulatory peritoneal dialysis (CAPD). Design A prospective, observational clinical study. Setting Peritoneal dialysis (PD) units of two university-based hospitals. Patients and Methods This study included 51 consecutive patients on CAPD. A straight double-cuffed Tenckhoff catheter with a straight intraperitoneal segment was used, and all catheters were inserted using a modified percutaneous placement method under local anesthesia. The catheter was introduced directly into the deep pelvis through an intramuscular tract, which had been created by tapered dilators. Peritoneal dialysis was initiated immediately after catheter insertion without a break-in procedure. Catheter-related complications were surveyed during the 12 months after initiation of CAPD. Results Within the first month, only 1 pericatheter leakage (1.9%) was detected. There were no cases of visceral perforation or severe hemorrhage during catheter insertions. Catheter malfunction due to catheter tip migration, exit-site infection, and peritonitis developed in only 1.9%, 3.9%, and 3.9% of patients, respectively. After 1 month following catheter insertion, no further incidences of pericatheter leakage occurred during the follow-up period. All catheters, except one that was reinserted due to tip migration, survived throughout the study period. Conclusion The rates of pericatheter leakage and other catheter-related complications are relatively low in CAPD patients using our percutaneous catheter placement method without a break-in procedure. This procedure is comparatively simple and less invasive than other catheter placement methods, and allows for immediate start of PD after catheter insertion, without a break-in procedure.

Effects of early detection of peritoneal catheter migration on clinical outcomes: 15‐years experiences from a single centre

“…As described previously, all PD catheters were inserted by a nephrologist with a modified percutaneous placement method using guidewire. 11 All PD catheters were doublecuffed, straight-end, Tenckhoff catheters with a swan neck (SN) or non-swan neck (NSN) configuration. PD was initiated without a break-in period immediately after catheter insertion.…”

“…Our previously published results have shown that most of catheter migration did not associate with catheter malfunction in these PD population. 11 Our practice is to detect catheter migration without poor outflow early and then to attempt conservative management with rigorous catharsis using high doses of oral lactulose. Unlike the results of previous studies, fluoroscopic or laparoscopic procedures and surgical revision are rarely needed to restore catheter migration in our centre.…”

Shorter break‐in period is a viable option with tighter PD catheter securing during the insertion

“…11 The resulting tight catheter securing improved the catheter outcome irrespective of the surgical 12,13 or percutaneous insertions. 11 In both of our insertion techniques, similar catheter securing was achieved through a combination of an intramuscular tunnel and two additional purse-string sutures. Although our study had the limitation of a retrospective design, an initial hospital stay during the break-in period, prospective data recording and the patient follow up exclusively in the PD clinics ensured an adequate capturing of the catheter-related outcomes.…”

“…These modifications focused on a tight inner cuff fixation either by additional sutures around the inner cuff 13 or by inner cuff securing in an intramuscular tunnel. 11 Apparently, these results have a tremendous clinical relevance; however, owing to the single arm designs, these studies could not exclude a confounding effect of other known risk factors for catheter leak on the observed results.…”

“…[11][12][13] In these studies, the inner-cuff fixation was achieved either by placing additional purse-string sutures at the posterior and anterior rectus sheaths, 12,13 or by securing inner cuff in an intramuscular tunnel created in the rectus muscle. 11 The resulting tight catheter securing improved the catheter outcome irrespective of the surgical 12,13 or percutaneous insertions. 11 In both of our insertion techniques, similar catheter securing was achieved through a combination of an intramuscular tunnel and two additional purse-string sutures.…”