Salvage of Malpositioned and Malfunctioning Peritoneal Dialysis Catheters by Manipulation with a Modified Malecot Introducer

Abstract

Percutaneous peritoneal dialysis (PD) catheter manipulation successfully corrects displacement and contributes to catheter salvage. We describe a new device for the percutaneous treatment of malpositioned PD catheters, the modified Malecot introducer technique, which is an improvement over previous methods because its flexible consistency also allows the manipulation of swan-neck catheters. Twenty-one patients experienced catheter displacement managed by the new introducer: 12 males, average time in PD 13.7+/-23.2 months, six with "swan-neck" catheter, seven obese, and six with previous abdominal surgery. Catheter manipulation was technically successful in 19 of 21 cases (90.4%) by the end of the first week and in 15 cases (71.4%) at 1 month. An additional eight episodes of malposition occurred ranging from 10 to 300 days after the first manipulation. A second manipulation using the same introducer was performed and resulted in long-term patency in seven patients. No complications were reported. In the long-term follow-up, only one patient removed PD catheter for mechanical dysfunction. Overall survival of manipulated catheters was 32.7+/-23.4 months. Function at 1 month correlated with function by the first week (r=0.513; p=0.017) and the need of a second manipulation with age (r=0.494; p=0.027) but not with obesity or previous abdominal surgery. We conclude that manipulation using the modified Malecot introducer is a simple and effective procedure for the correction of malpositioned PD catheters. It also represents a new alternative for the management of displaced "swan-neck" catheters.

A Modified Open Surgery Technique for Peritoneal Dialysis Catheter Placement Decreases Catheter Malfunction

“…C atheter malfunction, commonly seen in peritoneal dialysis (PD), is a major cause for PD technique failure (1-4). Aggressive interventions are usually needed to restore catheter function once catheter malfunction occurs (5-8). The need for intervention not only increases medical costs, but also increases the risk for complications accompanying the secondary procedures.…”

A Modified Open Surgery Technique for Peritoneal Dialysis Catheter Placement Decreases Catheter Malfunction

“…Aggressive interventions are usually needed to restore catheter function once catheter malfunction occurs (5)(6)(7)(8). The need for intervention not only increases medical costs, but also increases the risk for complications accompanying the secondary procedures.…”

Postimplantation X-ray parameters predict functional catheter problems in peritoneal dialysis

“…9,12 Similarly, there was no significant association of the outcomes with weight or body mass index, although the available literature shows equivocal findings in this respect. [13][14][15] However, as can be judged from Tables 2 and 3, swan neck angle category was associated with body size, and inclination was related to body size and history of abdominal surgery. From this, it can be interpreted that proper positioning of a PD catheter in the abdominal wall is a greater challenge in obese patients and patients with a history of abdominal surgery.…”