Is peritoneoscopic-assisted Tenckhoff Catheter Insertion safe and effective in our nephrologists' hand?

• Main Authors: Ahmad, MK, Seman, Mohd Ramli, Draman, Che Rosle, Wan Ali, Wan Ahmad Syahril Rozli, Ramli, Norazsida
• Format: Conference or Workshop Item
• Language: English; English
• Published: 2013
• Subjects: R Medicine (General)
• Online Access: http://irep.iium.edu.my/58981/6/Peritoneoscope%20abstract.pdf; http://irep.iium.edu.my/58981/18/58981_outcome%20of%20peritoneoscope-assisted.pdf; http://irep.iium.edu.my/58981/

Background: The practice of peritoneal dialysis (PD) catheter insertion by nephrologists has been advo¬cated to enhance PD penetration with encouraging outcome as shown in several centres. In this study, we evaluate the safety and effectiveness of our catheter insertion via peritoneoscopic method. Methods: We report our local experience in tenchkoff catheter insertion using the Y Tec peritoneoscopic method. Data were collected retrospectively from March 2011 to June 2012, for patient’s characteristics, procedural complications, and catheter outcome. Results: A total of 41 catheters were inserted by nephrologist and trainees. Majority of patients were diabetics (58.5%) with mean age of 57.44 ± 14.40 years. Primary catheter failure, as defined by catheters that failed to function within 1 month after insertion, occurred in 6 (14.6%) of cases. Of those 6 cases, 4 experienced mechanical problems and 2 involved bowel injury. 2 of patients experienced mechanical problems resumed peritoneal dialysis after the catheter was replaced and repositioned, however the other 2 patients converted to hemodialysis. Complications from small-bowel injury were recognized in 2 patients, 1 of each occurred intraoperatively and postoperatively; both underwent laparotomy for bowel repair. No mortality was at¬tributable to Tenckhoff catheter insertion. In our series of patients, the major cause of peritoneal catheter failure was infectious complications secondary to perito¬nitis, 6 (14.6%). Mean technique survival for the catheters was 5.37 ± 4.58 (95%CI). Diabetic patients seemed to have shorter catheter survival compared to non-diabetics, however it was not different statistically; p 0.5. The 6-month and 1-year catheter survival rates were 67% and 48% respectively. Conclusions: We showed an acceptable primary catheter outcome and safety profiles, with the needs for continuous learning as well as monitoring of operators performance for better catheter survival. References: Asif A, Pflederer TA, Vieira CF, Diego J, Roth D, Agarwal A. Does catheter insertion by nephrologists improve perito¬neal dialysis utilization? A multicenter analysis. Semin Dial 2005; 18:157–60. Li PK, Chow KM. Importance of peritoneal dialysis cath¬eter insertion by nephrologists: practice makes perfect. Nephrol Dial Transplant 2009; 24:3274–6.