A Change to Radiological Peritoneal Dialysis Catheter Insertion: Three-Month Outcomes

Abstract

♦♦ ♦♦ ♦ Background: Best practices for peritoneal dialysis (PD) catheter insertion call for timely placement of catheters to reduce complications and increase the likelihood of a successful initiation of PD. The purpose of our study was to assess if a change in approach to PD catheter insertion, including a switch to radiological insertion of PD catheters and introduction of a dialysis access nurse to coordinate all patient care, was associated with more outpatient procedures and achievement of guideline-based outcomes, including timelier PD starts. ♦♦ ♦♦ ♦ Methods: We conducted a single-center retrospective chart review of all patients that had their first PD catheter inserted at our center over a 7-year period ending in 2007. ♦♦ ♦♦ ♦ Results: PD catheters were placed in 88 patients by interventional radiology and in 125 patients by surgical insertion during an earlier period. Insertion of PD catheters by interventional radiology was significantly associated with a higher rate of outpatient procedures (70% vs 32%, p < 0.0001) than surgical placement. At PD start, 82% of patients that underwent radiological insertions had an estimated glomerular filtration rate of over 8 mL/minute/ 1.73 m 2 and their mean serum albumin level was 38.2 g/L. ♦♦ ♦♦ ♦ Conclusions: The new procedure of radiological insertion of PD catheters, coordinated by a dedicated dialysis access nurse, was associated with more outpatient procedures than the earlier surgical method and allowed patients to receive a PD catheter with timing consistent with clinical practice recommendations.

Best Practices Consensus Protocol for Peritoneal Dialysis Catheter Placement by Interventional Radiologists

“…Placement of the PD catheter by interventional radiologists has been advocated as a cost-effective, efficient, and safe procedure (22). Placement of the catheter by IR allows for certain operational efficiencies by avoiding the need for an initial surgical consultation, operating room scheduling, recovery room time, and involvement of an anesthesiologist.…”

Infrastructure Requirements for an Urgent-Start Peritoneal Dialysis Program

“…Catheters placed by interventional nephrologists or radiologists allow for the rapid initiation of PD and may offer several logistical efficiencies by obviating the need for surgical consultation, scheduling of an operating room, general anesthesia, and a recovery room (2,11,12). Although some interventional nephrologists or radiologists have little experience with placing PD catheters, that skill is readily obtainable.…”

Patient Education and Care for Peritoneal Dialysis Catheter Placement: A Quality Improvement Study

“…S killed peritoneal dialysis catheter (PDC) placement is vital to the success of any peritoneal dialysis (PD) program (1)(2)(3)(4)(5)(6)(7)(8)(9). The PDC is the lifeline for PD patients and an important target for quality improvement efforts (1)(2)(3)(4)(5)8,(10)(11)(12)(13). Malfunction of the PDC and related complications can lead to patient discomfort, infection, a need for revision, and technique failure (3,4,6,(12)(13)(14)(15).…”

“…The PDC is the lifeline for PD patients and an important target for quality improvement efforts (1)(2)(3)(4)(5)8,(10)(11)(12)(13). Malfunction of the PDC and related complications can lead to patient discomfort, infection, a need for revision, and technique failure (3,4,6,(12)(13)(14)(15). These events can be quite frustrating for patients and providers, increasing health care costs and potentially contributing to reduced utilization of PD (6,7,12,13,(15)(16)(17).…”

“…Malfunction of the PDC and related complications can lead to patient discomfort, infection, a need for revision, and technique failure (3,4,6,(12)(13)(14)(15). These events can be quite frustrating for patients and providers, increasing health care costs and potentially contributing to reduced utilization of PD (6,7,12,13,(15)(16)(17). Although the technical competence of operators is vital, successful PDC placement involves more than just the insertion procedure; it relies on adherence to established protocols and care before, during, and after surgery (1,2,(4)(5)(6)13,16,(18)(19)(20)(21)(22).…”