Post Insertion Catheter Care in Peritoneal Dialysis (Pd) Centres Across Europe. Part 2: Complication Rates and Individual Patient Outcomes

Abstract

The first part of this report, which looked at centre policy, showed that there was no consensus on the best way to manage a patient in the rest period between PD catheter insertion and the first use of the catheter for dialysis. This paper intends to investigate if the differences in policy had any effect on complication rate and individual patient outcomes. Data were included from 298 patients of 49 participating centres. The results revealed a high rate of catheter related complications, with half of the patients having been treated for complications including leakage (29%), malfunction (23%) or infection (10%), and a quarter of patients having been hospitalised for catheter problems. Leakage was more frequently observed in lean and obese patients and if the catheter was only immobilized for a short time period. Diabetes, having constipation at first use and having rested for less than 6 hours after catheter insertion were significant risk factors for malfunction. Infection seemed to be related to the type of catheter used and hygienic precautions (not significant) and showed a significant relationship with the frequency of dressing changes. There is still an important lack of evidence on which to develop an optimal protocol for PD catheter insertion and care before first use.

Patient Education and Care for Peritoneal Dialysis Catheter Placement: A Quality Improvement Study

“…Despite the existence of best-practice guidelines, concerns have been raised that these recommendations are not followed by practitioners (11,12,21,22,25). Furthermore, deviation from recommendations may be an underappreciated contributor to PD technique failure (11,12,21,22).…”

“…Furthermore, deviation from recommendations may be an underappreciated contributor to PD technique failure (11,12,21,22).…”

“…These events can be quite frustrating for patients and providers, increasing health care costs and potentially contributing to reduced utilization of PD (6,7,12,13,(15)(16)(17). Although the technical competence of operators is vital, successful PDC placement involves more than just the insertion procedure; it relies on adherence to established protocols and care before, during, and after surgery (1,2,(4)(5)(6)13,16,(18)(19)(20)(21)(22). Expert bodies have established clinical practice guidelines providing specific recommendations for each step involved in PDC placement (1)(2)(3)(4)(5) …”

“…Quality improvement for PDC placement may be challenging because of deficiencies in physician and nursing knowledge, lack of established protocols, and inconsistent practice patterns (10,12,21,22,26). In particular, the education and care patients receive related to PDC placement may be difficult to assess because of a lack of available metrics.…”

SAGES guidelines for laparoscopic peritoneal dialysis access surgery

“…Postoperative narcotic analgesic requirements further aggravate this underlying propensity for constipation. Any experienced PD practitioner will affirm that constipation is the most common reason for post procedure catheter flow dysfunction, having been noted in 68 % of patients with constipation at first dialysis, compared to only 13 % in patients without constipation [15]. Moreover, the necessity of acute treatment of postoperative constipation may lead to transmural migration of bacteria resulting in peritonitis [16].…”