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Crabtree JH, Hathaway PB. Patient Selection and Planning for Image-Guided Peritoneal Dialysis Catheter Placement. Semin Intervent Radiol 2022; 39:32-39. [PMID: 35210730 PMCID: PMC8856782 DOI: 10.1055/s-0041-1741078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Image-guided percutaneous peritoneal dialysis (PD) catheter insertion has become increasingly relied upon to provide urgent access for late presenting kidney failure patients, to overcome surgical backlogs and limited operating room access, to avoid general anesthesia in high-risk patients, and, by itself, as an alternative approach to surgical PD access. Advanced planning for the procedure is essential to assure the best possible outcome. Appropriate selection of patients for percutaneous PD catheter placement, choosing the most suitable catheter type, determining insertion and exit site locations, and final patient preparations facilitate the performance of the procedure, minimizes the risk of complications, and improves the likelihood of providing a successful long-term peritoneal access.
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Affiliation(s)
- John H. Crabtree
- Division of Nephrology and Hypertension, Harbor-University of California Los Angeles Medical Center, Torrance, California,Address for correspondence John H. Crabtree, MD 340 South Lemon Avenue, Suite 2404, Walnut, CA
| | - Peter B. Hathaway
- Utah Imaging Associates, Inc., St. Marks Hospital Interventional Radiology, Salt Lake City, Utah
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2
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Milan Manani S, Virzì GM, Tantillo I, Giuliani A, Dian S, Marcello M, Costa E, Marturano D, Ronco C, Zanella M. Peritoneal Vicenza "Short" Catheter Outcomes and Comparison with International Society for Peritoneal Dialysis Guidelines. Blood Purif 2021; 51:726-731. [PMID: 34883486 DOI: 10.1159/000519316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A well-functioning peritoneal catheter is key to success of peritoneal dialysis (PD). The Vicenza "short" catheter is a modified Tenckhoff catheter with a shorter intraperitoneal segment. The aim of this study was to evaluate the incidence of catheter-related complications and catheter survival rate using the Vicenza "short" catheter, according to the goals suggested by the International Society for Peritoneal Dialysis (ISPD) guidelines. Second, we compared insertion techniques used in our center. METHODS This is a retrospective cohort, single-center study analyzing incident PD patients undergoing Vicenza "short" peritoneal catheter placement between January 1, 2015, and December 31, 2019. As clinical outcomes, we evaluated catheter patency at 12 months, exit-site/tunnel infection and peritonitis within 30 days of catheter insertion, visceral injury, or significant hemorrhage during the procedure, in accordance with ISPD guidelines. RESULTS The percentage of patency at 12 months for all catheter insertion methods was 88.91%, and the percentage for laparoscopic placement was 93.75%. The exit-site/tunnel infection and peritonitis occurring within 30 days of catheter insertion were, respectively, 0.75% and 2.2%; the visceral injury leading to intervention was 0.75%. We did not have any case of significant hemorrhage. All results were in line with ISPD guidelines. CONCLUSION We conclude that the Vicenza "short" catheter is a suitable device for peritoneal access. The implantation procedure is safe and easy to perform, and both nephrologists and surgeons can do it. A confident use and a proper implantation of the Vicenza "short" catheter help achieve the clinical ISPD goals for the PD access procedure in terms of catheter survival and complication rates.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Silvia Dian
- International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.,DIMED, University of Padova, Padova, Italy
| | - Matteo Marcello
- International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.,Libera Università Vita Salute San Raffaele, Milan, Italy
| | - Elisa Costa
- Department of Internal Medicine, Nephrology Dialysis and Transplantation Clinics, Ospedale Policlinico San Martino, Genoa, Italy
| | - Davide Marturano
- International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.,DIMED, University of Padova, Padova, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.,DIMED, University of Padova, Padova, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
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Ito Y, Ryuzaki M, Sugiyama H, Tomo T, Yamashita AC, Ishikawa Y, Ueda A, Kanazawa Y, Kanno Y, Itami N, Ito M, Kawanishi H, Nakayama M, Tsuruya K, Yokoi H, Fukasawa M, Terawaki H, Nishiyama K, Hataya H, Miura K, Hamada R, Nakakura H, Hattori M, Yuasa H, Nakamoto H. Peritoneal Dialysis Guidelines 2019 Part 1 (Position paper of the Japanese Society for Dialysis Therapy). RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00348-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AbstractApproximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.
