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The optimal catheter insertion site and the common locations of the catheter tip after catheter migration in peritoneal dialysis. Distance from the pubic symphysis to the Douglas fossa (ab), and distance from the pubic symphysis to the optimal insertion site (ac) measured on a midline sagittal CT screenshot of a male patient and b midline sagittal CT screenshot of a female patient. c The straight Tenckhoff catheter is bent backwards and to the right and the tip is above the pelvic cavity; d the straight Tenckhoff catheter has migrated to the left side, with the end above the pelvis; e the straight Tenckhoff catheter is curled and the tip has migrated to the central pelvis
Source publication
Background
The aim of this retrospective study was to assess the efficacy of a modified peritoneal dialysis catheter insertion technique for reducing the incidence of mechanical complications.
Methods
We conducted a retrospective analysis of clinical data of 346 patients undergoing peritoneal dialysis catheter insertion at our peritoneal dialysis...
Citations
... A PD catheter is a flexible tube that is usually secured to the abdominal wall, with its distal end suspended within the rectovesical pouch. To maintain its position, the catheter can be secured on the anterior abdominal wall with sutures [8][9][10]. To avoid fixing the catheter with sutures, some investigators prefer to use preperitoneal tunnel technology to prevent catheter displacement [11,12]. ...
... In this study, we observed that the group with a smaller IM angle ( < 39.4 • vs. > 39.4 • ) had a lower risk of catheter displacement. This finding seems to provide insight into the effectiveness of advanced techniques, such as preperitoneal tunneling or intraperitoneal fixation [8,12]. Tunneling techniques minimize or eliminate the IM angle, thereby preventing the generation of elastic forces that facilitate catheter tip malposition. ...
Catheter displacement is a common complication of peritoneal dialysis. The aim of this study was to explore the correlation between catheter morphology and displacement by analyzing CT data, providing a scientific basis for optimizing catheter morphology within abdominal wall layers.
We retrospectively analyzed the clinical data of 94 patients. The parameters for analyzing catheter morphology were defined based on six key points identified from CT images. The covariates considered in the analysis included demographics, primary disease, body size, peritoneal dialysis method, and total weekly urea clearance index.
During a mean follow-up period of 1056 ± 480 days, only the angle of the intramuscular part (IM angle) of the catheter significantly correlated with the time to first catheter displacement according to the multivariate analysis (hazard ratio [HR]: 1.039, 95% confidence interval [CI] 1.02–1.058, \(p<\)0.01). When the cut-off value of IM angle was 39.4\(^\circ\), the area under receiver-operating characteristic (ROC) curve for predicting catheter displacement was 0.791 (95% CI 0.701–0.881, \(p<\) 0.01), with a sensitivity and specificity of 82.9% and 66.0%, respectively. Kaplan–Meier survival curves showed that the catheter survival rate was significantly higher in the group with an IM angle < 39.4\(^\circ\) than in the group with an IM angle > 39.4\(^\circ\) (log-rank \(\chi ^2\)=19.479, \(p<\)0.01). None of the catheter morphology parameters were significantly correlated with technique survival in the multivariate analysis.
There is a correlation between catheter morphology and catheter displacement. An IM angle > 39.4\(^\circ\) is an independent risk factor for catheter displacement, while the position and angle of the subcutaneous part are not correlated with catheter displacement.
... Nevertheless, there is no current literature comparing the efficacy of this tunneling technique in reducing catheter migration with other procedures. Moreover, several studies [3][4][5] have described the "traditional" open surgical dissection technique without a musculofascial tunnel. However, those studies reported a higher catheter migration rate in comparison to other modified procedures, in which an additional skin incision [4] or supplementary sutures [5] were needed to "orient" the catheter downward. ...
... Moreover, several studies [3][4][5] have described the "traditional" open surgical dissection technique without a musculofascial tunnel. However, those studies reported a higher catheter migration rate in comparison to other modified procedures, in which an additional skin incision [4] or supplementary sutures [5] were needed to "orient" the catheter downward. ...
... In contrast, four patients in the no-tunnel group (3.4%) experienced catheter dysfunction due to migration. Various current modifications for open surgery [4,5] involve performing additional incisions or sutures to extend the catheter route, reducing malfunction episodes, and prolonging catheter survival. However, our musculofascial tunnel modification required only a brief extension of surgical time and did not necessitate a significant procedure alteration. ...
