Alpha replacement method for displaced peritoneal catheter: a simple and effective maneuver

Displacement of the peritoneal catheter tip is one of the most frequent causes of catheter malfunction. As a consequence, appropriate peritoneal effluent drainage is impossible. Alternatives to catheter exchange or invasive abdominal intervention did not appear until the alpha maneuver was described by Yoshihara et al. We review our experience with this maneuver over the last 7 years. We used the alpha maneuver in 24 peritoneal dialysis (PD) patients (13 men and 11 women) with a mean age of 52 +/- 16 years. Some patients required several repeat procedures (total procedures: 32). The mean time between placement of the catheter and performance of the alpha maneuver was 6.5 +/- 7.9 months. In all patients, the technique was indicated for problems with peritoneal effluent drainage, after verification of catheter tip displacement by radiologic examination. In 6 patients, the initial maneuver was unsuccessful and had to be repeated. The first maneuver was effective in 11 of 24 cases (46%) and unsuccessful in the other 13 (54%). No differences in sex, renal disease, or age were seen between the two groups. The mean time between catheter placement and tip displacement detection was significantly lower in the cases of ineffective maneuver (2.7 +/- 4.3 months) than in those that met with success (10.8 +/- 9 months). In other words, 84% of unsuccessful maneuvers were performed in the first 3 months of catheter life. Of the 11 patients successfully treated, 6 continued on PD for 14.7 +/- 6.3 months. Two other patients were transplanted with normal-functioning catheters, and two more left PD (after 10 and 17 months) for reasons unrelated to the catheter. One patient required a catheter change owing to breakdown in the Silastic after disruption by the metallic guide, which perforated the catheter wall. The 13 ineffective maneuvers involved 7 omentum entrapments, 1 procedure that was repeated effectively 15 days later, and 5 definite failures requiring catheter change. The failure rate may therefore be considered to be 20.8%, taking into consideration that omentum entrapment should not be an indication for the procedure. We conclude that the alpha maneuver for a displaced peritoneal catheter is a simple and effective procedure that can be applied at the patient's bedside. In consequence, it should be the technique of first choice in these situations. Only when the alpha maneuver fails should invasive methods, including catheter change, be considered.