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Updated: Nov 16, 2025

Laparoscopic-Assisted Seldinger Technique for Peritoneal Dialysis Catheter Insertion
Published on: May 23, 2025
Catheter Diversion Procedure With Exit-Site Renewal Promotes Peritoneal Dialysis Catheter Survival
Rikako Oki1, Yoshifumi Hamasaki1, Yohei Komaru1
1Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan.
Introduction:
Catheter-related infections such as exit site infection (ESI) and tunnel infection (TI) are major causes of peritoneal dialysis (PD) discontinuation. For ESI/TI treatment, catheter diversion procedure (CDP) with exit-site renewal for catheter salvage presents an alternative to catheter removal. Nevertheless, CDP capability of improving PD catheter survival remains unclear.
Methods:
We retrospectively reviewed our hospital patients who started PD during 2001-2019 (n=148): 33 treated for ESI/TI by CDP (CDP group) and 115 treated for ESI/TI using conservative therapy or none (non-CDP group). A "virtual discontinuation group" was designated for patients in the CDP group who had received PD catheter removal instead of CDP and who had stopped PD. Kaplan-Meier analysis and log-rank test PD were used for intergroup catheter survival comparison. Associations between clinical factors and PD discontinuation or death were examined using Cox proportional hazards regression analyses.
Results:
For patients (76% male, mean age of 61.7±13.0 years), 40 CDP were performed for 33 CDP group patients. Infection-free rates at 30 and 90 days after CDP were, respectively, 90% and 67%. The CDP group PD catheter survival rate was significantly higher than that of virtual discontinuation group (P < .01) and higher than that of the non-CDP group (P = .03). Multivariate analysis revealed independent association of serum albumin concentration (hazard ratio 0.33, 95% confidence interval 0.17-0.67), PD+HD combination therapy (hazard ratio 0.29, 95% confidence interval 0.17-0.49), and CDP (hazard ratio 0.44, 95% confidence interval 0.24-0.80) with PD discontinuation or death.
Conclusion:
Results show that CDP may improve PD catheter survival as an effective and less-invasive surgical treatment for ESI/TI to avoid withdrawal of PD.
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Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...

