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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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