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Recent advances in peritoneal dialysis catheter placement: the association between method of insertion, operator, and
Robert R Quinn1, Matthew J Oliver2
1Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary.
Insights
Peritoneal dialysis (PD) catheter placement outcomes are comparable between percutaneous and surgical methods. Prior abdominal surgeries do not negatively impact PD catheter outcomes, but adhesions increase complication risks.
Area of Science:
- Nephrology
- Surgical Innovation
- Dialysis Technology
Background:
- Peritoneal dialysis (PD) offers comparable outcomes to hemodialysis at a lower cost.
- Effective PD catheter function is crucial, yet complications are common.
- Current PD access guidelines lack robust evidence.
Purpose of the Study:
- To review outcomes of percutaneous versus surgical PD catheter placement.
- To examine the influence of operator type on PD catheter outcomes.
- To assess the impact of prior abdominal procedures and adhesions on PD catheter success.
Main Methods:
- Comparative analysis of percutaneous and surgical PD catheter insertion techniques.
- Review of data on operator experience and volume in PD catheter placement.
- Evaluation of patient selection criteria, including history of abdominal surgeries and intraoperative findings of adhesions.
Main Results:
- Conflicting data exists regarding percutaneous versus surgical PD catheter placement, potentially due to patient selection and operator factors.
- Previous abdominal surgeries do not predict worse PD catheter outcomes and should not typically exclude patients.
- Adhesions at catheter insertion increase complication risk, but PD therapy continues successfully in most cases (<20% require re-intervention).
Conclusions:
- PD catheter placement method (percutaneous vs. surgical) requires further clarification based on patient selection and operator expertise.
- Patient history of abdominal surgery is not a contraindication for PD catheter placement.
- While adhesions pose a risk, PD remains viable for most patients, even with adhesions present.
Purpose Of Review:
Peritoneal dialysis (PD) is associated with comparable outcomes to hemodialysis and is much less expensive to provide in most parts of the world. A well functioning PD catheter is required, but complications are frequent, and while there are guidelines for the placement and care of a PD access, they are based on low-quality evidence.
Recent Findings:
Data reporting the outcomes of percutaneous, as compared to surgical pathways for placement of catheters and the role of operator type in determining outcomes are examined. The impact of prior abdominal procedures on patient selection and the prognostic importance of the presence of adhesions at the time of catheter insertion are reviewed.
Summary:
There are conflicting data about the relative merits of percutaneous as compared to surgical placement of catheters that may relate to differences in patient selection, operator experience, or operator volume. Prior abdominal procedures are not associated with worse PD catheter outcomes and likely should not influence patient selection, except in exceptional circumstances. Finally, the presence of adhesions is associated with a higher risk of complications. However, even in the presence of adhesions, the termination of PD therapy and need for re-intervention occurs in <20% of patients.