Background:
Peritoneal dialysis (PD) catheter migration impedes the efficacy of dialysis. Therefore, several techniques involving additional sutures or incisions have been proposed to maintain catheter position in the pelvis.
Aim:
To evaluate the efficacy of creating a short musculofascial tunnel beneath the anterior sheath of the rectus abdominis during PD catheter implantation.
Methods:
Patients who underwent PD catheter implantation between 2015 and 2019 were included in this retrospective study. The patients were divided into two groups based on the procedure performed: Patients who underwent catheter implantation without a musculofascial tunnel before 2017 and those who underwent the procedure with a tunnel after 2017. We recorded patient characteristics and catheter complications over a two-year follow-up period. In addition, postoperative plain abdominal radiographs were reviewed to determine the catheter angle in the event of migration.
Results:
The no-tunnel and tunnel groups included 115 and 107 patients, respectively. Compared to the no-tunnel group, the tunnel group showed lesser catheter angle deviation toward the pelvis (15.51 ± 11.30 vs 25.00 ± 23.08, P = 0.0002) immediately after the operation, and a smaller range of migration within 2 years postoperatively (13.48 ± 10.71 vs 44.34 ± 41.29, P < 0.0001). Four events of catheter dysfunction due to migration were observed in the no-tunnel group, and none occurred in the tunnel group. There was no difference in the two-year catheter function survival rate between the two groups (88.90% vs 84.79%, P = 0.3799).
Conclusion:
The musculofascial tunnel helps maintain catheter position in the pelvis and reduces migration, thus preventing catheter dysfunction.
... Recently, several approaches have been attempted to reduce the incidence of omental wrapping. Two studies reported that implanting the catheter at a lower site on the paramedial area above the pubic symphysis completely prevented omental wrapping [5,6]. However, these studies did not clarify the incidence of post catheter insertion discomfort, including pelvic floor pain or persistent desire to defecate, considering that implantation of the catheter at a lower site could induce direct contact between the catheter tip and the pelvic floor. ...
... The pubic symphysis has been recommended as a reliable reference for the ideal location of the catheter tip on the upper part of the true pelvis [7]. To reduce the incidence of omental wrapping, one possible approach is to implant the catheter on a lower site; this approach was reported to have 0% incidence of omental wrapping, compared with the 7.6% incidence after a traditional surgical procedure [5,6]. ...
Background
Catheter dysfunction, especially omental wrapping, is a serious complication of peritoneal dialysis (PD). Although catheter implantation at a lower site was reported to prevent omental wrapping, this method could induce insufficient drainage of the PD solution and cause pain or a persistent desire to defecate, when the intraperitoneal catheter is of insufficient length or when its tip is in direct contact with the pelvic floor, respectively. The aim of this study was to assess the efficacy and safety of a novel PD catheter insertion method of approaching from the McBurney point, from the outer side of the abdomen.
Methods
This retrospective study included 23 patients with end-stage renal disease who were started on PD from January 2017 to July 2018 at Ashikaga Red Cross Hospital, Tochigi, Japan. Among them, 16 patients underwent a PD catheter insertion using a conventional method, whereas 7 patients underwent a novel method of approaching from the McBurney point. Infectious and mechanical complications were evaluated until August 2020.
Results
There were 18 men and 5 women, with a mean age of 63.1 ± 13.6 years. All patients were followed up postoperatively for a mean duration of 27.2 ± 13.4 months. No patient experienced omental wrapping, insufficient drainage of the PD solution, and pain or persistent desire to defecate in both groups. Both the incidence of infectious and mechanical complications (times per patient-year) were not statistically different between patients undergoing a conventional and a novel PD catheter insertion (0.18 vs. 0.24; p = 0.79 and 0.03 vs. 0.16; p = 0.16, respectively).
Conclusions
This novel method of PD catheter insertion from the McBurney point was safe, caused less discomfort, and was effective in preventing catheter dysfunction.
