Peritoneal dialysis catheters: a comparison between percutaneous and conventional surgical placement techniques

Percutaneous peritoneal dialysis catheter (PDC) placement is a well-tolerated, rapidly performed side-room procedure that allows the rapid initiation of dialysis without the delay imposed in co-ordinating a surgeon, theatre time, and theatre staff. We retrospectively reviewed the clinical outcome of 230 PDC inserted over a 30-month period. Fifty were placed percutaneously (group P) and 180 were placed using conventional surgical techniques, 107 in patients commencing CAPD (group A) and 73 in patients commencing CAPD (group A) and 73 in patients previously established on CAPD (group B). Total experience accumulated was 2563 patient months: 270 patient months group P, 1381 patient months group A, 912 patient months group B. Percutaneous PDC insertion was non-elective, and reserved for patients unfit for general anaesthesia or haemodialysis. Group P patients were older (P < 0.001) and had increased early mortality (P < 0.005) due to underlying pathology. Death and early mechanical failure contributed to a shorter mean duration of catheter use in group P (9.0 +/- 2.3 months compared to 15.3 +/- 9.6 months group A and 17.3 +/- 9.7 group B) (P < 0.05). The peritonitis rate was similar in group P (1 per 6.75 patient months) and group B (1 per 7.4 patient months) but significantly lower in group A (1 per 15.7 patient months) (P < 0.01). We conclude that percutaneous PDC placement provides a safe, reliable access for peritoneal dialysis and is especially suitable for ill patients who would not tolerate general anaesthesia.