Optimizing peritoneal dialysis catheter placement

Abstract

Long-term success of peritoneal dialysis as a kidney replacement therapy requires a well-functioning peritoneal dialysis catheter. With ongoing reductions in infectious complications, there is an increased emphasis on the impact of catheter-related and mechanical complications. There is currently a marked variation in the utilization of various types of catheters (double cuff vs single cuff, coiled tip vs straight tip), methods of catheter insertion (advanced laparoscopic, open surgical dissection, image guided percutaneous, blind percutaneous), timing of catheter insertion, location of catheter placement (pre-sternal v. abdominal) and peri-operative practices. Specialized approaches to catheter placement in clinical practice include use of extended catheters and embedded catheters. Marked variations in patient lifestyle preferences and comorbidities, specifically in high acuity patient populations (polycystic kidney disease, obesity, cirrhosis) necessitate individualized approaches to catheter placement and care. Current consensus guidelines recommend local procedural expertise, consideration of patient characteristics and appropriate resources to support catheter placement and long-term functioning. This review focuses on an overview of approaches to catheter placement with emphasis on a patient-centered approach.

A New, Safe, and Effective Technique for Percutaneous Insertion of a Peritoneal Dialysis Catheter

“…This confirms that patients at a high risk of adhesions should not be qualified for PCP. This is in line with ISPD guidelines and other studies [1,3,5,9].…”

“…It requires minimal infrastructure yet provides similar survival rates compared to hemodialysis and is cost-effective. In addition, PD is the preferred method for patients awaiting kidney transplantation [1][2][3][4][5][6][7].…”

“…Proper catheter placement is a key element for successful peritoneal dialysis (PD). At present, there are three techniques available for PD catheter placement, which include open surgery, laparoscopic surgery, and percutaneous catheter placement (PCP) [1][2][3][4][5]. Currently, there is no consensus on the preferred catheter placement method.…”

“…The availability of a surgical team may limit the number of procedures performed. Additionally, surgical methods require general anesthesia, which may be associated with potential complications, especially in end-stage renal disease patients co-morbid with advanced chronic heart failure [1][2][3][4]. On the other hand, surgical techniques have an advantage due to the possibility of performing partial omentectomy, omentopexy, or adhesiolysis during the catheter implantation [1][2][3][4][5].…”

“…The procedure is performed under ultrasound control. After the insertion of the guidewire, a dilator and the peel-away sheath are advanced over the guidewire into the abdominal cavity, allowing implantation of the catheter [1][2][3][4][5][6][7]. However, the procedure performed in this way may carry a risk of mechanical complications, especially when performed without fluoroscopic control.…”