Abstract
Purpose
Peritoneal dialysis (PD) catheter tip migration accounts for the majority of cases of PD catheter malfunction. In this case series, we described our experiences of using a modified PD catheter implantation approach through a site that is lower than the site that is conventionally used, to reduce catheter malfunction.
Methods
We retrospectively identified 76 patients who received PD catheter implantation at the Affiliated Wujin Hospital of Jiangsu University, among whom 39 received the traditional approach of low-site insertion and 37 received a modified approach of very-low-site insertion. All participants were followed up for at least 2 years after PD catheter implantation, and the development of catheter dysfunction or death during this period was monitored.
Results
We found that the survival rate of the initially inserted catheter was 75.68% among the very-low-site group. This survival rate was significantly better than that observed among the low-site group (48.72%; p = 0.029). Kaplan–Meier curves of the initial catheter survival also showed that the catheter survival was significantly higher in the patients in the very-low-site group than those in the low-site group (log rank p = 0.012). Complications, such as catheter tip migration, were not observed in the very-low-site group, while tip migration occurred in 15.38% of the patients in the low-site group (very-low-site group vs low-site group: p = 0.039).
Conclusions
A safe and simple PD catheter implantation can be performed either through the low-site approach or the very-low-site approach.
Similar content being viewed by others
References
Liu FX, Gao X, Inglese G, Chuengsaman P, Pecoits-Filho R, Yu A (2015) A global overview of the impact of peritoneal dialysis first or favored policies: an opinion. Perit Dial Int 35:406–420
Choy AS, Li PK (2015) Sustainability of the peritoneal dialysis-first policy in Hong Kong. Blood Purif 40:320–325
Ma TK, Chow KM, Kwan BC, Ng JK, Choy AS, Kwong VW, Pang WF, Leung CB, Li PK, Szeto CC (2018) Peritoneal dialysis catheter revision and replacement by nephrologist for peritoneal dialysis catheter malfunction. Nephron 138:214–219
Asif A (2005) Peritoneal dialysis catheter insertion. Minerva Chir 60:417
Lan L, Jiang J, Wang P, Ren W, Hu Z (2015) Peritoneal dialysis catheter placement in the right lower quadrant is associated with a lower risk of catheter tip migration: a retrospective single-center study. Int Urol Nephrol 47:557–562
Shrestha BM, Shrestha D, Kumar A, Shrestha A, Boyes SA, Wilkie ME (2018) Advanced laparoscopic peritoneal dialysis catheter insertion: systematic review and meta-analysis. Perit Dial Int 38:163–171
Mo M, Ju Y, Hu H, Zhang W, Pan J, Zheng Q, Chen J, Su L, Dou X (2017) Peritoneal dialysis catheter emplacement by advanced laparoscopy: 8-year experience from a medical center of China. Sci Rep 7:9097
Zhang L, Liu J, Shu J, Hu J, Yu X, Mao H, Ren H, Hong H, Xing C (2011) Low-site peritoneal catheter implantation decreases tip migration and omental wrapping. Perit Dial Int 31:202–204
Pan A, Poi MJ, Matos J, Jiang JS, Kfoury E, Echeverria A, Bechara CF, Lin PH (2016) Long-term outcomes of single-port laparoscopic placement of peritoneal dialysis catheter. Vasc Endovasc Surg 50:343–348
Jiang C, Xu L, Chen Y, Yan X, Sun C, Zhang M (2014) A modified open surgery technique for peritoneal dialysis catheter placement decreases catheter malfunction. Perit Dial Int 34:358–367
Shen Q, Jiang X, Shen X, Yu F, Tu Q, Chen W, Ye Q, Behera TR, He Q (2017) Modified laparoscopic placement of peritoneal dialysis catheter with intra-abdominal fixation. Int Urol Nephrol 49:1481–1488
Keramati MR, Abbaszadeh-Kasbi A, Keshvari A (2018) Laparoscopic omentopexy, rectus sheath tunneling and implantation of the peritoneal dialysis catheter using a peritoneal dialysis port. Perit Dial Int 38:187–191
Krezalek MA, Bonamici N, Lapin B, Carbray J, Velasco J, Denham W, Linn J, Ujiki M, Haggerty SP (2016) Laparoscopic peritoneal dialysis catheter insertion using rectus sheath tunnel and selective omentopexy significantly reduces catheter dysfunction and increases peritoneal dialysis longevity. Surgery 160:924–935
Tu QD, He Q, Shen XG, Jiang XX, Liu YM, Shen QQ, Zhang HJ, Chen WF, Yao LX (2016) Clinical comparison of modified laparoscopic and conventional placement of peritoneal dialysis catheters. Zhonghua Yi Xue Za Zhi 96:3586–3589
Keshvari A, Keramati MR, Nassajian MR, Mohsenipour M, Nouritaromlou MK (2016) Introduction of a new laparoscopic trocar for insertion of peritoneal dialysis catheters and making a proper rectus sheath tunneling. Surg Endosc 30:5325–5329
Dell’aquila R, Chiaramonte S, Rodighiero MP, Di Loreto P, Spano E, Nalesso F, Cruz D, Kuang D, Ronco C (2006) The Vicenza “Short” peritoneal catheter: a twenty year experience. Int J Artif Organs 29:123–127
Wang H, Jia H, Lv X, Ding G (2014) Peritoneal catheter fixation to the abdominal wall in surgical catheter implantation to prevent malfunction. Blood Purif 38:109–114
Figueiredo A, Goh BL, Jenkins S, Johnson DW, Mactier R, Ramalakshmi S, Shrestha B, Struijk D, Wilkie M (2010) Clinical practice guidelines for peritoneal access. Perit Dial Int 30:424–429
Acknowledgements
This study was supported by Jiangsu University Medical Clinical Science and Technology Development Fund of China (JLY20160035) and Changzhou Wujin Science and Technology Bureau Fund of China (WS201610).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This study was approved by the ethics committee of the Affiliated Wujin Hospital of Jiangsu University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Written informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Gong, LF., Lu, JK., Tang, WG. et al. Peritoneal dialysis catheter insertion using a very-low-site approach: a 5-year experience. Int Urol Nephrol 51, 1053–1058 (2019). https://doi.org/10.1007/s11255-019-02164-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-019-02164-8