Minimally invasive ‘pull technique’ for peritoneal dialysis catheter removal

Abstract

A simple, noninvasive method for removing peritoneal dialysis (PD) catheters, called the “pull technique,” has become popular in recent years. Physicians still worry, however, about the range of its application and possible complications such as infection of the retained cuff and breakage. We, therefore, applied this technique in patients and enriched its administration for removing PD catheters. Altogether, 24 PD catheter removals in 24 patients were reviewed during the period from July 2018 to October 2019 in our hospital. Using the pull technique, the PD catheter’s superficial cuff was dissected using an electronic knife, and the deep cuff was retained. All patients’ catheters were successfully removed with no breakage. No incision or retained cuff was infected during the follow-up period (1.1–15.6 months). The appropriate peak force of pull traction was approximately 12–13 pounds, not very different from the mean maximum tensile force of 21.48 pounds for silicone tube breakage. The use of intermittent (rather than sustained) traction may reduce the breakage risk of the silicone tube. This method is a safe, practical, minimally invasive method for removing PD catheters, and it is suitable for application on special patients with peritonitis or who are on an immunosuppressant.

Comparison between the ‘pull technique’ and open surgery for peritoneal catheter removal in Chinese patients on peritoneal dialysis

“…In the study, a broken catheter was the only reported operative failure in the PT group. From the reports of Quiroga et al 9 and Wang et al, 10 the procedure success rate is 100% (in 31 and 24 cases, respectively). No instrument was ever used in the stretching process since it was supposed that the pull force would be higher at the holding point of the instrument.…”

“…It might also explain the difference between superficial and deep cuff infections among the studies. 9,10,12 Two other potential complications are ascitic leakage and subcutaneous bleeding. In the present study, ascitic leakage happened in only one patient (1.6%).…”

“…It might also explain the difference between superficial and deep cuff infections among the studies. 9,10,12…”

Laparoscopic observations of adhesions between peritoneal dialysis catheters and intraperitoneal organs: A retrospective, observational study

“…Several reports described the pull technique method for PD catheter removal. 7,8 It is considered to be a minimally invasive and simple method.…”

Three cases of retained cuff related infection after manual pull removal of peritoneal dialysis catheter

“…Moreover, all three patients had superficial cuff-related infections. Wang et al [5] improved the 'pull technique' by isolating the superficial cuff and then using the 'pull technique' for PD catheter removal. He used the improved 'pull technique' in 24 patients and no cuff-related infection occurred.…”