Safety and Efficacy of Bedside Peritoneal Dialysis Catheter Placement in the COVID‐19 Era: Initial Experience at a New York City Hospital

Abstract

Introduction Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is common in critically ill patients with COVID-19. Unparalleled numbers of patients with AKI and shortage of dialysis machines and operative resources prompted consideration of expanded use of urgent-start peritoneal dialysis (PD) and evaluation of the safety and efficacy of bedside surgical placement of PD catheters. Study design Bedside, open PD catheter insertions were performed in early April 2020, at a large academic center in New York City. Patients with SARS-CoV-2 infection and AKI and ambulatory patients with chronic kidney disease and impending need for RRT were included. Detailed surgical technique is described. Results Fourteen catheters were placed at the bedside over 2 weeks, 11 in critically ill COVID-19 patients and three in ambulatory patients. Mean patient age was 61.9 years (43-83), and mean body mass index was 27.1 (20-37.6); four patients had prior abdominal surgery. All catheters were placed successfully without routine radiographic studies or intraoperative complications. One patient (7%) experienced primary nonfunction of the catheter requiring HD. One patient had limited intraperitoneal bleeding while anticoagulated, which was managed by mechanical compression of the abdominal wall and temporarily holding anticoagulation. All other catheters had an adequate function at 3-18 days of follow-up. Conclusions Bedside placement of PD catheters is safe and effective in ICU and outpatient clinic settings. Our surgical protocols allowed for optimization of critical hospital resources, minimization of hazardous exposure to healthcare providers and a broader application of urgent-start PD in selected patients. Long-term follow-up is warranted.

Acute Peritoneal Dialysis With Percutaneous Catheter Insertion for COVID-19–Associated Acute Kidney Injury in Intensive Care: Experience From a UK Tertiary Center

“…Although others have reported the use of PD during the COVID-19 pandemic, 12 , 13 , 14 our study is the largest to date and the only one to describe bedside percutaneous catheter insertion (as opposed to open or laparoscopic surgical insertion). In our study, no complications leading to significant harm were reported following catheter insertion, even in patients with failed catheter insertion attempts.…”

SARS-CoV-2 and Viral Sepsis: Immune Dysfunction and Implications in Kidney Failure

“…Indeed, the emerging literature highlights that the number of patients with AKI requiring CRRT is unprecedented in modern history [ 53 ]. These therapeutic interventions have proved fundamental as lifesaving measures in patients with severe forms of COVID-19 and impaired renal function [ 153 , 154 , 155 ].…”

Optimizing Kidney Replacement Therapy During the COVID-19 Pandemic Across a Complex Healthcare System

“…Each site identified one key nephrologist with PD experience to coordinate urgent start PD. We identified general or transplant surgeons who could perform bedside PD catheter insertion in accordance with International Society of Peritoneal Dialysis (ISPD) guidelines (11)(12)(13). To ensure effective PD delivery, we excluded patients with extensive surgical history, ascites, active gastrointestinal issues, who required prone ventilation or had high oxygen/PEEP requirements.…”