Delayed complications following Tenckhoff catheter removal

Efficacy and safety of removing peritoneal dialysis catheters using the pull technique

PURPOSE

To study the efficacy and safety of peritoneal dialysis (PD) catheter removal using the pull technique.

METHODS

We conducted a retrospective analysis of 36 patients in whom the pull technique was used to remove a PD catheter. We evaluated the efficacy, safety, and health economic benefits of this technique by analyzing the pain score, duration of the procedure, complications during or after the procedure, and cost.

RESULTS

The mean age (± standard deviation) of the 36 patients was 51 ± 14 years involving 27 males and 9 females with a mean body mass index was 23.4 ± 2.6. The mean duration of PD was 28 months (range 4-96 months). The site of the pull technique for peritoneal dialysis catheter removal was at the bedside or in the treatment room, with local anesthesia or no anesthesia. The mean duration of the procedure (from anesthesia to complete removal of the PD catheter) was 5-15 min. Only one patient experienced catheter rupture and no patients developed procedural or post-procedural bleeding or abdominal wall leakage. Infection did not occur at the inner or outer cuffs, tunnel, or outlet. Pain scores analyzed by a 10-point visual analogue scoring technique both immediately and 24 h after the procedure were 3.5 ± 1.7 and 1.2 ± 0.8, respectively.

CONCLUSIONS

The pull technique is simple to perform, takes a short time, results in few complications and small wounds, causes only mild pain, enables fast recovery, and results in low medical costs.

Pull technique versus open surgical removal of the catheter for peritoneal dialysis: a retrospective cohort study

BACKGROUND

The open surgical technique (OST) is the main modality for peritoneal dialysis (PD) catheter removal; however, the pull technique (PT) is emerging as a minimally invasive alternative. At present, the safety and relative equivalence of PT and OST are unclear.

METHODS

In this retrospective study, we reviewed the medical records of consecutive patients who underwent PD catheter removal via PT or OST at the Xinyang Central Hospital from April 2015 to October 2019. Complication-free survival (CFS) and surgical outcomes 365 days after PD catheter removal were evaluated and compared between groups.

RESULTS

The PD catheter was removed in 89 patients. The final sample of 80 patients was selected based on eligibility for inclusion and exclusion criteria. Ten patients experienced complications (PT group, n = 2; OST group, n = 8), including death (n = 6), dialysate leak (n = 3), and incisional dehiscence (n = 1). Epidemiological and preoperative clinical characteristics were similar in all patients. Kaplan-Meier plots for CFS revealed significant differences in prognostic outcomes between the groups. Multivariate analysis revealed that CFS was similar in both groups (with OST as a reference; hazard ratio, 0.21; 95% confidence interval [CI], 0.03-1.27; P = 0.09). We observed significant differences in the operative time, blood loss, operative pain score, and anesthetic use between the groups (all P < 0.001). The length and cost of hospitalization were similar in both the groups.

CONCLUSIONS

PT is superior to OST in terms of blood loss, anesthetic use, operative pain score, and operating time without sacrificing safety and survival benefits.

Comparison between the 'pull technique' and open surgery for peritoneal catheter removal in Chinese patients on peritoneal dialysis

BACKGROUND

The removal techniques for peritoneal dialysis (PD) catheters are open surgical dissection (OD) and the 'pull technique' (PT). The latter is limitedly used because of uncertainty about its feasibility and safety. This study aimed to compare the outcomes and complications between the two techniques.

METHODS

This retrospective study included patients who underwent PD catheter removal from January 2015 to January 2021 in four PD centres in China. The patients were grouped according to the different removal techniques and were followed up to observe the potential complications.

RESULTS

The demographic characteristics of patients in the PT (n = 68) and OD (n = 44) groups showed no significant difference. The indications for PD catheter removal were similar between the two groups, except for a higher frequency of peritonitis in the OD group (p = 0.010). In the PT group, the main complications were broken catheter (7.4%), superficial cuff infection (4.8%) and subcutaneous bleeding (4.8%). In the OD group, the main complications were death (9.1%) and subcutaneous bleeding (4.6%).

CONCLUSION

PT might be a safe and reliable technique for PD catheter removal compared to OD. Considering its simple and non-invasive nature, PT should be recommended as the alternative to OD in suitable PD patients.

Minimally invasive 'pull technique' for peritoneal dialysis catheter removal

A simple, noninvasive method for removing peritoneal dialysis (PD) catheters, called the "pull technique," has become popular in recent years. Physicians still worry, however, about the range of its application and possible complications such as infection of the retained cuff and breakage. We, therefore, applied this technique in patients and enriched its administration for removing PD catheters. Altogether, 24 PD catheter removals in 24 patients were reviewed during the period from July 2018 to October 2019 in our hospital. Using the pull technique, the PD catheter's superficial cuff was dissected using an electronic knife, and the deep cuff was retained. All patients' catheters were successfully removed with no breakage. No incision or retained cuff was infected during the follow-up period (1.1-15.6 months). The appropriate peak force of pull traction was approximately 12-13 pounds, not very different from the mean maximum tensile force of 21.48 pounds for silicone tube breakage. The use of intermittent (rather than sustained) traction may reduce the breakage risk of the silicone tube. This method is a safe, practical, minimally invasive method for removing PD catheters, and it is suitable for application on special patients with peritonitis or who are on an immunosuppressant.