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Crabtree JH, Burchette RJ. Prospective Comparison of Downward and Lateral Peritoneal Dialysis Catheter Tunnel-Tract and Exit-Site Directions. Perit Dial Int 2020. [DOI: 10.1177/089686080602600612] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectiveGuidelines for optimal peritoneal dialysis access support both downward and lateral exit-site directions. Numerous clinical reports support the superiority of downward exit sites but none substantiate lateral configurations.MethodsThis prospective study compared infectious and mechanical complications between 85 catheters with a preformed arcuate bend to produce a downward exit site and 93 catheters with a straight intercuff segment configured to create a lateral exit site.ResultsKaplan–Meier survivals were not different for time to first exit-site infection ( p = 0.62), tunnel infection ( p = 0.89), or peritonitis ( p = 0.38) for downward and lateral exit-site directions. Poisson regression showed no differences in rates (episodes/patient-year) of exit-site infection (0.26 vs 0.27, p = 0.86), tunnel infection (0.02 vs 0.03, p = 0.79), peritonitis (0.42 vs 0.43, p = 0.87), or catheter loss (0.06 vs 0.09, p = 0.29) for downward and lateral exit sites. Kaplan–Meier analyses of antibiotic-free intervals for exit-site ( p = 0.94) and peritonitis infections ( p = 0.72) were not different for the two groups. There was one case of catheter tip displacement with flow dysfunction in each group. There were no pericatheter hernias or spontaneous cuff extrusions. Catheter survival between groups was not different ( p = 0.20).ConclusionsCatheter types employing downward and lateral tunnel-tract and exit-site configurations produce equivalent outcomes for infectious and mechanical complications.
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Affiliation(s)
- John H. Crabtree
- Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, Bellflower
| | - Raoul J. Burchette
- Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, California, USA
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Crabtree JH, Shrestha BM, Chow KM, Figueiredo AE, Povlsen JV, Wilkie M, Abdel-Aal A, Cullis B, Goh BL, Briggs VR, Brown EA, Dor FJMF. Creating and Maintaining Optimal Peritoneal Dialysis Access in the Adult Patient: 2019 Update. Perit Dial Int 2019; 39:414-436. [PMID: 31028108 DOI: 10.3747/pdi.2018.00232] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/14/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- John H Crabtree
- Division of Nephrology and Hypertension, Harbor-University of California Los Angeles Medical Center, Torrance, CA, USA
| | - Badri M Shrestha
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Kai-Ming Chow
- Division of Nephrology, Carol and Richard Yu PD Research Centre, Prince of Wales Hospital, Chinese University of Hong Kong
| | - Ana E Figueiredo
- School of Health Sciences, Nursing School - Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Johan V Povlsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Ahmed Abdel-Aal
- Department of Radiology, Section of Interventional Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brett Cullis
- Hilton Life Renal Unit, Pietermaritzburg, South Africa
| | - Bak-Leong Goh
- Department of Nephrology, Hospital Serdang, Kuala Lumpur, Malaysia
| | - Victoria R Briggs
- Department of Nephrology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Frank J M F Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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Qayyum A, Yang L, Fan SL. Optimizing Peritoneal Dialysis Catheter Placement by Lateral Abdomen X-Ray. Perit Dial Int 2015; 35:760-2. [PMID: 26703848 DOI: 10.3747/pdi.2014.00263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ahad Qayyum
- Joint International Society of Nephrology & Kidney Research, Barts Health NHS Trust, London, UK Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | - Lisa Yang
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | - Stanley L Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
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Cho Y, Baer R, Killen JP, Mantha M. Outcomes of nephrologist-inserted peritoneal catheters in indigenous patients from Far North Queensland. Perit Dial Int 2015; 34:663-7. [PMID: 25228217 DOI: 10.3747/pdi.2011.00261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Richard Baer
- Renal Unit Cairns Base Hospital Cairns, Australia
| | | | - Murty Mantha
- Renal Unit Cairns Base Hospital Cairns, Australia
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Bender FH. Avoiding harm in peritoneal dialysis patients. Adv Chronic Kidney Dis 2012; 19:171-8. [PMID: 22578677 DOI: 10.1053/j.ackd.2012.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 04/05/2012] [Accepted: 04/06/2012] [Indexed: 12/16/2022]
Abstract
This review is focused on minimizing complications and avoiding harm in peritoneal dialysis (PD) patients. Issues related to planning for PD are covered first, with emphasis on PD versus hemodialysis outcomes. Catheter types and insertion techniques are described next, including relevant recommendations by the International Society for Peritoneal Dialysis. A brief review of both noninfectious and infectious complications follows, with emphasis on cardiovascular and metabolic complications. Finally, recommendations for preventing PD-related infections are provided. In conclusion, with proper catheter insertion technique, good training, and attention to detail during the tenure in PD, excellent outcomes can be obtained in a well-informed motivated patient.
