Reposition of a displaced peritoneal catheter: the Helsinki whiplash method

Dialysate outflow obstruction caused by displacement of the catheter tip is a relatively common complication of peritoneal dialysis, occurring in up to 20% of implanted catheters and often requiring surgical intervention. We describe a simple method used to reposition straight, Tenckhoff-type catheters. The procedure is performed under fluoroscopic control using a 2 mm thick catheter guide, bent fo form a slight curve. The catheter guide is introduced near the tip of the migrated catheter and then rotated in order to bring the catheter to the pelvis. Experiences over the five-year period 84-89 are summarized. In more than 60% of the patients, the first displacement occurred within one month of insertion of the catheter, and 70% of the catheters migrated to the right. The procedure was used in 21 patients to treat 50 displacements. In 86% of the cases the procedure was successful. 52% of the patients needed only one reposition while 48% experienced two or more displacements and subsequent repositions. Five patients eventually needed replacement of the catheter or were permanently switched to hemodialysis. The reposition procedure was practically free of complications.