Few Outflow Problems With a Self-locating Catheter for Peritoneal Dialysis: A Randomized Trial

Abstract

We developed a technique for direct start of peritoneal dialysis. Using a coiled or straight Tenckhoff catheter often results in obstruction of flow. A self-locating Wolfram catheter is on the market. It is not clarified if this results in a benefit.The primary aim of this study was to perform a randomized investigation to clarify if the use of a self-locating peritoneal dialysis (PD) catheter would result in different flow problems than a straight Tenckhoff catheter.A total of 61 insertions were made who were randomized and received either a straight Tenckhoff (n = 32) or a self-locating Wolfram catheter (n = 29). A previously described operation technique allowed immediate postoperative start of dialysis. Seven straight Tenckhoff catheters had to be changed into self-locating catheters, and none vice versa, due to flow problems (P = 0.011). An early leakage resulted in temporarily postponed PD in 4 patients. This study showed that using the present operation technique the self-locating PD-catheter causes fewer obstruction episodes than a straight Tenckhoff catheter. This facilitates immediate postoperative start of PD.

Trial registration: ClinicalTrials.gov NCT02347592.

FIGURE 1

(A) Cross-section at the level of ∼3 cm below the navel showing the layers where the catheter is placed during the surgery. The inner cuff of the catheter is fixed between the peritoneum and the inner fascia by 2 purse string sutures. A third suture closes the outer fascia around the catheter before the catheter proceeds in the subcutaneous tissue toward the exit. (B) A bended stylet is inserted into a Tenckhoff catheter before insertion into the abdomen. This technique helps to guide the catheter toward the left fossa in the pelvis area. (C) The peritoneal membrane is exposed and lifted by a forceps. A purse string suture is fixed before a small incision allows insertion of the catheter. (D) The catheter insertion is guided by the stylet. By a rotation the tip of the catheter is turned toward the front of the peritoneum, thereby avoiding that the catheter is embedded in the intestine. Thereafter the catheter is located into the right position before the stylet is partly withdrawn. (E) The first purse string suture is tightened around the catheter below the inner cuff. (F) The inner cuff is embedded between the peritoneum and inner fascia and the second purse string suture fixes its position and tightens the channel. (G) The catheter exits the outer fascia in a direction upwards and to the right before bending into the subcutaneous space. The exit through the fascia is closed around the catheter to fix and tighten the position. (H) A self-locating catheter can be inserted in the same way.

FIGURE 2

Kaplan–Meier distribution of catheter survival in relation to need of reoperation due to outflow failure. The self-locating Wolfram catheter is shown with open circles and the straight Tenckhoff catheter with open triangles.