Implantation of Presternal Catheter Using Moncrief Technique: Aiming for Fewer Catheter-Related Complications

Abstract

♦ Objectives To reduce catheter-related complications, we developed a new technique of catheter implantation, combining a presternal catheter with the Moncrief technique. ♦ Methods The presternal catheter, consisting of 2 catheters joined by a titanium extender, was surgically implanted. Its end was left embedded in the presternal wall. A few weeks after implantation, the embedded subcutaneous catheter was exteriorized, exiting in the 4th intercostal space, and peritoneal dialysis (PD) was commenced. ♦ Results Using the new technique, 9 catheters were implanted (3 in women and 6 in men). Exteriorization was performed 30.6 ± 14.3 days after implantation of the catheter. Total observation period was 70 patient–months. Average hospitalization was 4.4 ± 1.3 days for catheter implantation, and 2.6 ± 2.6 days for exteriorization. Peritoneal dialysis commenced on the day of exteriorization with an exchange volume of 1.8 ± 0.3 L, using 4 exchanges daily. During the observation period, none of the patients experienced a catheter infection or dialysate leak. One non infectious complication was observed (a catheter wrapped in omentum). ♦ Conclusions Our approach of combining a presternal catheter and the Moncrief technique had some advantages not only in regard to catheter infection and dialysate leakage, but also in regard to quality of life and hospitalization for the patient.

2009 Japanese Society for Dialysis Therapy Guidelines for Peritoneal Dialysis

“…Step‐wise initiation of peritoneal dialysis is commonly practiced in Japan. By this approach, a peritoneal dialysis catheter is implanted before the appearance of uremic symptoms, facilitating the initiation of PD at an optimal time (6).…”

Prevention of infectious complications in peritoneal dialysis: best demonstrated practices

“…38 For this reason, some have proposed a buried PD catheter for weeks to months prior to use. [39][40][41] This approach is practical in planned initiations of dialysis, but has not been shown to decrease infection risk. 39 Tissue defense protects against bacterial penetration in some patients.…”

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

“…When renal function declines to the point of needing to initiate dialysis, the external limb is brought to the outside through a small skin incision. Because the catheter has been afforded extended healing time within the abdominal wall, the patient is able to proceed straight to full-volume PD without the necessity of a break-in period that ordinarily accompanies a newly placed catheter (2,3).…”