... The results of the International Pediatric Peritoneal Dialysis Network (IPPN) Registry revealed that 270 (60%) of 452 access revisions were caused by mechanical dysfunction [4]. The effects of catheter type, tunnel structure, and surgical technique on NICPD have also been investigated [8][9][10][11][12]. However, with the advances in dialysis technology and patient expectations, and also the differences between populations and centers with regard to outcomes, the need for large-scale studies in this field remains. ...
Background
Peritoneal dialysis (PD) is the most common kidney replacement therapy in children. Complications associated with PD affect treatment success and sustainability. The aim of this study was to investigate the frequency of PD-related non-infectious complications and the predisposing factors.Methods
Retrospective data from 11 centers in Turkey between 1998 and 2018 was collected. Non-infectious complications of peritoneal dialysis (NICPD), except metabolic ones, in pediatric patients with regular follow-up of at least 3 months were evaluated.ResultsA total of 275 patients were included. The median age at onset of PD and median duration of PD were 9.1 (IQR, 2.5–13.2) and 7.6 (IQR, 2.8–11.9) years, respectively. A total of 159 (57.8%) patients encountered 302 NICPD within the observation period of 862 patient-years. The most common NIPCD was catheter dysfunction (n = 71, 23.5%). At least one catheter revision was performed in 77 patients (28.0%). Longer PD duration and presence of swan neck tunnel were associated with the development of NICPD (OR 1.191; 95% CI 1.079–1.315, p = 0.001 and OR 1.580; 95% CI 0.660–0.883, p = 0.048, respectively). Peritoneal dialysis was discontinued in 145 patients; 46 of whom (16.7%) switched to hemodialysis. The frequency of patients who were transferred to hemodialysis due to NICPD was 15.2%.Conclusions
Peritoneal dialysis-related non-infectious complications may lead to discontinuation of therapy. Presence of swan neck tunnel and long duration of PD increased the rate of NICPD. Careful monitoring of patients is necessary to ensure that PD treatment can be maintained safely.
Chronic kidney disease (CKD) is the 16th leading cause of years of life lost worldwide with increasing prevalence due to increasing cardiovascular disease burden secondary to diabetes mellitus, hypertension, and obesity, as well as aging of the population. Despite years of research, CKD remains a slowly progressive condition characterized by irreversible nephron loss leading to end-stage kidney disease and premature death. In the primary care settings, patients diagnosed with CKD should be screened using risk assessment tools that incorporate GFR and albuminuria to help direct treatment, monitoring, and referral strategies. CKD patients need surveillance for complications of CKD, such as hyperkalemia, anemia, metabolic acidosis, hyperphosphatemia, secondary hyperparathyroidism, and vitamin D deficiency. Primary care providers should be able to identify patent with a high risk of CKD progression (e.g., estimated GFR <30 mL/min/1.73 m² or rapid decline in estimated GFR, albuminuria ≥300 mg per 24 hours) and be promptly referred to a nephrologist. Management of CKD mainly includes cardiovascular risk reduction (e.g., blood pressure control and statin), reduction of albuminuria (e.g., angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers), modifications to drug dosing (e.g., certain antibiotics and oral hypoglycemic agents), and avoidance of potential nephrotoxins (e.g., IV contrast, nonsteroidal anti-inflammatory drugs). Available therapeutics have limited benefit and might only impede disease progression. Developing novel therapeutic approaches to avoid the progression of CKD is a clinically unmet need.
End-stage renal disease (ESRD) is a life-changing diagnosis that sharply decreases longevity. Patients with advancing and progressive chronic kidney disease benefit from early nephrology referral. Renal replacement therapy includes dialysis and kidney transplant. Dialysis modalities include hemodialysis and peritoneal dialysis; both can be performed either at home or at an outpatient unit and either during the daytime or overnight. Preparation for renal replacement therapy requires a multidisciplinary approach. Patients who actively participate in dialysis education prior to ESRD are more likely to choose their preferred dialysis modality. Additionally, these patients are more likely to have a dialysis access that is in place and ready to use prior to initiating renal replacement therapy. These parameters have been associated with improved survival, better quality of life, and fewer complications on dialysis. Patients who perform a home dialysis modality also demonstrate better control of ESRD-related complications, including hypertension, volume overload, hyperphosphatemia, and anemia. Patients who elect neither to pursue nor continue dialysis are managed conservatively with palliative care and hospice support.
