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Al-Hwiesh AK, Abdul-Rahman IS, Divino-Filho JC, Nasreldin MA, Al-Hwiesh AA, Al-Audah N, Althubaini HH, Abdulgalil M, Salah GA, Al-Baggal MZ, Abu-Oun BA, Al-Audah N, Al-Ramadan HS, Alfalah K, Almarri Z, Al-Awal AA. A nephrologist dream of peritoneal dialysis catheter with zero migration: A multicenter prospective study. Ther Apher Dial 2024; 28:89-95. [PMID: 37583361 DOI: 10.1111/1744-9987.14045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/29/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION PD catheter tip migration is a common complication and a significant cause of catheter malfunction. In this perspective, we present our experience with a new catheter and a new technique that involves the use of a new triple cuff PD catheter and a low entry site in an attempt to prevent PD catheter migration. METHODS A total of 503 incident PD patients have been studied in more than one PD center over a period of 5 years. RESULTS During the 5-year follow up we recorded zero percent catheter migration. Other technical complications were poor drainage in 3.4%, omental wrap in 2.8%, early leakage in 3.4%, and catheter replacement in 2.4%. By the end of the study, the one-year PD catheter survival was 97.6%. CONCLUSION Our new triple cuff PD catheter and our low-entry approach seem to be effective in preventing PD catheter migration and minimizing other mechanical complications.
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Affiliation(s)
- Abdullah K Al-Hwiesh
- Deparment of Nephrolgy, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Ibrahiem Saeed Abdul-Rahman
- Deparment of Nephrolgy, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | | | - Mohamed A Nasreldin
- Deparment of Nephrolgy, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Amani A Al-Hwiesh
- Deparment of Nephrolgy, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Nadia Al-Audah
- Ministry of Health, Dammam Central Hospital, Dammam, Saudi Arabia
| | - Hatem H Althubaini
- Deparment of Nephrolgy, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Moaz Abdulgalil
- Deparment of Nephrolgy, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Ghassan A Salah
- Ministry of Health, King Fahd Hospital, Al-Hassa, Saudi Arabia
| | | | | | - Nehad Al-Audah
- Deparment of Nephrolgy, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | | | - Kaltham Alfalah
- Deparment of Nephrolgy, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Zahra Almarri
- Deparment of Nephrolgy, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Ayat A Al-Awal
- Deparment of Nephrolgy, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
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Li P, Choo D, Deved V, Shah N, Shurraw S, Zuidema S, Samji R. Salvage of Malfunctioning Peritoneal Dialysis Catheters: An Algorithm for Recanalization and Repositioning. J Vasc Interv Radiol 2021; 32:902-906. [PMID: 33771711 DOI: 10.1016/j.jvir.2021.03.522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/05/2021] [Accepted: 03/14/2021] [Indexed: 11/26/2022] Open
Abstract
A peritoneal dialysis catheter salvage algorithm was developed and performed for 40 patients with documented catheter malfunction (obstruction and/or malposition) referred to the interventional radiology suite. This procedure utilized a metallic stiffener for repositioning and rotating dual guide wires for recanalization. A retrospective analysis of 35 cases of fluoroscopic manipulation showed that in 83% of the cases, the catheters were successfully repositioned and/or recanalized, and in 59%, they remained patent at 30 days. No major adverse events occurred. The results suggest that this algorithm is a safe and effective approach to salvage malfunctioning peritoneal dialysis catheters and that a trial of fluoroscopic salvage can be considered prior to surgical intervention.
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Affiliation(s)
- Paul Li
- University of Alberta Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas Choo
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Vinay Deved
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nikihl Shah
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sabin Shurraw
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sylvia Zuidema
- University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Rahim Samji
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.
