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A Journal on Nephrology and Urology

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Minerva Urologica e Nefrologica 2004 December;56(4):359-65

language: English, Italian

Routine insertion of permanent peritoneal dialysis cathethers in the nephrology ward. The sliding percutaneous technique

Basile B., De Padova F., Parisi A., Montanaro A., Giordano R.

Divi­sion of Neph­rol­o­gy, Dis­trict Hos­pi­tal, Mar­ti­na Fran­ca, Taran­to (Ita­ly)


Aim. A pre­req­ui­site to the tech­ni­cal suc­cess of per­i­to­neal dial­y­sis in its dif­fer­ent mod­ifi­ca­tions is a ­safe, reli­able, cor­rect­ly posi­tioned, and func­tion­ing per­i­to­neal cath­e­ter. The ­ideal meth­od for inser­tion of per­ma­nent cath­e­ters (PC) ­remains debat­able. The ­most com­mon­ly ­used tech­nique is an ­open sur­gi­cal ­approach, by min­i­lap­a­rat­o­my. Oth­ers ­have pro­posed a ­blind ­approach, ­using ­either a tro­car meth­od or a mod­i­fied Sel­ding­er tech­nique or an inser­tion by ­means of per­i­to­ne­os­co­py.
Meth­ods. We ­describe our 5-­year expe­ri­ence (May 1997 - ­June 2002) ­with 68 per­cut­ane­ous PC inser­tions in 63 con­sec­u­tive ­patients. A mod­i­fied tech­nique of per­cut­ane­ous PC inser­tion was ­used ­that ­here we ­call slid­ing per­cut­ane­ous tech­nique (SPT): 1) a mid­line inci­sion is ­made 4 cm ­below the umbil­i­cus; the peri­to­ne­um is punc­tured ­using a ­straight plas­tic cath­e­ter ­with a sty­let. The cath­e­ter is ­pushed cau­dal­ly ­towards the ­left ­iliac fos­sa; 2) a ­straight ­stiff 90 cm sty­let is insert­ed ­through the tem­po­rary cath­e­ter, ­which is sub­se­quent­ly ­removed. The sty­let has 2 ­tips, a ­blunt prox­i­mal one, ­which is ­pushed ­through the cath­e­ter ­into the ­iliac fos­sa, and the dis­tal one; 3) hav­ing the sty­let in ­situ, a dou­ble-­cuffed ­curled-end PC is mount­ed at the dis­tal tip of the sty­let start­ing ­from the ­curl; ­then, the PC is gent­ly ­slid ­down ­along the sty­let as a ­train ­does ­along the ­rail-way. PC fail­ure was ­defined as mechan­i­cal dys­func­tion, per­sis­tent dia­ly­sate ­leak and per­sis­tent per­i­to­nitis, or ­exit ­site/tun­nel infec­tion requir­ing PC remov­al. Fur­ther­more, PC fail­ure was ­defined as ear­ly, if occur­ring in the ­first 30 ­days ­after PC place­ment, or ­late, if occur­ring ­more ­than 30 ­days post­-op­er­a­tion. ­Life-­table esti­mates of PC sur­vi­val ­were deter­mined by ­Kaplan-Mei­er anal­y­sis.
­Results. Ear­ly com­pli­ca­tions: in the 1st ­month on dial­y­sis, obstruc­tion to dia­ly­sate ­flow was the com­mon­est ­cause lead­ing to PC fail­ure. The ear­ly actu­ar­i­al sur­vi­val (AS) was 90%. ­Late com­pli­ca­tions: per­i­to­nitis was the com­mon­est ­cause of PC fail­ure. The ­late AS, i.e. exclud­ing the cath­e­ter fail­ures occur­ring in the 1st ­month ­post-oper­a­tion, was 82% at 3 ­years. Glo­bal AS, i.e. includ­ing ­both ear­ly and ­late PC fail­ures, was excel­lent (74% at 3 ­years).
Con­clu­sion. ­Even ­though ­this ­study is ret­ro­spec­tive and ­does not com­pare per­cut­ane­ous ­with sur­gi­cal PC place­ment tech­niques, it ­allows us to ­state ­that per­cut­ane­ous PC inser­tion is a ­well-tol­er­at­ed, rap­id­ly per­formed, ­side-­room pro­ce­dure ­that ­gives excel­lent ­results, ­above all ­when ­using SPT.

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