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Peritoneal dialysis for acute renal failure in infants: a comparison of three types of peritoneal access
H S Kohli1, A Barkataky, R S Kumar
1Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
For infants needing peritoneal dialysis (PD), the guide wire inserted femoral vein catheter showed fewer complications than other methods. This PD access method is recommended for pediatric acute renal failure patients.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Medical Device Innovation
Background:
- Peritoneal dialysis (PD) access in infants presents challenges due to small anatomy, increasing risks of morbidity and mortality.
- Choosing the appropriate PD catheter is crucial for safe and effective treatment in pediatric patients.
Purpose of the Study:
- To compare the complication rates of three different peritoneal dialysis (PD) catheter types in infants undergoing intermittent PD.
- To identify the safest and most effective PD access method for pediatric acute renal failure management.
Main Methods:
- A retrospective analysis of 79 intermittent PD sessions in 51 infants with acute renal failure.
- Comparison of complication profiles for intravenous cannula, stylet catheter, and guide wire inserted femoral vein catheter PD access.
- Evaluation of mechanical complications (blockade, bleeding) and infectious complications (peritonitis).
Main Results:
- The guide wire inserted femoral vein catheter had the lowest total complication rate (20%), significantly lower than intravenous cannula (33%) and stylet catheter (66%).
- Stylet catheters were associated with higher rates of local puncture site and intraperitoneal bleeding.
- Catheter blockade was most frequent with intravenous cannulas (22.2%).
- While peritonitis occurred in 4.0-8.3% across groups, the guide wire inserted catheter showed the lowest incidence.
Conclusions:
- The guide wire inserted femoral vein catheter is associated with the fewest mechanical and overall complications for intermittent PD in infants.
- This PD access method offers a safer alternative compared to intravenous cannulas and stylet catheters for pediatric patients.
- Further research into optimizing PD access in neonates and infants is warranted to reduce procedure-related morbidity and mortality.
Abstract:
Peritoneal access for peritoneal dialysis (PD) poses a significant problem in infants due to their small size and can result in considerable morbidity and occasional mortality. This study was carried out to compare the complications associated with three different types of PH catheters for intermittent PD. A total of 79 session of PD were given to 51 infants with acute renal failure. Twenty-nine infants received 1, 18 received 2 and 2 infants received 3 and 4 sessions of PD, respectively. For PD access an intravenous cannula was used in 36, stylet catheter in 18, and guide wire inserted femoral vein catheter in 25 procedures. Percentage reduction of serum creatinine per PD session was comparable in infants being dialysed with different types of PD access. Local puncture site and intraperitoneal bleed were associated with the use of a stylet catheter during 4 procedures each (22.2%). Catheter blockade was commonest with the intravenous cannula (22.2%), followed by guide wire inserted femoral vein catheter (16%), and was least with the stylet catheter (5.5%). Total mechanical complications were lower with guide wire inserted femoral vein catheter (16%) as compared to intravenous cannula (25%) and stylet catheter (66%) (p < 0.05). There were 4 episodes of peritonitis (5.0%), 3 bacterial and 1 fungal. Although peritonitis was more common with intravenous cannula (8.3%) than guide wire inserted catheter (4%) and stylet catheter (nil), the difference was not statistically significant. Total complications including mechanical and infective were least with guide wire inserted femoral vein catheter (20%), followed by intravenous cannula (33%) and stylet catheter (66%) (p < 0.05). Of 51 infants, 20 died (39.0%). The PD procedure per se resulted in mortality in 2 cases, 1 because of massive intraperitoneal bleed due to stylet induced injury of an intra abdominal blood vessel and the other due to fungal peritonitis. To conclude, of the three types of access for intermittent PD, complications related to the PD procedure are the least with guide wire inserted femoral vein catheter.