Complications and catheter survival with prolonged embedding of peritoneal dialysis catheters

Brown, Pierre Antoine; McCormick, Brendan; Knoll, Greg; Su, Yuhua; Doucette, Steve; Fergusson, Dean; Lavoie, Susan

doi:10.1093/ndt/gfn003

Cited by 37 publications

(42 citation statements)

References 20 publications

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“…Few studies have evaluated the efficacy and outcomes of different approaches to timing of the embedment procedure. Recommendations for timing of placement tend to fall into 2 categories: those suggesting embedment within a prespecified time period before anticipated initiation of dialysis and those identifying a threshold level of eGFR (6,18). The first approach presumes that clinicians can reliably predict when a given patient will begin dialysis; however, such appraisals are exceedingly inaccurate.…”

Section: Much Of the Early Literature Following The Introduction Of Tmentioning

confidence: 99%

“…While the catheter embedment strategy appears to reduce central venous catheter use and may improve patient fidelity to original modality choice, exceptionally long embedment periods might adversely affect catheter functionality or result in a number of futile placements in which the catheter was never used because of death, onset of medical conditions preventing self-care, transplantation, or removal during unrelated surgery (6). Optimal use of the catheter embedding approach requires appropriate timing of the catheter placement procedure in order to reach an acceptable balance among these competing concerns.…”

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confidence: 99%

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Embedded Catheters: Minimizing Excessive Embedment Time and Futile Placement While Maintaining Procedure Benefits

2015

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♦ Background: Embedding peritoneal catheters far in advance of anticipated need may successfully commit patients to their modality choice and reduce central venous catheter use but can be complicated by excessive embedment periods and futile catheter placement. ♦ Objective: Embedded catheter outcomes were studied to identify factors that minimize inordinate embedment time and futile placement while maintaining procedure benefits. ♦ Methods: Clinical and laboratory data were examined in 107 patients with embedded catheters that were either externalized, remained embedded, or were futilely placed. ♦ Results: Externalization of 84 catheters was performed after a median embedment period of 9.4 months. Flow dysfunction occurred in 14.3% of externalized catheters. Overall function rate was 98.8% after laparoscopic revision. One patient changed their mind about modality choice. Except for 1 patient hospitalized acutely in a facility unfamiliar with embedded catheters, none remaining on a peritoneal dialysis pathway initiated dialysis with a central venous catheter. Including catheters with extremely long embedment periods, the incidence of futile placement was 13.1%. Multiple regression analysis identified estimated glomerular filtration rate (eGFR) and serum albumin as the 2 variables best associated with catheter embedment duration (r 2 = 0.44, p < 0.0001). Diabetic nephropathy was statistically more likely to be associated with lower serum albumin values (p < 0.0001); however, no association was noted between diabetic status and embedment duration (p = 0.62).

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Section: Much Of the Early Literature Following The Introduction Of Tmentioning

confidence: 99%

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confidence: 99%

Embedded Catheters: Minimizing Excessive Embedment Time and Futile Placement While Maintaining Procedure Benefits

2015

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“…Our previously published results have shown an increase in the rate of mechanical obstruction to catheter flow among those catheters that are left buried for .5 months before use (5). Patients with obstructed catheters are treated with vigorous flushing, high-dose laxatives, and tissue plasminogen activator (tPA) if there is evidence for inflow or outflow obstruction.…”

Section: Introductionmentioning

confidence: 99%

Fluoroscopic Manipulation of Peritoneal Dialysis Catheters

Miller

McCormick

Lavoie

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Mechanical failure of the peritoneal dialysis (PD) catheter is an important cause of technique failure. Fluoroscopic guidewire manipulation may be undertaken in an attempt to correct the failure. The purpose of this study was to determine the efficacy of fluoroscopic manipulation of previously embedded PD catheters, the factors associated with successful manipulation, and the complication rate associated with manipulation.Design, setting, participants, & measurements A single-center, retrospective review of 70 consecutive PD patients undergoing fluoroscopic manipulation for mechanical failure of their PD catheter from June 2006 to February 2011 was undertaken. Logistic regression models were developed to determine the variables associated with successful manipulation.Results Of the 70 manipulations, 44 were successful (62.9%). In univariate analysis, catheters located in the pelvis compared with those in the upper abdomen (73.5% versus 42.9%, P=0.01) and catheters that were previously functional compared with those that failed at exteriorization (75.0% versus 46.7%, P=0.04) were more likely to be successfully manipulated. Time embedded, previous hemodialysis, and number of intra-abdominal surgeries were not correlated with likelihood of successful manipulation. In multivariate analysis, catheters located in the pelvis (P=0.01) and those with secondary failure (P=0.01) were more likely to successfully manipulated. Two of the patients developed peritonitis (2.9%), neither requiring cessation of PD.Conclusions Fluoroscopic manipulation is an effective and safe therapy for failed PD catheters that are unresponsive to conservative treatment. Properly positioned catheters and those that were previously functional are more likely to be successfully manipulated.

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“…However, as with Moncrief's procedure, the risk of PDC obstruction is enhanced by a longer embedding period. Brown et al reported that the proportion of PDCs to primary failure was significantly higher in patients in whom the catheter had been embedded for five months longer, compared to those in whom it was embedded for a shorter time 6) . In addition, there are concerns about local infection and peritonitis due to the indwelling PDC.…”

Section: Discussionmentioning

confidence: 99%

Resumption of Peritoneal Dialysis by Externalization of the Embedded Catheter: A Case Report

Kaneshiro

Sakurada

Hisamichi

et al. 2016

J St. Marianna Univ

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We previously reported a re-embedding catheter technique for peritoneal dialysis (PD) patients with high risk of catheter removal at the discontinuation of PD. We recently operated on a 50-year-old female patient who had resumed PD by externalization of the catheter after the re-embedding catheter technique. The patient had been on PD for acute kidney injury (AKI) due to a hypertensive emergency in 2009, but had discontinued PD after seven months because her creatinine levels decreased to 2 mg/dL. However, because her renal function did not normalize and she preferred to undergo PD for future renal replacement therapy, we applied the re-embedding catheter technique. She resumed PD by externalization of the catheter four years later. We consider the reembedding catheter technique a useful method for AKI patients who do not recover normal renal function.

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Complications and catheter survival with prolonged embedding of peritoneal dialysis catheters

Cited by 37 publications

References 20 publications

Embedded Catheters: Minimizing Excessive Embedment Time and Futile Placement While Maintaining Procedure Benefits

Embedded Catheters: Minimizing Excessive Embedment Time and Futile Placement While Maintaining Procedure Benefits

Fluoroscopic Manipulation of Peritoneal Dialysis Catheters

Resumption of Peritoneal Dialysis by Externalization of the Embedded Catheter: A Case Report

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