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Zhang L, Ma X, Zheng Y, Tian S, Zhang J, Yan L, Gu Y, Shao F. Efficacy and safety of removing peritoneal dialysis catheters using the pull technique. Int Urol Nephrol 2024; 56:1129-1135. [PMID: 37646969 DOI: 10.1007/s11255-023-03761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
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.
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Affiliation(s)
- Lina Zhang
- Henan Provincial Key Laboratory of Kidney Disease and Immunology, Department of Nephrology, Peritoneal Dialysis Center, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xu Ma
- Henan Provincial Key Laboratory of Kidney Disease and Immunology, Department of Nephrology, Peritoneal Dialysis Center, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yanping Zheng
- Henan Provincial Key Laboratory of Kidney Disease and Immunology, Department of Nephrology, Peritoneal Dialysis Center, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Suge Tian
- Henan Provincial Key Laboratory of Kidney Disease and Immunology, Department of Nephrology, Peritoneal Dialysis Center, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jing Zhang
- Henan Provincial Key Laboratory of Kidney Disease and Immunology, Department of Nephrology, Peritoneal Dialysis Center, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Lei Yan
- Henan Provincial Key Laboratory of Kidney Disease and Immunology, Department of Nephrology, Peritoneal Dialysis Center, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yue Gu
- Henan Provincial Key Laboratory of Kidney Disease and Immunology, Department of Nephrology, Peritoneal Dialysis Center, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China.
| | - Fengmin Shao
- Henan Provincial Key Laboratory of Kidney Disease and Immunology, Department of Nephrology, Peritoneal Dialysis Center, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China.
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Sakurada T, Yoshida K, Morikubo S, Kojima S. Resuming peritoneal dialysis after secondary embedding of the peritoneal dialysis catheter in the end-of-life period: A case report. Perit Dial Int 2024; 44:70-72. [PMID: 37069778 DOI: 10.1177/08968608231163005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Secondary embedding of a peritoneal dialysis (PD) catheter has been performed for patients whose kidney function has improved enough to stop dialysis but recovery is not expected to be long term. In addition, we have also performed the procedure for patients who have poor general condition due to severe cerebrovascular and/or cardiac disease or who wish to have PD again at the end of life. Here, we report the case of the first terminal haemodialysis (HD) patient who resumed PD using a secondarily embedded catheter as an end-of-life choice. The patient had undergone secondary embedding of a PD catheter and had been transferred to HD, during which time multiple pulmonary metastases of thyroid cancer were observed. She hoped to resume PD in the end-of-life period, and the catheter was subsequently externalised. The catheter was used immediately, and the patient has continued on PD over the past 1 month without infectious or mechanical complications. For elderly end-stage kidney disease patients with progressive disease and cancer, secondary embedding of the PD catheter may be an option to permit them to live the remainder of their lives at home.
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Affiliation(s)
- Tsutomu Sakurada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Keisuke Yoshida
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Satoru Morikubo
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shigeki Kojima
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Pull technique versus open surgical removal of the catheter for peritoneal dialysis: a retrospective cohort study. Clin Exp Nephrol 2022; 26:827-834. [PMID: 35426593 DOI: 10.1007/s10157-022-02222-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/29/2022] [Indexed: 11/03/2022]
Abstract
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.
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Flanigan M, Gokal R. Peritoneal Catheters and Exit-Site Practices toward Optimum Peritoneal Access: A Review of Current Developments. Perit Dial Int 2020. [DOI: 10.1177/089686080502500204] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.”
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Affiliation(s)
- Michael Flanigan
- University of Iowa, University of Iowa Hospitals, Iowa City, Iowa, USA
| | - Ram Gokal
- Department of Renal Medicine, Manchester Royal Infirmary and University of Manchester, United Kingdom
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Kahveci A, Ari E, Asicioglu E, Arikan H, Tuglular S, Ozener C. Peritoneal Dialysis Catheter Removal by Nephrologists: Technical Aspect from a Single Center. Perit Dial Int 2020; 30:570-2. [DOI: 10.3747/pdi.2009.00220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Arzu Kahveci
- Division of Nephrology Department of Internal Medicine Marmara University School of Medicine Istanbul, Turkey
| | - Elif Ari
- Division of Nephrology Department of Internal Medicine Marmara University School of Medicine Istanbul, Turkey
| | - Ebru Asicioglu
- Division of Nephrology Department of Internal Medicine Marmara University School of Medicine Istanbul, Turkey
| | - Hakki Arikan
- Division of Nephrology Department of Internal Medicine Marmara University School of Medicine Istanbul, Turkey
| | - Serhan Tuglular
- Division of Nephrology Department of Internal Medicine Marmara University School of Medicine Istanbul, Turkey
| | - Cetin Ozener
- Division of Nephrology Department of Internal Medicine Marmara University School of Medicine Istanbul, Turkey
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Grieff M, Mamo E, Scroggins G, Kurchin A. The ‘Pull’ Technique for Removal of Peritoneal Dialysis Catheters: A Call for Re-Evaluation of Practice Standards. Perit Dial Int 2020; 37:225-229. [DOI: 10.3747/pdi.2016.00152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/26/2016] [Indexed: 11/15/2022] Open
Abstract
BackgroundThe 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.MethodsWe 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).ResultsOf the 46 catheter removals by the ‘pull’ technique, there was only 1 case of retained cuff infection.ConclusionsThe ‘pull’ technique is a safe method for Tenckhoff catheter removal with low risk of infection. We strongly recommend it as the procedure of choice.
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Affiliation(s)
- Marvin Grieff
- Department of Medicine, Rochester, NY, USA
- Rochester General Hospital, Rochester, NY, USA; and University of Rochester School of Medicine, Rochester, NY, USA
| | - Elizabeth Mamo
- Medical Library, Department of Information Technology, Rochester, NY, 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: 170] [Impact Index Per Article: 34.0] [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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Sakurada T, Kaneshiro N, Otowa T, Oishi D, Koitabashi K, Matsui K, Konno Y, Sato Y, Shibagaki Y, Kimura K. Re-embedding catheter technique at the discontinuation of peritoneal dialysis. Perit Dial Int 2015; 35:360-1. [PMID: 26015419 DOI: 10.3747/pdi.2013.00313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tsutomu Sakurada
- Division of Nephrology and Hypertension, Integrated Care Center for Kidney Disease, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Nagayuki Kaneshiro
- Division of Nephrology and Hypertension Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Takanori Otowa
- Division of Nephrology and Hypertension, Integrated Care Center for Kidney Disease, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Daisuke Oishi
- Division of Nephrology and Hypertension, Integrated Care Center for Kidney Disease, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kenichiro Koitabashi
- Division of Nephrology and Hypertension, Integrated Care Center for Kidney Disease, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Katsuomi Matsui
- Division of Nephrology and Hypertension, Integrated Care Center for Kidney Disease, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yusuke Konno
- Division of Nephrology and Hypertension Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Yuichi Sato
- Department of Internal Medicine and Department of Urology, Integrated Care Center for Kidney Disease, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Integrated Care Center for Kidney Disease, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kenjiro Kimura
- Division of Nephrology and Hypertension, Integrated Care Center for Kidney Disease, St. Marianna University School of Medicine, Kawasaki, Japan
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