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Cullis B, Al-Hwiesh A, Kilonzo K, McCulloch M, Niang A, Nourse P, Parapiboon W, Ponce D, Finkelstein FO. ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 update (adults). Perit Dial Int 2020; 41:15-31. [PMID: 33267747 DOI: 10.1177/0896860820970834] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
SUMMARY STATEMENTS (1) Peritoneal dialysis (PD) should be considered a suitable modality for treatment of acute kidney injury (AKI) in all settings (1B). GUIDELINE 2: ACCESS AND FLUID DELIVERY FOR ACUTE PD IN ADULTS (2.1) Flexible peritoneal catheters should be used where resources and expertise exist (1B) (optimal).(2.2) Rigid catheters and improvised catheters using nasogastric tubes and other cavity drainage catheters may be used in resource-poor environments where they may still be life-saving (1C) (minimum standard).(2.3) We recommend catheters should be tunnelled to reduce peritonitis and peri-catheter leak (practice point).(2.4) We recommend that the method of catheter implantation should be based on patient factors and locally available skills (1C).(2.5) PD catheter implantation by appropriately trained nephrologists in patients without contraindications is safe and functional results equate to those inserted surgically (1B).(2.6) Nephrologists should receive training and be permitted to insert PD catheters to ensure timely dialysis in the emergency setting (practice point). (2.7) We recommend, when available, percutaneous catheter insertion by a nephrologist should include assessment with ultrasonography (2C).(2.8) Insertion of PD catheter should take place under complete aseptic conditions using sterile technique (practice point).(2.9) We recommend the use of prophylactic antibiotics prior to PD catheter implantation (1B).(2.10) A closed delivery system with a Y connection should be used (1A) (optimal). In resource poor areas, spiking of bags and makeshift connections may be necessary and can be considered (minimum standard).(2.11) The use of automated or manual PD exchanges are acceptable and this will be dependent on local availability and practices (practice point). GUIDELINE 3: PERITONEAL DIALYSIS SOLUTIONS FOR ACUTE PD (3.1) In patients who are critically ill, especially those with significant liver dysfunction and marked elevation of lactate levels, bicarbonate containing solutions should be used (1B) (optimal). Where these solutions are not available, the use of lactate containing solutions is an alternative (practice point) (minimum standard).(3.2) Commercially prepared solutions should be used (optimal). However, where resources do not permit this, then locally prepared fluids may be life-saving and with careful observation of sterile preparation procedure, peritonitis rates are not increased (1C) (minimum standard).(3.3) Once potassium levels in the serum fall below 4 mmol/L, potassium should be added to dialysate (using strict sterile technique to prevent infection) or alternatively oral or intravenous potassium should be given to maintain potassium levels at 4 mmol/L or above (1C).(3.4) Potassium levels should be measured daily (optimal). Where these facilities do not exist, we recommend that after 24 h of successful dialysis, one consider adding potassium chloride to achieve a concentration of 4 mmol/L in the dialysate (minimum standard) (practice point). GUIDELINE 4: PRESCRIBING AND ACHIEVING ADEQUATE CLEARANCE IN ACUTE PD (4.1) Targeting a weekly K t/V urea of 3.5 provides outcomes comparable to that of daily HD in critically ill patients; targeting higher doses does not improve outcomes (1B). This dose may not be necessary for most patients with AKI and targeting a weekly K t/V of 2.2 has been shown to be equivalent to higher doses (1B). Tidal automated PD (APD) using 25 L with 70% tidal volume per 24 h shows equivalent survival to continuous venovenous haemodiafiltration with an effluent dose of 23 mL/kg/h (1C).(4.2) Cycle times should be dictated by the clinical circumstances. Short cycle times (1-2 h) are likely to more rapidly correct uraemia, hyperkalaemia, fluid overload and/or metabolic acidosis; however, they may be increased to 4-6 hourly once the above are controlled to reduce costs and facilitate clearance of larger sized solutes (2C).(4.3) The concentration of dextrose should be increased and cycle time reduced to 2 hourly when fluid overload is evident. Once the patient is euvolemic, the dextrose concentration and cycle time should be adjusted to ensure a neutral fluid balance (1C).(4.4) Where resources permit, creatinine, urea, potassium and bicarbonate levels should be measured daily; 24 h K t/V urea and creatinine clearance measurement is recommended to assess adequacy when clinically indicated (practice point).(4.5) Interruption of dialysis should be considered once the patient is passing >1 L of urine/24 h and there is a spontaneous reduction in creatinine (practice point). The use of peritoneal dialysis (PD) to treat patients with acute kidney injury (AKI) has become more popular among clinicians following evidence of similar outcomes when compared with other extracorporeal therapies. Although it has been extensively used in low-resource environments for many years, there is now a renewed interest in the use of PD to manage patients with AKI (including patients in intensive care units) in higher income countries. Here we present the update of the International Society for Peritoneal Dialysis guidelines for PD in AKI. These guidelines extensively review the available literature and present updated recommendations regarding peritoneal access, dialysis solutions and prescription of dialysis with revised targets of solute clearance.
