Fluoroscopic Manipulation of Peritoneal Dialysis Catheters

Abstract

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.

Efficacy and safety of fluoroscopic manipulation using the alpha-replacer for peritoneal catheter malposition

“…In addition, fluoroscopic manipulation has several advantages, such as shortening of treatment time and better patient acceptance of the treatment. Our results demonstrate the merit of fluoroscopic manipulation, as is also described in other reports [6,7,11].…”

“…The incidence rate of catheter malposition was 25.0 % (23/92) and 0.095/patient-year (23/241.4). It was similar to the rates in previous reports (16.8, 22.1 % and 0.073/patient-year, respectively) [11,13,14]. Of the 23 cases, 22 cases had outflow failure, and 1 case had both outflow and inflow failure.…”

“…Several previous reports have compared surgical procedures with fluoroscopic manipulation [3][4][5]11]. In general, surgical procedures have a higher success rate (90-100 %) than fluoroscopic manipulation (44-78 %) [3-5, 7-9, 11].…”

“…To evaluate the differences between successful and failed cases, we analyzed the interval between catheter placement and malposition and that between catheter exteriorization and malposition. In addition, primary failure was defined as malposition at the time of catheter exteriorization, and secondary failure as malposition after functional PD therapy (correct position at the time of exteriorization) [11]. Complications, including peritonitis and abdominal injury, were defined as the occurrence of complications within 7 days after alphareplacement treatment.…”

“…However, surgical procedures are associated with the risk of several complications, such as abdominal peritonitis, hernia and dialysate leakage. Therefore, fluoroscopic manipulation is a useful non-surgical alternative, due to the lower risk of complications as compared to surgical procedures [6][7][8][9][10][11]. Various devices and techniques have previously been used for this, including fluoroscopic manipulation for peritoneal catheter malposition.…”