Pneumoperitoneum needle vs. introducer needle: Comparison of complications and short‐term outcomes in percutaneously inserted peritoneal dialysis catheters in naïve abdomens

Abstract

Percutaneous peritoneal dialysis catheter (PDC) insertion for continuous ambulatory peritoneal dialysis (CAPD) entails a higher risk of complications such as bowel injury, vascular injury, and catheter migration compared to the surgical insertions. We conducted a comparative analysis of two techniques of peritoneal entry for PDC insertion by Seldinger technique. We performed a retrospective review of 426 percutaneously inserted PDCs in nonobese naïve abdomens for CAPD at two tertiary care teaching hospitals in India over 6 years. Comparison of various mechanical complications, and short‐term catheter survival was done between use of introducer needle (Group “I”) and spring‐loaded pneumoperitoneum (Veress) needle (Group “V”). Group “I” to “V” patient ratio was 277:149. Group “I” had heavier patients (p = 0.03) whereas “V” group had a dominance of diabetes (p = 0.009) and prior hemodialysis patients (p = 0.03). At 3 months, the odds of mechanical complications (OR = 0.27, p = 0.004), PDC migration (OR = 0.18, p = 0.02), and omental wrapping (OR = 0.13, p = 0.04) were less in “V” group. No bowel injury occurred with Veress needle use. At 6 months, “V” group had higher odds of event‐free sustained PDC tip position (OR = 0.39, p = 0.003), and catheter survival (p = 0.03), and the cumulative events were lesser too (p = 0.002). Refractory peritonitis and deaths with functioning catheter were comparable between both the groups. In this first‐of‐its‐kind study, spring‐loaded Veress pneumoperitoneum needle use was safer, entrusted sustained PDC tip position in pelvis, and had a better catheter survival compared to use of introducer needle for peritoneal entry in percutaneously inserted PDCs. These findings should be confirmed by a randomized controlled study.

Research on comprehensive analysis of patient comfort and complication rate using haemodialysis indwelling needles in AVF puncture in haemodialysis treatment

“…Our study proposes with the improvement of the development level of modern science and technology, blood purification operation technology has been continuously optimized that. Similalrly, according to Dogra et al 11 and Kashima and Ninomiya 12 the treatment safety, comfort and long-term survival rate of maintenance haemodialysis patients have also been significantly improved. One of the significant issues in haemodialysis is how choose a pathway that can be used for a long time and maintain good blood flow.…”