Modified Peritoneal Dialysis Catheter Insertion: Comparison with a Conventional Method

Abstract

PurposeThe conventional trocar and cannula method in peritoneal dialysis (PD) catheter insertion has its limitation in clinical setting. The aim of this study was to compare a modified method for percutaneous PD catheter insertion with the conventional method, and demonstrate advantages of the modified method.Materials and MethodsPatients at a single center who had percutaneous PD catheters inserted by nephrologists from January 2006 until September 2012, using either a modified method (group M) or the conventional trocar and cannula method (group C), were retrospectively analyzed, in terms of baseline characteristics, complications experienced up to 3 months after the procedure, and the suitability of the procedure for patients.ResultsGroup M included 82 subjects, while group C included 66 cases. The overall early complication rate in group M (1.2%) was significantly lower than that in group C (19.7%) (p<0.001). The catheter revision rate during timeframe for early complications was significantly lower in group M (0%) than in group C (6.1%) (p=0.024). When comparing Procedure time (1 h 3 min±16 min vs. 1 h 36 min±19 min, p<0.01), immediate post-procedural pain (2.43±1.80 vs. 3.14±2.07, p<0.05), and post-procedure days until ambulation (3.95±1.13 days vs. 6.17±1.34 days, p<0.01), group M was significantly lower than group C. There was no significant difference in total hospitalization period (14.71±7.05 days vs. 13.86±3.7 days).ConclusionOur modified PD catheter insertion method shows its advantages in early complication rate, early complications revision rate, and the patients' conveniences.

Randomized controlled trials for comparison of laparoscopic versus conventional open catheter placement in peritoneal dialysis patients: a meta-analysis

“…Lee et al reported [29] that 102 patients who received PD were divided into two groups, which received either laparoscopic or conventional catheter placement, and were followed up for 6 months after the operation. The results showed that the probability of transabdominal tube displacement and blockage in patients who received traditional laparotomy was 12%.…”

Randomized Controlled Trials for Comparison of Laparoscopic Versus Conventional Open Catheter Placement in Peritoneal Dialysis Patients: A Meta-Analysis

“…Compared with laparoscopic minimally invasive PD catheterization, conventional PD catheterization has the following disadvantages: 1) a long operation time, strong pain, a long incision length and a slow recovery [30] ; 2) a limited field of vision, as it is not as open as the laparoscopic minimally 11 invasive operation, and blindcatheter placement by hand leads to inaccurate catheter placement, easy catheter movement or catheter obstruction by the greater omentum [3] ; 3) the incision infection rate is high, with ESRD often associated with a variety of diseases, poor resistance, and traditional PD catheterization associated with a longer incision length and a high staining rate that often lead to surgical failure [3] ; and 4) the operation is more difficult for obese patients [3] . Zhang Lee et al reported [32] that 102 patients who received PD were divided into two groups, which received either laparoscopic or conventional catheter placement, and were followed up for 6 months after the operation. The results showed that the probability of transabdominal tube displacement and blockage in patients who received traditional laparotomy was 12%.…”

Procedimientos en cirugía: Colocación percutánea del catéter de diálisis peritoneal

“…Se introduce el catéter a través de la férula, dirigiendo la punta hacia hueco pélvico por la corredera izquierda, siempre respetando la memoria del catéter. La pelvis izquierda es preferida ya que las asas intestinales -con su peristalsis-tienden a perpetuar el catéter en su lugar [10] (figura 3). Una vez introducido el catéter hasta el dispositivo proximal de dacron, se abre la férula para extraerla.…”

“…Al parecer, con la misma eficacia [8] y no mayores complicaciones [9] que la colocación quirúrgica. Las principales ventajas que presenta esta técnica son la economía y el tiempo de hospitalización, así como el uso de anestesia local y sedación durante su colocación, evitando las complicaciones potenciales de la anestesia general [10].…”