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Analysis of risk factors for omental herniation associated with removal of peritoneal catheters
B Copnell1, J D Best, B Capewell
1Intensive Care Unit, Royal Children's Hospital, Melbourne, Australia.
Insights
Instilling saline into peritoneal catheters before removal does not prevent omental herniation in children. This complication is more likely in smaller children, with longer catheter dwell times, and without pharmacological paralysis.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Critical Care Medicine
Background:
- Peritoneal catheters are commonly used in pediatric cardiac surgery.
- Catheter removal can lead to omental herniation, causing serious complications like bleeding and obstruction.
- Saline instillation is a proposed but unstudied preventive measure.
Purpose of the Study:
- To evaluate the efficacy of saline instillation in preventing omental herniation during peritoneal catheter removal.
- To identify risk factors associated with omental herniation in pediatric patients.
Main Methods:
- A randomized controlled trial involving 404 pediatric patients with peritoneal catheters.
- Study group received saline (1 mL/kg) before catheter removal; control group did not.
- Data collected included omentum extrusion, patient weight, catheter dwell time, and paralysis status.
Main Results:
- Omental herniation occurred in 39% of the saline group and 33% of the control group.
- Logistic regression indicated smaller children, longer catheter dwell times, and lack of paralysis increased risk.
- Saline instillation did not significantly reduce omental herniation rates.
Conclusions:
- Saline instillation is ineffective in preventing omental herniation post-peritoneal catheter removal.
- Further research is needed to develop effective strategies for preventing this complication.
- Risk factors identified include patient size, catheter duration, and paralysis status.
Background:
Peritoneal catheters may be used routinely in children undergoing cardiac surgery. Removal of the catheter is often complicated by omental herniation, which can cause intraperitoneal bleeding, peritonitis, and bowel obstruction. Instillation of saline into the catheter before removal is used in some institutions as a preventive measure, but the practice has never been investigated.
Objective:
To determine the effectiveness of instilling saline into peritoneal catheters before their removal in reducing the occurrence of omental herniation and to determine risk factors for omental herniation.
Methods:
A total of 404 patients with peritoneal catheters in place were randomized to either the control or the study group. The study group (n = 204) had saline (1 mL/kg; maximum, 10 mL) instilled into the catheter before the catheter was removed; the control group (n = 200) did not. Extrusion or no extrusion of omentum was recorded. Other data collected included the child's weight, the length of time the catheter was in place, whether peritoneal dialysis was performed, and whether the child was pharmacologically paralyzed when the catheter was removed.
Results:
Extrusion of omentum occurred in 39% of the study group and in 33% of the controls. Results of logistic regression analysis suggested that omental herniation was more common in smaller children, children whose catheters remained in place longer, and children who were not pharmacologically paralyzed when the catheter was removed.
Conclusions:
Instillation of saline does not appear to reduce the occurrence of omental herniation. Further research into strategies to reduce this complication is recommended.
