Percutaneous Peritoneal Dialysis Catheter Insertion by a Nephrologist: A New, Simple, and Safe Technique

Abstract

♦ Background: Insertion of the peritoneal dialysis (PD) catheter by a nephrologist has been encouraged by several studies. The ultimate goal is to provide safe, timely, and effective catheter insertion without an unduly long wait time or delay. The success of PD depends partly on the ease of catheter insertion. We developed a new technique for percutaneous PD catheter insertion by nephrologists. Our new technique, in addition to being easy, proved to be safe and to eliminate the need for the peel-away sheath. ♦ Methods: Data were collected prospectively on all patients having a PD catheter inserted by a nephrologist using our new technique (40 catheters in 38 patients). All catheters were evaluated for infectious and mechanical complications. ♦ Results: The mean duration of the procedure from skin sterilization to the end of insertion was 24 ± 3 minutes. No bowel perforation or serious hemorrhage was recorded. Poor initial drainage was recorded in 12.5% of the catheters (n = 5) during the 4 weeks after insertion. The incidence of early exit-site leakage was 2.5% (1 catheter). Episodes of exit-site infection occurred in 5.0% and 12.5% of catheters (within 1 month and by the end of study period respectively). Two episodes of peritonitis were reported by the end of the 12-month period. Catheter survival was 95.0% and 87.5% at 6 months and 12 months respectively. ♦ Conclusions: Percutaneous bedside placement of PD catheters using our new technique is safe and carries less morbidity in terms of bowel perforation, catheter-related infection, and exit-site leak. In addition, our new technique appears to have a high success rate and to offer considerable savings in terms of operating time.

Acute Kidney Injury in Critically Ill Patients: A Prospective Randomized Study of Tidal Peritoneal Dialysis Versus Continuous Renal Replacement Therapy

“…Our PD unit at King Fahd University Hospital is one of the most experienced in the Middle East with PD therapy. Importantly, we have developed a new technique in PD catheter insertion that made the rapid institution of PD much simpler than before . In our study, Physioneal was chosen as a potentially more physiologic dialysate as it limits the potential undesirable side effects of the lactate‐buffered solutions .…”

“…Our protocol indicated that treatment should be given continuously with a change of membrane every 48 h. In patients randomized to TPD, a flexible double cuff Tenckhoff catheter (Flex‐Neck Classic Peritoneal Dialysis Catheter, Merit Medical Systems, Inc. South Jordan, UT, USA) was used. All PD catheters were inserted by trained nephrologists using Al‐Hwiesh technique (Fig. ).…”

Peritoneal Dialysis for Acute Kidney Injury Treatment in the United States: Brought to You by the COVID-19 Pandemic

“…Therefore, percutaneous catheter insertion with or without image guidance may be considered for peritoneal access 29,30 . Although experience with percutaneous placement is not as widespread, it is a technique that can be performed at bedside or in the radiology suite by surgeons, interventional radiologists, or interventional nephrologists who have learnt these techniques for the first time during the COVID-19…”

Ultrasound‐guided percutaneous peritoneal dialysis catheter insertion using multifunctional bladder paracentesis trocar: A modified percutaneous PD catheter placement technique

“…In contrast, retrospective studies have reported incidences of 20.2% using blind percutaneous insertion and 27.1% using laparoscopy 20,21 . In some reports, incision and tunnel infection have occurred regardless of technique (surgical laparotomy, percutaneous puncture, or laparoscopic catheterization) 5,20,22 . We believe that our new PD catheterization method has inherent advantages in this regard.…”

“…20,21 In some reports, incision and tunnel infection have occurred regardless of technique (surgical laparotomy, percutaneous puncture, or laparoscopic catheterization). 5,20,22 We believe that our new PD catheterization method has inherent advantages in this regard.…”