Comparison for four techniques of catheter insertion in patients undergoing continuous ambulatory peritoneal dialysis.
27
Citation
0
Reference
10
Related Paper
Citation Trend
Abstract:
To compare four different ways of implanting catheters for continuous ambulatory peritoneal dialysis (CAPD) in an effort to reduce the incidence of complications.Retrospective study.Teaching hospital, Taiwan.166 Patients who had 180 catheters inserted between 1985 and 1993.49 Catheters were inserted through midline incisions (in 24 of which the catheter was fixed with an additional suture) and 131 were inserted through paramedian incisions (in 88 of which the catheter was fixed with an additional suture).Morbidity, particularly the incidence of migration of the catheter and incisional hernia.8/68 Catheters migrated in patients in whom no additional fixing suture had been used, compared with 2/112 in whom an additional suture had been used (p = 0.007). There were 4 incisional hernias in 49 midline, compared with 0/131 paramedian, incisions (p < 0.0001). Significantly more catheters had to be removed after midline than after paramedian incisions (35/49 compared with 56/131, p = 0.0008); chi square for independence 15.02, df 3, p = 0.0018.For the implantation of catheters for CAPD the paramedian incision is associated with significantly fewer complications than the midline incision and the incidence is even lower if the catheter is fixed to the lower peritoneum with an additional suture.Keywords:
Incisional Hernia
Surgical incision
Cite
Cite
Citations (2)
Fifteen per cent of patients with end stage renal insufficiency are being treated in Greece with continuous ambulatory peritoneal dialysis (CAPD). Postoperative hernia, which is mostly incisional, is a complication which may compromise the efficacy of the method. We present our experience on patients undergoing CAPD, concerning this complication.
Incisional Hernia
Cite
Citations (13)
Objective: This study aims to review the usage and complication of paramedian approach for CAPD catheter insertion. Material & Methods: This is a retrospective study. All ESRD patients ongoing CAPD at the Dialysis Clinic of Zainoel Abidin General Hospital in Aceh, Indonesia between January 1, 2009 and December 31, 2018 were included in the present study. Complication outcomes included mechanical and infectious complications are documented and reviewed. Results: A total of 190 ESRD patients had been performed CAPD catheter insertion using paramedian approach in this period. Out of these patients, complication occurred in 31 cases (16.32%). All the complication that occurred in this study are 5 cases of leakage (2.63%), 9 cases of infection (4.74%), 8 cases of drainage problem (4.21%), 9 cases of malposition (4.74%), and no case of bowel perforation. From total of 9 cases of infections, 1 patient had peritonitis from the catheter insertion. The other infection was exit site infection. Conclusion: CAPD catheter insertion using paramedian approach is safe with low complication rates. It could decrease post-operative complications and can be recommended for CAPD catheter insertion technique due to its safety.
Perforation
Cite
Citations (0)
Laparotomic correction with or without omentectomy is occasionally required for malposition of a peritoneal dialysis (PD) catheter. We reviewed the incidence of incisional hernia following laparotomic PD catheter correction with or with omentectomy. From January 1996 to December 1998, PD catheters were implanted by non open-dissection technique using a trocar in 148 patients. Laparotomy for PD catheter malposition was required in 20 of the 148 patients. Omentectomy was performed simultaneously in 11 patients. After laparotomy, the wound was closed with interrupted or continuous layered polyglycolidelactide polymer sutures. Dialysis was resumed after the third or fourth day. Incisional hernia developed in 30% (6/20) of all patients undergoing laparotomy, but in none of the patients not undergoing laparotomy. The incidence increased when omentectomy was performed [5/11 (45.5%) vs 1/9 (11.1%)]. Multiparity, female sex, and laparotomy at a later time also predisposed to development of incisional hernia. Among the patients with incisional hernia, 2 patients showed multiple recurrences and 1 patient showed later leakage; PD catheters were lost in these patients. Another 3 patients continued continuous ambulatory peritoneal dialysis (CAPD) without a recurrence. The results suggest that incisional hernia is prevalent following laparotomic PD catheter correction, especially when omentectomy is performed simultaneously. Situations that seem to increase the risk of incisional hernia--inevitably encountered during corrective laparotomic omentectomy--are discussed. An evaluation is necessary concerning whether omentectomy acts as an independent risk factor for incisional hernia, and whether incisional hernia occurs more frequently when omentectomy is performed after a period on CAPD as compared with when it is performed at the time of PD catheter implantation. Laparotomic omentectomy should be performed as a last resort for the correction of PD catheter malposition.