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Affiliation(s)
- Brett Cullis
- Renal and Intensive Care Unit, Hilton Life Hospital, South Africa.,Department of Renal and Solid Organ Transplantation, Red Cross War Memorial Childrens Hospital, 37716University of Cape Town, South Africa
| | - Abdullah Al-Hwiesh
- Department of Internal Medicine, Nephrology Division, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Kajiru Kilonzo
- Department of Internal Medicine, 108095Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Mignon McCulloch
- Department of Renal and Solid Organ Transplantation, Red Cross War Memorial Childrens Hospital, 37716University of Cape Town, South Africa
| | - Abdou Niang
- Nephrology Department, Cheikh A. Diop University, Dakar, Senegal
| | - Peter Nourse
- Department of Renal and Solid Organ Transplantation, Red Cross War Memorial Childrens Hospital, 37716University of Cape Town, South Africa
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Ko YK, Kim YB, Shin WJ, Lim CH, Cheon W, Park JH, Lee JH, Jo YI. Effects of early detection of peritoneal catheter migration on clinical outcomes: 15-years experiences from a single centre. Nephrology (Carlton) 2019; 25:413-420. [PMID: 31257697 PMCID: PMC7187436 DOI: 10.1111/nep.13627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2019] [Indexed: 12/03/2022]
Abstract
Aim Catheter migration is an important cause of catheter malfunction in peritoneal dialysis (PD). The purpose of this study was to investigate the effect of early detection of catheter migration on clinical outcomes. Methods A retrospective review of 135 consecutive patients initiating PD immediately following catheter insertion from 2002 to 2017 was undertaken. In order to detect catheter migration without malfunction early, serial abdominal‐pelvic radiographic examinations were performed according to a predefined protocol. Conservative management with rigorous catharsis was undertaken to correct catheter migration. A Kaplan–Meier method was used to calculate survival rate. Results Mean follow‐up period was 42.8 ± 34.9 months. Catheter migration occurred in 62.4%. Among them, 85.9% occurred within the first 2 weeks after catheter insertion. There were no significant associations between catheter migration and variables such as gender, obesity, DM and type of catheter. Success rate of conservative management with rigorous catharsis was 91.1%. Catheter survival at 1 and 5 years were 91.5% and 64.6% in the migration group and 81.2% and 69.9% in the non‐migration group, respectively (Log–rank test, P = 0.915). Patient survival at 1 and 5 years were 96.8% and 85.8% in the migration group and 91.9% and 82.3% in the non‐migration group, respectively (P = 0.792). Conclusion Early detection of PD catheter migration allowed the migrated tip to be easily corrected with conservative management. Once the migrated catheter tip was restored, catheter migration itself did not affect catheter survival. These findings suggest that early detection and correction of catheter migration is important for improving clinical outcomes. In this retrospective study of 135 peritoneal dialysis patients, serial X‐rays were used for early detection of catheter migration. In over 90% patients, conservative management with rigorous catharsis (defined as an increase in stool frequency more than four times a day) was successful in restoring normal catheter position and function when the problem is identified early.
