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Updated: Apr 23, 2026
Laparoscopic-Assisted Seldinger Technique for Peritoneal Dialysis Catheter Insertion
Published on: May 23, 2025
Prophylactic peritoneal dialysis catheter does not decrease time to achieve a negative fluid balance after the
Lindsay M Ryerson1, Andrew S Mackie1, Joseph Atallah2
1Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Insights
Prophylactic peritoneal dialysis catheter (PDC) insertion did not improve fluid balance post-Norwood procedure in neonates with hypoplastic left heart syndrome. The intervention also showed no physiological benefits and was linked to increased adverse events.
Area of Science:
- Pediatric Cardiac Surgery
- Neonatal Intensive Care
- Fluid Management
Background:
- Postoperative fluid overload is a significant risk for neonates undergoing cardiopulmonary bypass and cardiac surgery.
- Peritoneal dialysis catheter (PDC) and peritoneal dialysis are recognized for their efficacy in managing fluid balance postoperatively.
- Hypoplastic left heart syndrome (HLHS) necessitates complex surgical interventions like the Norwood procedure, often leading to fluid management challenges.
Purpose of the Study:
- To evaluate the efficacy of prophylactic PDC insertion during the Norwood procedure in neonates with HLHS.
- To determine if prophylactic PDC insertion reduces the time to achieve a negative fluid balance post-surgery.
- To assess the impact of prophylactic PDC on physiological variables and clinical outcomes.
Main Methods:
- A single-center randomized controlled trial was conducted.
- Neonates with HLHS were randomized to either prophylactic PDC insertion (with or without dialysis) or standard care (no PDC).
- Outcomes measured included time to negative fluid balance, lactate levels, vasoactive-inotrope scores, time to sternal closure, extubation, and hospital length of stay.
Main Results:
- The mean time to achieve a negative fluid balance was similar between the prophylactic PDC group (2.70 days) and the standard care group (2.67 days) (P=.93).
- No significant differences were observed in physiological variables, time to sternal closure, extubation, or hospital length of stay between the groups.
- Four patients (36%) in the prophylactic PDC group experienced serious adverse events, compared to none in the standard care group (P=.03).
Conclusions:
- Prophylactic PDC insertion did not accelerate the achievement of negative fluid balance after the Norwood procedure in neonates with HLHS.
- The intervention did not demonstrate benefits in postoperative physiological parameters or clinical outcomes.
- Prophylactic PDC was associated with a higher incidence of serious adverse events, suggesting potential risks outweighing benefits.
Objective:
Infants and children who undergo cardiopulmonary bypass and cardiac surgery are at risk of postoperative fluid overload. Peritoneal dialysis catheter (PDC) and peritoneal dialysis are reported to be effective means of postoperative fluid management. We sought to test the hypothesis that PDC insertion in the operating room at the time of Norwood palliation would decrease the time to achieve a negative fluid balance in a group of neonates with hypoplastic left heart syndrome.
Methods:
A single center randomized controlled trial was performed. We randomized neonates with hypoplastic left heart syndrome to prophylactic PDC, with or without dialysis, or standard care (ie, no PDC).
Results:
Twenty-two neonates were included; 10 were randomized to PDC and 12 were randomized to standard care. The mean time to first postoperative negative fluid balance was 2.70 ± 1.06 days for the prophylactic PDC group and 2.67 ± 0.65 days for the standard care group (P = .93). There was no difference between the 2 groups in time to lactate ≤ 2 mmol/L, maximum vasoactive-inotrope score on postoperative days 2 to 5, time to sternal closure, time to first extubation, modified clinical outcome score, or hospital length of stay. Twenty-one patients (95%) survived to hospital discharge. Four patients randomized to prophylactic PDC had 1 or more serious adverse events compared with no patients in the standard care group (P = .03).
Conclusions:
Prophylactic PDC, with or without dialysis, did not decrease the time to achieve a negative fluid balance after the Norwood procedure, did not alter physiological variables postoperatively, and was associated with more severe adverse events.