Omentectomy
Incisional Hernia
Cite
Citations (3)
Cuff
Exit site
Cite
Citations (35)
Objective: Catheter-related infections represent a primary infectious complication in patients with continuous ambulatory peritoneal dialysis (CAPD). A one-stage operation or two-stage procedure can be taken to remove and replace the infected catheter in CAPD patients. We retrospectively compared clinical features and outcomes between two surgical groups between 1994 and 2003 at National Cheng Kung University Hospital. Methods: We performed the two-stage procedure to replace infected catheter before 1997. In 1997, we began to adopt a one-stage surgical procedure to treat CAPD patients who had exit-site (ES) or tunnel (T) infections, but the conventional two- stage operation was performed for patients with peritonitis. During this study period from 1994 to 2003, 10 patients received the one-stage operation (eight with ES infection and two with T infection) while the other 10 patients (five with ES/T infections and five with peritonitis) received the two-stage procedure. After insertion of new catheters, the patients underwent substitutive hemodialysis therapy for 10 days prior to restarting CAPD and were subsequently followed up for at least three months. Results: The patients receiving the one-stage operation showed no significant differences in the mean age, duration of antibiotic therapy prior to operation, and clinical outcome as compared with those receiving the two-stage procedure. The interval for substitutive hemodialysis therapy prior to restarting CAPD was 10.0±0.0 days for patients in the one-stage group. In the two-stage group, the mean durations of substitutive hemodialysis therapy were 31.2±8.4 days (P=0.001) for patients with ES/T infections and 56.2±12.3 days (P=0.001) for those with peritonitis, which were longer as compared with that in the one-stage group. Conclusion: The one-stage operation seemed to yield satisfactory results in treatment of CAPD patients with ES/T infections, and shortened the interval for substitutive hemodialysis, thus allowing an early return to CAPD as compared with the conventional two-stage surgery. It is more practical and may also be safe to use the one-stage operation to treat tract-infected catheter in CAPD patients.
Cite
Citations (0)
The management of catheter-related infections has become a major challenge in continuous ambulatory peritoneal dialysis treatment. We identified five patients on continuous ambulatory peritoneal dialysis who failed conservative medical management for exit site infections. Each patient underwent incision and debridement along the subcutaneous course of the catheter, exteriorization of the superficial cuff, and establishment of a new exit site at the medial aspect of the wound. This novel technique of incision and debridement along the subcutaneous tunnel and relocation of the exit site has not been described in the literature. In four of five patients, this technique controlled the exit site infection and arrested the progression of the infection to peritonitis, preventing the need for catheter removal.
Exit site
Debridement (dental)
Dialysis catheter
Cuff
Cite
Citations (7)
To describe our experience with chronic ambulatory peritoneal dialysis in children with the prune belly syndrome (PBS).From our peritoneal dialysis (PD) program we were able to review the medical records of 6 boys with PBS. Data were collected on potential complications such as infections, hernias, growth, and problems encountered with PD catheter insertion.The ages of the 6 boys ranged from 10 months-17 years. The dialysis duration was from 9-22 months, with a total of 76 patient-months on PD. There was one death, possibly as a complication of an exit-site infection. Five received a renal transplant, and 4 have functioning grafts. Peritonitis occurred once in every 10.8 patient-months, and exit-site or tunnel infection was diagnosed every 7.6 patient-months. Four patients required PD catheter replacement because of tunnel infection in 2, persistent exit-site infection in 1, and fluid leakage in 1. Of a total of nine catheters, three were inserted using a laparoscopic technique. There were no leaks in these three; however, there was one exit-site infection. Two patients had inguinal hernias that required surgery.Deficiency of abdominal musculature in PBS poses potential problems for the use of PD, in particular, catheter anchorage, exit-site healing, and leakage. In our patients the most serious complications were infections of the exit site or catheter tunnel. Our experience suggests that a laparoscopic technique may provide improved catheter placement. PD offers a potentially successful form of dialysis for patients with PBS.
Prune belly syndrome
Cite
Citations (22)
Background This study was to compare the postoperative complication rates of continuous ambulatory peritoneal dialysis (CAPD) catheter insertion via open technique between two groups of patients, those with and those without a history of previous abdominal surgery. Methods A review was carried out in 122 patients over a 2-year period. The patients were divided into two groups: those with and those without previous lower abdominal surgery. All patient records were retrospectively analyzed until the time of catheter failure or to current time if alive and receiving CAPD. Patient characteristics, operative factors, and postoperative complications were recorded. Results Postoperative complications were reported as catheter malfunction in 16 patients and CAPD-related peritonitis in 36 patients. The complication rates in the group of patients with previous abdominal surgery were 16.7% catheter malfunction and 33.3% CAPD-related peritonitis. In patients without previous lower abdominal surgery, a catheter malfunction rate of 12.5% and a peritonitis rate of 28.8% were seen. The operation time in patients with previous abdominal surgery was longer than that in patients without previous abdominal surgery. However, no statistically significant difference in postoperative complication rates was detected between patients with and patients without previous lower abdominal surgery. Conclusion CAPD remains a reliable modality in the treatment of end-stage renal disease and does not increase postoperative complications in patients with previous abdominal surgery.
Cite
Citations (29)