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Figueiredo A, Goh BL, Jenkins S, Johnson DW, Mactier R, Ramalakshmi S, Shrestha B, Struijk D, Wilkie M. Clinical practice guidelines for peritoneal access. ARCH ESP UROL 2010; 30:424-9. [PMID: 20628103 DOI: 10.3747/pdi.2010.00087] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Ana Figueiredo
- Faculdade de Enfermagem, Nutrição e Fisioterapia, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
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McCormick BB, Bargman JM. Noninfectious Complications of Peritoneal Dialysis: Implications for Patient and Technique Survival: Table 1. J Am Soc Nephrol 2007; 18:3023-5. [PMID: 18003770 DOI: 10.1681/asn.2007070796] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Brendan B McCormick
- Division of Nephrology, Kidney Research Center, and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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Abstract
Many burdensome interventions that adversely affect the utilization of peritoneal dialysis as renal replacement therapy and patient satisfaction with this treatment modality can be avoided by early peritoneal access placement with embedded catheters, implantation techniques that preempt common catheter complications, and the use of access devices that provide flexibility in exit site location. Catheter embedding consists of subcutaneously burying the external limb of the catheter tubing at the time of the insertion procedure. Interval exteriorization of the catheter is performed when dialysis is needed. Earlier commitment by patients to peritoneal dialysis can be achieved by elimination of catheter maintenance until dialysis is necessary. Catheter embedding is a practical strategy to avoid temporary hemodialysis with vascular catheters and reduces stress on operating room access by allowing more efficient scheduling as non-urgent procedures. Laparoscopic catheter placement enables proactive techniques not available to other conventional insertion methods. These techniques include rectus sheath tunneling to prevent catheter tip migration, selective prophylactic omentopexy to prevent omental entrapment, selective resection of epiploic appendages to prevent catheter obstruction, adhesiolysis to eliminate compartmentalization, and diagnosis and simultaneous repair of previously undiagnosed abdominal wall hernias. Both standard and extended 2-piece catheter systems are necessary to customize the peritoneal access to a variety of body configurations. Catheters should be able to produce lower abdominal, mid-abdominal, upper abdominal, and upper chest exit site locations that facilitate management by the patient without sacrificing deep pelvic position of the catheter tip or resulting in excessive tubing stress during passage through the abdominal wall.
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Affiliation(s)
- J H Crabtree
- Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, Bellflower, CA 90706, USA.
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Bender FH, Bernardini J, Piraino B. Prevention of infectious complications in peritoneal dialysis: best demonstrated practices. Kidney Int 2007:S44-54. [PMID: 17080111 DOI: 10.1038/sj.ki.5001915] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Peritoneal dialysis (PD) related infections continue to be a serious complication for PD patients. Peritonitis can be associated with pain, hospitalization and catheter loss as well as a risk of death. Peritonitis risk is not evenly spread across the PD population or programs. Very low rates of peritonitis in a program are possible if close attention is paid to the causes of peritonitis and protocols implemented to reduce the risk of infection. Protocols to decrease infection risk in PD patients include proper catheter placement, exit-site care that includes Staphylococcus aureus prophylaxis, careful training of patients with periodic retraining, treatment of contamination, and prevention of procedure-related and fungal peritonitis. Extensive data have been published on the use of antibiotic prophylaxis to prevent exit site infections. There are fewer data on training methods of patients to prevent infection risk. Quality improvement programs with continuous monitoring of infections, both of the catheter exit site and peritonitis, are important to decrease the PD related infections in PD programs. Continuous review of every episode of infection to determine the root cause of the event should be routine in PD programs. Further research is needed examining approaches to decrease infection risk.
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Affiliation(s)
- F H Bender
- Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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