Changing the peritoneal dialysis access algorithm with a precise technique of percutaneous Seldinger PD catheter...

Area of Science:

• Nephrology
• Minimally Invasive Surgery
• Medical Devices

Background:

• The Seldinger technique, introduced in 1953, is a method for accessing hollow organs or blood vessels.
• Over the past two decades, it has been adapted for Peritoneal Dialysis (PD) catheter placement, known as Seldinger PD (SPD).
• Advancements like ultrasound, X-ray guidance, and micropuncture techniques have aimed to enhance SPD safety and accuracy.

Purpose of the Study:

• To describe a novel, rigorous Seldinger PD technique developed at the authors' institution.
• To evaluate the feasibility of replacing emergency Central Vein Catheter Hemodialysis with urgent-start PD.
• To establish an ultra-safe, minimally invasive procedure suitable for high-risk patients under local anesthesia.

Main Methods:

• A new Seldinger PD technique was developed and applied to the first 64 cases.
• The study focused on a cohort of critically ill patients, including those with "crashed" renal failure, those unfit for general anesthesia, and the obese.
• The procedure was performed under local anesthesia, with progressive modifications reflecting a learning curve.

Main Results:

• The technique demonstrated no procedure-related mortality, organ injury, or significant bleeding.
• Technical success rate was 97% (intention-to-treat), with 36% of cases being urgent-start PD.
• All catheters were correctly placed in the pelvic pouch, with minimal revisions needed for early-stage migration (18% with imaging follow-up).

Conclusions:

• The described Seldinger PD technique is safe, precise, and cost-effective.
• It offers a viable alternative to other PD catheter placement methods.
• The technique is suitable for a broad range of patients, including those with significant comorbidities.