Stiff wire manipulation of peritoneal dialysis catheters

From January 1989 to June 1994 we examined the success rate of fluoroscopically guided stiff wire manipulation of malfunctioning peritoneal dialysis catheters (PDCs) at St. Paul's Hospital, Saskatoon. There were 341 (201 male, 140 female) patients with a PDC. There were 118 manipulations (70 initial, 48 remanipulations) for malposition, fibrin clot, or kinked catheter. Single-cuff Tenckhoff catheters accounted for 95% of manipulated PDCs. No complications including peritonitis, exit-site infections, ruptured catheter, or bowel perforation were reported postmanipulation. A successful manipulation was defined as a functional PDC at 30 days postmanipulation. There was an overall success rate of 64%-67% for initial manipulations (IM) and 48% for remanipulations (RM). Ninety percent of those PDCs requiring IM occurred within 42 days of surgical insertion. RM occurred on average 55 days after IM. There were no risk factors identified that predisposed patients for PDC manipulation. This success rate for combined IM and RM of PDCs is higher than those rates quoted in the literature (27%-42%). We conclude that fluoroscopically guided stiff wire manipulation of PDCs, including repeated attempts, is a safe and effective way of prolonging PDC life, thus avoiding the risks of repeated surgery, improving quality of life, and decreasing health care costs.