Peritoneal Catheters and Exit-Site Practices toward Optimum Peritoneal Access: A Review of Current Developments

Objective

This review updates the 1998 International Society for Peritoneal Dialysis (ISPD) recommendations for peritoneal dialysis catheters and exit-site practices (Gokal R, et al. Peritoneal catheters and exit-site practices toward optimum peritoneal access: 1998 update. Perit Dial Int 1998; 18:11–33.)

Design

Data Sources: The Ovid and PubMed search engines were used to review the Medline databases of January 1980 through June 2003. Searches were restricted to human data; primary key word searches included dialysis, peritoneal dialysis, and continuous ambulatory peritoneal dialysis cross referenced with access, catheter, dialysis catheter, peritoneal dialysis catheter, and Tenckhoff catheter. Related searches were provided via the PubMed related articles link. Study Selection: Reports were selected if they provided identifiable information on catheter design, catheter placement technique, and survival or placement complications. Reports without such data were excluded from review. Each study was then categorized by its characteristics: single-center or multicenter; retrospective or prospective; controlled trial, with or without random patient assignment; or review article.

Main Results

There are few randomized controlled evaluations testing how catheter design and/or placement influence long-term survival and function, and these are typically conducted at a single center. The majority of reports represent retrospective single-center experiences, and these are supplemented by occasional multicenter data registries.

Conclusions

There is substantial variability in catheter outcomes between centers, and this variability is more closely correlated with operator and center characteristics than with catheter design. Some catheter designs appear to impact long-term catheter success, and, in some cases, specific patient characteristics and dialysis formats combine with specific catheter designs to influence catheter survival. Most reporters prefer two-cuff designs and placement of the deep cuff at an intramuscular location. Intramuscular cuff placement results in fewer pericatheter leaks and hernias, but makes catheter removal more difficult. High-risk patients (those with previous pelvic surgery) benefit from visual inspection of the peritoneum during catheter placement, and in randomized controlled trials, catheters with pre-shaped arcuate subcutaneous segments (“swan neck” designs) reduce the risk of early drainage failure via “migration.”

The ‘Pull’ Technique for Removal of Peritoneal Dialysis Catheters: A Call for Re-Evaluation of Practice Standards

Background

The most commonly used peritoneal dialysis (PD) catheters have silicon tubing with attached Dacron cuffs. The current standard of care for PD catheter removal is by complete surgical dissection, withdrawing both the tubing and the cuffs. The intention is to avoid infection of any residual part of the catheter. We retrospectively analyzed our results with the alternative ‘pull’ technique, by which the silicon tube is pulled out, leaving the Dacron cuffs within the abdominal wall. This technique never gained popularity due to concern that the retained cuffs would get infected.

Methods

We reviewed our experience from an 18-month period, between January 2014 and June 2015. There were 46 catheter removals in 40 patients. All the catheters were of the double-cuffed coiled Tenckhoff type (Covidien, Dublin, Ireland).

Results

Of the 46 catheter removals by the ‘pull’ technique, there was only 1 case of retained cuff infection.

Conclusions

The ‘pull’ technique is a safe method for Tenckhoff catheter removal with low risk of infection. We strongly recommend it as the procedure of choice.

Technical report: use of ultrasound guidance in the removal of tunnelled venous access catheter cuffs

Venous access catheters are employed for a wide variety of reasons. On removal of the catheter, the subcutaneous catheter cuff can be difficult to extract; retention of the cuff has recognized complications. We describe a simple ultrasound technique that assists in the identification of the cuff within the subcutaneous tissues, simplifying subsequent cuff removal. This may lead to a reduction in associated complications.

Tenckhoff catheters post-renal transplantation: the 'pull' technique?

BACKGROUND

Tenckhoff catheters are used widely for the provision of continuous ambulatory peritoneal dialysis. Traditionally these catheters are removed surgically under anaesthesia. We set out to introduce and monitor prospectively a technique for removal of the Tenckhoff catheter by a 'pull' technique. The intention was to avoid the discomfort, risk and cost of traditional surgery.

METHODS

Over a 1-year period all renal transplant patients having their Tenckhoff catheter removed by this technique were monitored prospectively. All patients were followed for a minimum 2-year period after removal. In the pull technique steady non-jerky traction is applied to the catheter. Complications such as catheter breakage and cuff related sepsis were recorded.

RESULTS

Sepsis related to a retained cuff occurred in only one patient early in the series. There were no other complications. The procedure was well tolerated. Use of local anaesthesia used initially, was largely phased out over the course of study and the procedure moved from the theatre to the ward.

CONCLUSIONS

The pull technique is safe and well tolerated. The technique has significant advantages in selected patients without a history of recent peritonitis or exit site infection, in reducing risk to the patients, the pain of abdominal wall surgery and reduced usage of costly theatre time and in-patient beds.