Modified Peritoneal Dialysis Catheter Insertion: Comparison with a Conventional Method

Abstract

Purpose: The conventional trocar and cannula method in peritoneal dialysis (PD) catheter insertion has its limitation in clinical setting. The aim of this study was to compare a modified method for percutaneous PD catheter insertion with the conventional method, and demonstrate advantages of the modified method.

Materials and methods: Patients at a single center who had percutaneous PD catheters inserted by nephrologists from January 2006 until September 2012, using either a modified method (group M) or the conventional trocar and cannula method (group C), were retrospectively analyzed, in terms of baseline characteristics, complications experienced up to 3 months after the procedure, and the suitability of the procedure for patients.

Results: Group M included 82 subjects, while group C included 66 cases. The overall early complication rate in group M (1.2%) was significantly lower than that in group C (19.7%) (p<0.001). The catheter revision rate during timeframe for early complications was significantly lower in group M (0%) than in group C (6.1%) (p=0.024). When comparing Procedure time (1 h 3 min±16 min vs. 1 h 36 min±19 min, p<0.01), immediate post-procedural pain (2.43±1.80 vs. 3.14±2.07, p<0.05), and post-procedure days until ambulation (3.95±1.13 days vs. 6.17±1.34 days, p<0.01), group M was significantly lower than group C. There was no significant difference in total hospitalization period (14.71±7.05 days vs. 13.86±3.7 days).

Conclusion: Our modified PD catheter insertion method shows its advantages in early complication rate, early complications revision rate, and the patients' conveniences.

Keywords: Continuous ambulatory peritoneal dialysis; complication rate; modified method; nephrologists; peritoneal catheter insertion; trocar and cannula method.

Fig. 1. The modified method of peritoneal dialysis catheter insertion. (A) Abdomen is penetrated by mosquito hemostat. The hemostat is clenched during insertion and spread during removal to ensure appropriate opening. (B) More detailed schematics of the procedure. After making an incision in the anterior rectus sheath, a mosquito hemostat is inserted along the grain of the rectus muscle until it reaches the posterior rectus sheath. After puncturing the posterior rectus sheath and the peritoneum, the hemostat is removed while being spread to minimize muscle injury and to ensure an opening that is wide enough for the insertion of the Tenckhoff catheter.