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Affiliation(s)
- Young-Kyung Ko
- Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Young-Baek Kim
- Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Won-Jae Shin
- Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Chae-Ho Lim
- Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Woong Cheon
- Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Jung-Hwan Park
- Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea.,Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Jong-Ho Lee
- Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea.,Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Young-Il Jo
- Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea.,Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea
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Efficacy and safety of fluoroscopic manipulation using the alpha-replacer for peritoneal catheter malposition. Clin Exp Nephrol 2014; 19:521-6. [DOI: 10.1007/s10157-014-1007-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
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Sarafidis P, Bowes E, Rumjon A, Ansari B, Cairns H. A novel technique for repositioning, under local anesthetic, malfunctioning and migrated peritoneal dialysis catheters. Perit Dial Int 2013; 33:700-4. [PMID: 24335128 DOI: 10.3747/pdi.2012.00051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Miller M, McCormick B, Lavoie S, Biyani M, Zimmerman D. Fluoroscopic manipulation of peritoneal dialysis catheters: outcomes and factors associated with successful manipulation. Clin J Am Soc Nephrol 2012; 7:795-800. [PMID: 22362064 DOI: 10.2215/cjn.09850911] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Mechanical failure of the peritoneal dialysis (PD) catheter is an important cause of technique failure. Fluoroscopic guidewire manipulation may be undertaken in an attempt to correct the failure. The purpose of this study was to determine the efficacy of fluoroscopic manipulation of previously embedded PD catheters, the factors associated with successful manipulation, and the complication rate associated with manipulation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A single-center, retrospective review of 70 consecutive PD patients undergoing fluoroscopic manipulation for mechanical failure of their PD catheter from June 2006 to February 2011 was undertaken. Logistic regression models were developed to determine the variables associated with successful manipulation. RESULTS Of the 70 manipulations, 44 were successful (62.9%). In univariate analysis, catheters located in the pelvis compared with those in the upper abdomen (73.5% versus 42.9%, P=0.01) and catheters that were previously functional compared with those that failed at exteriorization (75.0% versus 46.7%, P=0.04) were more likely to be successfully manipulated. Time embedded, previous hemodialysis, and number of intra-abdominal surgeries were not correlated with likelihood of successful manipulation. In multivariate analysis, catheters located in the pelvis (P=0.01) and those with secondary failure (P=0.01) were more likely to successfully manipulated. Two of the patients developed peritonitis (2.9%), neither requiring cessation of PD. CONCLUSIONS Fluoroscopic manipulation is an effective and safe therapy for failed PD catheters that are unresponsive to conservative treatment. Properly positioned catheters and those that were previously functional are more likely to be successfully manipulated.
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Affiliation(s)
- Matthew Miller
- Division of Nephrology, McMaster University, Hamilton, Canada
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Laparoscopic correction of peritoneal catheter dysfunction. Indian J Surg 2008; 70:227-30. [PMID: 23133068 DOI: 10.1007/s12262-008-0065-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 09/19/2008] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To present our experiences with laparoscopic repair of peritoneal catheter dysfunction METHODS Total of 24 patients with peritoneal catheter malfunction were considered for two-port laparoscopic manipulation. Two patients with unsuccessful result in the first trial and 3 patients with successful peritoneal dialysis results were reoperated because of catheter dysfunction. RESULTS The success rates at the first and second manipulation was 79% and 80%. The most frequent cause of catheters dysfunction was migration of catheters out of the true pelvis. During the follow up, 8 patients were referred for renal transplantation, 8 underwent hemodialysis and 5 continued with normal catheter function. The mean longevity of the catheters after laparoscopic correction was 42 months. One year longevity rate as measured as 79%. CONCLUSION Laparoscopy is the procedure of choice even in recurrent cases, for correction of malfunctioning continuous ambulatory peritoneal catheters, because this procedure is the only technique that can detects pathologic causes of catheters malfunction and can resolve those problems at the same time.
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