Peritoneal catheter fixation combined with straight upward tunnel and low implant position to prevent catheter malfunction

Zhang, Qingyan; Jiang, Chunming; Zhu, Wei; Sun, Cheng; Xia, Yangyang; Tang, Taiwen; Wan, Cheng; Shao, Qiuyuan; Liu, Jing; Jin, Bo; Zhang, Miao

doi:10.1111/nep.12968

Cited by 6 publications

(3 citation statements)

References 22 publications

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“…The interventions introduced in the included studies were as follows: catheter type/configuration in 17 studies (36%) 14 –30 with the most frequently studied intervention was comparing straight versus coiled intra-abdominal part of the catheters (9 RCTs). Insertion technique in 15 studies (32%) 31 –45 with the most frequently studied intervention open versus laparoscopic catheter insertion (4 RCTs), two interventions in 3 studies (6%), 46 –48 and there were 6 other different interventions in 12 studies (26%) (Supplementary Table 1). Study characteristics of the included trials can be found in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…In our review, other outcomes have also been reported frequently like postoperative pain, 35,37,42,43,45,52,53 length of wound, 35,37,45 and incidence of delayed wound healing. 44,49 Postoperative pain is patient-centered and may warrant further characterization in terms of incidence and may be considered as targets for future ISPD PD access guidelines.…”

Section: Discussionmentioning

confidence: 99%

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Peritoneal dialysis access outcomes reported in randomized controlled trials: A systematic review

et al. 2020

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Background: Functional peritoneal dialysis (PD) access is critical to the success of PD therapy. The aim of this review is to describe the spectrum of definitions and methods employed in the measurement of unique outcomes across PD access trials particularly focusing on the outcomes of PD access flow restriction and operative-related outcomes. Methods: Using Cochrane CENTRAL registry, MEDLINE, and EMBASE, we searched for studies restricted to randomized controlled trials (RCTs) involving interventions related to PD access without restrictions on age, language, or publication year. Studies were screened and data abstracted by two independent reviewers. Definitions, outcome measures, and time points of measurements were captured and documented separately. Unique combinations of these variables resulted in reporting the different ways of measurements. Results: Of the 1768 screened studies, 47 RCTs were included among which 817 PD access outcomes were grouped into 7 broad categories. Interventions evaluated in the RCTs were catheter type/configuration ( n = 17), insertion technique ( n = 15), multiple interventions ( n = 3), and other (6 interventions, n = 12). PD access flow restriction (a subcategory of mechanical outcomes) and operative-related outcomes were reported in 91% and 58% of the included trials, respectively. Tip migration was the most frequently reported flow restriction outcome (59% of RCTs) followed by catheter dysfunction (23% of RCTs). Of the components utilized in definition of flow restriction, description of the impaired flow was reported in 37% of RCTs, need for intervention in 42% of RCTs, and presumed etiology of flow restriction in 60% of RCTs. Conclusion: Variability exists in the definitions, reporting methods, choice of outcomes, and analysis of the PD access outcomes across RCTs. Operative-related outcomes remain underreported across RCTs. Outcomes relating to PD access flow restriction were the most common complications reported in the included RCTs but were reported heterogeneously with variability in reporting of the three key components of its definition including description and severity of the flow restriction, the need for intervention and etiology of flow restriction. In the future, defining PD access flow restriction should include all of these components to better evaluate the comparative effect of various PD access interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Peritoneal dialysis access outcomes reported in randomized controlled trials: A systematic review

et al. 2020

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“…Experiences in Australia and other countries make it clear that nephrologists can perform these procedures safely and effectively. [16][17][18][19][20] Interventional nephrology is in its infancy in Australia and New Zealand, but may grow as more junior doctors are exposed to it during their training and with the support of the local society. 21 Patients outside of major cities may be the greatest beneficiaries of growth in interventional nephrology given their more limited access to vascular surgeons (demonstrated in the present survey) and their lower rates of commencing dialysis with a functioning fistula.…”

Section: Discussionmentioning

confidence: 99%

Arteriovenous access practices in Australian and New Zealand dialysis units

et al. 2019

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Background: The creation and maintenance of dialysis vascular access is associated with significant morbidity. Structured management pathways can reduce this morbidity, yet practice patterns in Australia and New Zealand are not known. We aimed to describe the arteriovenous access practices in dialysis units in Australia and New Zealand. Methods: An online survey comprising 51 questions was completed by representatives from dialysis units from both countries. In addition to descriptive analysis, responses were compared between units inside and outside of major cities. Results: Of 64 contacted units, 48 (75%) responded (Australia 43, New Zealand 5), representing 38% of dialysis units in Australia and New Zealand. While 94% of units provided pre-dialysis education, only 60% reported a structured pre-dialysis pathway and 69% had a dedicated vascular access nurse. Most units routinely monitored fistula/graft function using flow rate measurement (73%) or recirculation studies (63%). A minority used routine ultrasound (35%). Thrombectomy, fistuloplasty and peritoneal dialysis catheter insertion were rarely performed by nephrologists (4%, 4% and 17% of units, respectively). Units outside of a major city were less likely to have access to a local vascular access surgeon (6/13 (46%) vs 35/35 (100%), P < 0.001). There were no other significant differences between units on the basis of location. Conclusion: Much variation exists in unit management of arteriovenous access. Structured pre-dialysis pathways and dedicated vascular access nurses may be underutilised in Australia and New Zealand. The use of regular access blood flow measurement and ultrasound is common in both countries despite a lack of data supporting its effectiveness. There is room for both practice improvement and a need for further evidence to ensure optimal arteriovenous access care.

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Catheter type, placement and insertion techniques for preventing catheter-related infections in chronic peritoneal dialysis patients

Htay

Johnson

Craig

et al. 2019

Cochrane Database of Systematic Reviews

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Peritoneal catheter fixation combined with straight upward tunnel and low implant position to prevent catheter malfunction

Abstract: Catheter fixation combined with straight upward tunnel and low implant position can effectively prevent catheter malfunction in PD catheter placement.

Cited by 6 publications

References 22 publications

Peritoneal dialysis access outcomes reported in randomized controlled trials: A systematic review

Peritoneal dialysis access outcomes reported in randomized controlled trials: A systematic review

Arteriovenous access practices in Australian and New Zealand dialysis units

Catheter type, placement and insertion techniques for preventing catheter-related infections in chronic peritoneal dialysis patients

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