Outcomes in buried versus non-buried peritoneal dialysis catheters: A retrospective cohort study

Abstract

<jats:sec><jats:title>Aims:</jats:title><jats:p> To compare the rates of infections (peritonitis and exit site infections) in patients undergoing non-buried versus buried peritoneal dialysis catheterisation for end-stage renal failure. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A retrospective review of all patients who underwent peritoneal dialysis catheter placement by one primary surgeon between January 2008 and August 2019. Information collected included, catheter characteristics, immediate post-operative complications, date of catheter exteriorisation, date of peritoneal dialysis commencement, rate of successful catheter function at initiation of peritoneal dialysis and rates of catheter-related complications (i.e. infection, revision status and obstruction). </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> 110 peritoneal dialysis catheters were inserted (43 non-buried and 67 buried peritoneal dialysis catheters). The non-buried group was associated with a higher proportion acquiring an infection than the buried group (15% vs 30%, p = 0.054). Patients with buried catheters also had a 72% and 65% decreased likelihood of experiencing a catheter-related infection and peritonitis, respectively, over time compared to patients with non-buried catheters in the unadjusted (crude incidence rate ratio 0.28, 95% confidence interval 0.11, 0.70; P = 0.003). The proportion of catheter function at first use was 85% in the non-buried group and 78% in the buried group. Patients with non-buried versus buried catheters had similar proportions of complications, including: obstructions (25.6% vs 20.9%, p = 0.770), herniation (7.0% vs 4.0%, p = 0.327) and leaks (7.0% vs 1.5%, p = 0.134). </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> The use of the buried peritoneal dialysis catheter technique as compared to the standard technique has revealed fewer overall catheter-related infections, particularly episodes of peritonitis and similar rates of mechanical complications in our series. In addition to that, the other benefits of buried peritoneal dialysis catheters such as lower healthcare cost, patient convenience and a viable option for patients in remote communities should prompt physicians to continue assessing suitable candidates for buried peritoneal dialysis catheters. </jats:p></jats:sec>

Pre-Peritoneal Dialysis Peritonitis After Saline Infusion Sonohysterogram in a Patient With an Embedded Catheter: A Case Report

“… 4 - 6 Peritoneal dialysis–related peritonitis occurs mainly through these major routes: periluminal contamination, transluminal contamination, hematological spread after medical procedures, and bacterial translocation to the peritoneum after certain diagnostic procedures. 7 - 10 …”

“… 9 As an embedded PD catheter is covered by the patient’s skin, it exists in a sterile environment and makes transluminal or periluminal contamination from exit-site bacteria very unlikely. 9 However, hematogenous spread or translocation of bacteria is still possible. Herein, we present the first reported case of a patient with an embedded PD catheter who developed a catheter infection following a saline infusion sonohysterography (SIS).…”

“…[4][5][6] Peritoneal dialysis-related peritonitis occurs mainly through these major routes: periluminal contamination, transluminal contamination, hematological spread after medical procedures, and bacterial translocation to the peritoneum after certain diagnostic procedures. [7][8][9][10] Contamination after a diagnostic procedure, whether hematological or through translocation to the peritoneum, is a well-known risk factor for PD peritonitis, and guidelines established by the International Society of Peritoneal Dialysis (ISPD) recommend peri-procedure antibiotic prophylaxis for patients on PD undergoing obstetrical, gynecological, or gastrointestinal procedures. 4,11 The peri-procedure prophylaxis section in the ISPD guidelines does not include recommendations for patients who have a subcutaneously embedded PD catheter but have not yet initiated dialysis.…”

“…4 Subcutaneously embedded PD catheters are used in some centers as insertion of the catheter weeks to months in advance of the need for dialysis helps with planification of care for patients who will need PD in the future and because this technique allows for healing of the cuff in a sterile environment. 9 As an embedded PD catheter is covered by the patient's skin, it exists in a sterile environment and makes transluminal or periluminal contamination from exit-site bacteria very unlikely. 9 However, hematogenous spread or translocation of bacteria is still possible.…”