Peritoneal Dialysis Catheter Revision and Replacement by Nephrologist for Peritoneal Dialysis Catheter Malfunction

Abstract

Background: Catheter malfunction is an important cause of technique failure for peritoneal dialysis (PD) patients, and is commonly managed by surgeons or intervention radiologists. We reviewed our experience in catheter revision or replacement by nephrologists. Method: We reviewed the clinical outcome and complication rate of 95 consecutive patients who had PD catheter malfunction, with catheter revision or replacement by nephrologist. Result: Amongst the 95 patients, 32 had catheter revision, 24 catheter replacement via the original wound, and 39 catheter replacement via a new mini-laparotomy wound. Catheter survival was 71.6% at 1 month and 48.4% at 6 months; technique survival was 88.4% at 1 month and 77.4% at 6 months. When the 3 types of procedure were analyzed separately, technique survival at 1 month was 96.8, 75.0, and 89.7%, respectively, for patients who received catheter revision, catheter replacement via the original wound, and catheter replacement via a new mini-laparotomy wound (p = 0.0002), although their catheter survival rates were not significantly different. Also, 2 patients had bleeding that required urgent surgical exploration, 2 had wound infection, and 8 had peritonitis within 4 weeks after the surgery. Conclusion: PD catheter revision and replacement by nephrologist has an acceptable catheter survival and a reasonable complication rate. Given that prompt intervention is an important consideration, catheter revision and replacement by nephrologist is a suitable method for the management of catheter malfunction.

Effects of early detection of peritoneal catheter migration on clinical outcomes: 15‐years experiences from a single centre

“…Catheter survival showed no difference between the non‐migration group and the migration group. The survival rates for catheter at 5 years reported in other series are variable, ranging from 27% to 70.0% . The variability of catheter survival between centres was associated many factors, including the number of PD patients in a centre.…”

“…The survival rates for catheter at 5 years reported in other series are variable, ranging from 27% to 70.0%. [18][19][20][21] The variability of catheter survival between centres was associated many factors, including the number of PD patients in a centre. Lower technical survival rates are found mainly in centres with less than 20 patients on PD, and the relative risk of technical failure was 1.68 compared to large centers.…”

Risk Factors and Management of Catheter Malfunction During Urgent-Start Peritoneal Dialysis

“…However, we did not find the different rates of peritoneal dialysis related peritonitis between younger and older age patients, as well as between colonic dialysis group and no colonic dialysis group, suggesting that peritoneal dialysis related peritonitis was not a distinguishing factor for catheter dysfunction in patients of different ages and in patients with or without colonic dialysis although peritonitis has been reported to be more common in young patients ( 19 ). In addition, the technique and experience of the surgeon may contribute to the catheter survival time and success rate ( 32 , 33 ). Therefore, standardized training for surgeons should be carried out to improve the success rate of catheterization and reduce the incidence of catheter malfunction, thus prolonging both catheter and patient survival time.…”

Peritoneal Dialysis Catheters, Insertion Methods and Complications

“…Catheter repositioning with a stiff guide wire or forceps can be successful and causes little morbidity. 42 In this technique, a device such as a malleable rod, guide wire, cannula or tip-deflecting wire, is inserted into the catheter and is used to redirect or reposition the catheter tip in a more favourable position for PD. Laparoscopic repositioning with catheter fixation into the lower abdomen may be the ultimate therapy to solve this problem.…”