Nephrology Dialysis Transplantation, Vol 12, Issue 8 1661-1667, Copyright © 1997 by Oxford University Press
F Prischl, M Wallner, H Kalchmair, F Povacz and R Kramar
Background: The objectives of this open non-randomized
study were to evaluate the impact of a new peritoneal catheter placement
technique on catheter maintenance, and complications possibly related to
the access, e.g. leakage, infectious complications, or drainage failure.
Method: In a routine clinical setting, a two-cuff
swan-neck catheter was implanted surgically, but its external segment was
embedded in a subcutaneous pouch initially without exit site to enable
uncontaminated wound healing and tight ingrowth of the cuffs. After 4 weeks
at the earliest the distal catheter tip was set free by a small incision
under local anaesthesia, and CAPD was started.
Results: Using this technique, 26 catheters were
implanted in 17 males and nine females (mean age 52.3±17.4,
range 19-83 years). The catheters were buried subcutaneously for a median
of 79.5 (mean±SD 132.2±157.2, range 28-675) days, and
were activated in 21 patients. No leaks were seen, and only one abdominal
wall abscess secondary to a haematoma was found. Long-term follow up (mean
duration of CAPD 467.0±338.1, range 32-1320 days) revealed a
very low overall incidence of infectious complications, i.e. 0.80 per
patient-year (1 episode per 14.9 patient-months), and the incidence of
catheter-related peritonitis amounted to 0.036 per patient-year (1 episode
per 27.2 patient-years), only. However, the postoperative course was
complicated by seromas in two of 26, and subcutaneous haematomas in 12 of
26 patients, five of which were revised surgically. At catheter activation,
fibrin thrombi were found in nine of 21 patients and two had to be
operated. Omental catheter obstruction was diagnosed in four patients, and
followed by omentectomy. No relationship was seen between thrombus
formation and omental obstruction and duration of subcutaneous embedment
(P=0.27 and P=0.5 respectively) or patient age (P=0.06 and P-0.13
respectively; Mann-Whitney-test). There was also no relationship with
primary omentectomy or haematoma. Conclusion: We
conclude that although the very low incidence of infectious episodes
favours the new technique, further improvement is necessary to decrease the
unacceptable rate of perioperative complications. Subcutaneous embedding of
the catheter may then be considered in patients with expected problems of
wound healing, and those who wish to be prepared for peritoneal dialysis in
time. Keywords: CAPD; catheter; complications;
implantation; outcome; peritoneal dialysis
ORIGINAL ARTICLES
Initial subcutaneous embedding of the peritoneal dialysis catheter-a critical appraisal of this new implantation technique
3rd Department of Medicine/Nephrology, and 2nd Department of Surgery, Krankenhaus der Barmherzigen Schwestern vom Hl.Kreuz, Grieskirchnerstrasse 42, A-4600 Wels, Austria; Corresponding author
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  G. Kopriva-Altfahrt, P. Konig, M. Mundle, F. Prischl, J. M. Roob, M. Wiesholzer, A. Vychytil, and the Austrian Study Group for Prevention of Periton EXIT-SITE CARE IN AUSTRIAN PERITONEAL DIALYSIS CENTERS -- A NATIONWIDE SURVEY Perit. Dial. Int., May 1, 2009; 29(3): 330 - 339. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F.C. Prischl, F. Knoll, and R. Kramar Another Peritoneal Dialysis Catheter Encapsulated in Peritoneal Tissue Perit. Dial. Int., January 1, 2009; 29(1): 119 - 120. [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Bargman New Technologies in Peritoneal Dialysis Clin. J. Am. Soc. Nephrol., May 1, 2007; 2(3): 576 - 580. [Abstract] [Full Text] [PDF]
|
|