Bleeding complications associated with peritoneal dialysis catheter insertion.

Area of Science:

• Nephrology
• Surgical Procedures

Background:

• Peritoneal dialysis (PD) is a vital renal replacement therapy.
• Catheter insertion is a critical step in PD, with potential complications.
• Bleeding is a recognized, though infrequent, complication of PD catheter placement.

Purpose of the Study:

• To determine the incidence of major bleeding complications following surgical insertion of Tenckhoff catheters for peritoneal dialysis.
• To identify factors associated with bleeding events during PD catheter placement.

Main Methods:

• Retrospective review of 292 surgically placed double-cuffed Tenckhoff catheters between 1992 and 2003.
• Definition of major bleeding: hematocrit decline ≥3%, or need for surgery/transfusion within 2 weeks.
• Analysis of patient factors and perioperative management, including anticoagulation and coagulation parameters.

Main Results:

• A major bleeding complication rate of 2% (6 of 292 cases) was observed.
• Bleeding was associated with perioperative anticoagulation (3 cases), uremia/thrombocytopenia (1 case), aspirin/thrombocytopenia (1 case), and intraoperative bleeding (1 case).
• Preoperative coagulation parameters were not obtained in 2 of the 6 bleeding events.

Conclusions:

• Serious bleeding complications from PD catheter insertion are infrequent.
• Perioperative anticoagulation is a significant risk factor for bleeding.
• Holding anticoagulation for at least 24 hours postoperatively and correcting preoperative coagulation abnormalities may mitigate bleeding risk.