Ultrasound/Fluoroscopy‐Assisted Placement of Peritoneal Dialysis Catheters

Abstract

Peritoneal dialysis (PD) catheters may be inserted blindly, surgically, and either by laparoscopic, peritoneoscopic, or fluoroscopic approach. A modified fluoroscopic technique by adding ultrasound-assistance was performed in the present study to ensure entry into the abdominal cavity under direct ultrasound visualization. From March 2005 to May 2007, ultrasound-fluoroscopic guided placement of PD catheters was attempted in 32 end-stage renal disease (ESRD) patients. Preoperative evaluation was performed on all patients prior to the procedure. After initial dissection of the subcutaneous tissue anterior to the anterior rectus sheath, the needle was inserted into the abdominal cavity under the guidance of ultrasound. The position of the epigastric artery was also examined using ultrasonography to avoid the risk of arterial injury. PD catheters were successfully placed in 31 of the 32 ESRD patients using this technique. In all of these patients, the needle could be seen entering the abdominal cavity using an ultrasound. In one patient the procedure was abandoned because of bowel puncture by the micro-puncture needle that was inadvertently advanced into a loop of bowel. This patient did not develop acute abdomen nor needed any intervention. One patient died 4 days after placement of the catheter of unrelated causes. One patient was started on acute peritoneal dialysis the same day of catheter placement without any complications. The rest of the patients started peritoneal dialysis within 2-6 weeks of catheter placement. None of the patients had bleeding related to arterial injury as ultrasound was able to visualize the epigastric artery. Our experience shows that ultrasound-fluoroscopic technique is minimally invasive and allows for accurate assessment of the entry into the abdominal cavity. This technique can avoid the risk of vascular injury altogether.

The Effects of Previous Abdominal Operations and Intraperitoneal Adhesions on the Outcome of Peritoneal Dialysis Catheters

“…1 PD AND INTRAPERITONEAL ADHESIONS catheter insertion but also would adversely affect catheter survival. History of previous major abdominal surgery is considered a contraindication for blind and fluoroscopically assisted Seldinger needle-guidewire approaches to catheter insertion due to placement failure and risk of bowel perforation (5)(6)(7)(8)(9)(10). While open placement permits direct visual confirmation of entry into the peritoneal cavity, insertion of the catheter is still performed mostly by feel, and therefore blindly.…”

Fluoroscopically guided percutaneous peritoneal dialysis catheter placement: single center experience and review of the literature

“…23,24 Ultrasound allows for direct visualization of landmarks such as the subcutaneous tissue, the rectus sheath, and the peritoneal cavity, and the color flow Doppler capability helps to identify and avoid vessels such as the epigastric artery. We did not use ultrasound guidance, yet we did not encounter significant bleeding complications.…”

Section 5: Dialysis Interventions for Treatment of AKI

“…645, 646 Blind placement has been largely replaced by surgical placement or placement guided by ultrasound/fluoroscopy, laparoscopy, or peritoneoscopy. 647, 648, 649 Continuous-flow PD dictates the need for an efficient dual-lumen catheter or two separate catheters with ports separated maximally. 646 Outside the pediatric setting, no investigations have specifically looked at peritoneal catheters in the setting of AKI.…”