Percutaneous Fluoroscopically Guided Placement of Peritoneal Dialysis Catheters—A 10‐Year Experience

Abstract

Peritoneal dialysis (PD) catheters maybe inserted surgically or percutaneously. Since 1997, 209 patients in our unit have had a PD catheter inserted percutaneously with fluoroscopic guidance. Data on all these PD catheters were collected prospectively on a PROTON computer database. 5/209 (2.4%) insertion attempts were abandoned. 204 catheters were successfully placed giving an initial technical success of 97.6%. 200/204 catheters were used for dialysis. 13/200 (6.5%) catheters developed early exit site infections; 12/13 were successfully treated and dialysis proceeded uneventfully. 3/200 (1.5%) catheters developed early peritonitis; 1/3 was removed as antibiotic treatment was unsuccessful. 10/200 (5%) catheters developed an early leak; 2/10 did not resolve with conservative therapy and were removed. 14/200 (7%) catheters did not allow sufficient fluid entry for PD; all 14 had migrated out of the pelvis and were removed. In total, 18/200 (9%) catheters were removed in the first 2 months due to these early complications. The remaining 182/200 (91%) were fully functional for PD. Technical survival (excluding patient death with a functioning catheter and successful kidney transplantation) at 1, 2, and 5 years was 77%, 61%, and 31%, respectively. Our 10 year experience of PD catheters inserted percutaneously with fluoroscopic guidance demonstrates a high technical success and a low complication rate. The data presented may be used as the standard for this technique.

Fluoroscopically guided percutaneous peritoneal dialysis catheter placement: single center experience and review of the literature

“…Vaux and colleagues published the largest percutaneous fluoroscopically guided PD catheter placement experience to date. 10 They also used ultrasound guidance to gain entry to the peritoneum. The authors described 204 catheter placements with technical survival of their catheters at 1, 2, and 5 years of 77, 66, and 31%, respectively.…”

“…To reduce the risk of complication even further, some authors have described using fluoroscopy to guide placement and confirm the desired location of the catheter in the peritoneal cavity and to document free flow of dialysate. [10][11][12][13][14][15][16] These authors note that should any complication arise during fluoroscopically guided percutaneous placement of PD catheters these complications are recognized quickly and managed conservatively. Most reports describe the use of pre-procedure antibiotics and the subsequent risk of infection has been minimal.…”

Complications of the Peritoneal Access and Their Management

“…In both, hemorrhagic complications were not discussed. Again, in a 10-year experience of percutaneous fl uoroscopic insertion, no episodes of bleeding were described [32]. We believe this lack of information results from the absence of major episodes of bleeding in these studies.…”

“…When dialysate leakage occurs into subcutaneous tissues, it is sometimes occult and diffi cult to diagnose. The incidence reports of dialysate leaks may varies from less than 1-20% [16,18,19,32,56,[58][59][60]. This variation may be explained by the nonuniformity of defi nitions.…”

Guidelines for laparoscopic peritoneal dialysis access surgery

“…The distal cuff is placed in the rectus sheath and the catheter is tunneled and brought out a separate stab incision. Several retrospective reviews have shown similar complication rates to open surgical insertion with failure rates between 0 and 5 % [84][85][86][87]. However, most of these studies only included patients who have never had abdominal surgery.…”