Risk factors for early peritoneal dialysis catheter failure in children

Background

There is uncertainty regarding the optimal approach for surgical placement of peritoneal dialysis (PD) catheters in children. Operative technique, catheter selection, and patient variables (eg, age or prior surgical history) may influence catheter lifespan.

Methods

A retrospective review of all PD catheters placed at a tertiary children's medical center during a 6-year period was performed. Our primary outcome was catheter function 2 months after placement. Data were analyzed using Student 2-tailed t test or χ² analysis.

Results

There were 121 PD catheters placed in 81 patients. The median primary functional catheter lifetime was 109 days. Primary PD catheter failure (within 2 months) occurred in 36 catheters (30%). Patients with primary catheter failure (8 ± 7 years) were younger than patients with a functioning catheter at 2 months (12 ± 5 years; P = .002). Catheters placed without simultaneous omentectomy were more likely to fail (P = .042). Catheter failure rate was not significantly different based upon operative technique or catheter type.

Conclusion

Omentectomy at the time of catheter placement decreased the risk of early catheter failure. In contrast, type of catheter or laparoscopic placement did not influence the likelihood of early catheter failure.     

Similar Outcomes of Catheters Implanted by Nephrologists and Surgeons: Analysis of the Brazilian Peritoneal Dialysis Multicentric Study

A good catheter implantation technique is important to allow for effective peritoneal access function and long‐term technique survival. Studies regarding results obtained by nephrologists in comparison with surgeons have been limited to small single‐center experiences. Thus, the objective of this study was to explore the impact of the peritoneal dialysis (PD) catheter insertion operator on early catheter complications and on technique survival in a large national multicentric cohort study (Brazilian Peritoneal Dialysis Multicentric Study, BRAZPD). Adult incident patients recruited in the BRAZPD from December 2004 to October 2007 having undergone first PD catheter implantation were included in the analysis. Mechanical and infectious early complication rates were defined as time to the first event occurring up to 3 months after catheter insertion and adjusted for comorbidities. Valid data of 736 patients (mean age of 59 ± 16 years old, 52% women, 61% white) were analyzed. Mechanical (HR 0.99 [CI 0.56–1.76]; p = 0.98) and infectious (HR 0.63 [CI 0.32–1.23]; p = 0.17) early complication rates were similar between groups. Long‐term catheter survival was also similar between groups. Early complications rates and catheter survival were similar between groups defined by operator profile (nephrologist or surgeon), supporting the role of interventional nephrology in the placement of PD catheters.     

Impact of primary omentectomy on longevity of peritoneal dialysis catheters in children

Background

The purpose of this study was to determine the impact of omentectomy on peritoneal dialysis catheter failure rates in pediatric patients with renal failure.

Methods

A retrospective review of children undergoing peritoneal catheter placement was performed over a 22-year period. Children were segregated into those undergoing catheter placements with omentectomy or without.

Results

One hundred sixty-three patients were reviewed, with a 1:1.03 ratio of male to female patients. The mean age was 6.25 ± 5.58 years. Fifty-three percent underwent omentectomy. Catheter failure was observed in 63 children (39%). Catheter obstruction was identified in 36%. Peritonitis led to failure in 9.8%. Catheter failure rate was significantly reduced with the performance of omentectomy (23% without omentectomy vs 15% with omentectomy, P = .0054). Differences in time to catheter failure did not reach statistical significance in the omentectomy group (759 vs 280 days, P = .13).

Conclusions

Omentectomy conferred improved utility of peritoneal catheters in children. Omentectomy appears useful in children undergoing peritoneal dialysis catheter placement.     

A single-center experience on percutaneously performed partial omentectomy in pediatric peritoneal dialysis patients

Objective: This study describes a single-center experience on percutaneously performed partial omentectomy procedure in pediatric peritoneal dialysis (PD) patients who showed early catheter dysfunction and required catheter replacement due to catheter flow obstruction. Materials and methods: We performed a retrospective review of clinical outcomes from pediatric PD patients who underwent percutaneous catheter replacement by pediatric nephrologists between November 1995 and December 2012. Partial omentectomy was performed in those patients in whom omental or adhesion trapping to the catheter tip was seen. Results: During the study period, catheter dysfunction that eventually required percutaneous catheter replacement occurred in 32 (23.7%) children. Of these, 9 patients were performed partial omentectomy. Mean age at initiation of PD and time of omentectomy was 97.48?±?46.06 and 98.53?±?45.55 months, respectively. Catheter dysfunction appeared after a mean 1.20?±?1.0 months. The causes of catheter dysfunction were omental wrapping and malposition. No peritonitis occurred before omentectomy. Mean total operation time was 60?±?8.83?min. No complications were encountered during the procedure. After omentectomy, mean catheter survival period was 5.92?±?6.88 months. A total of five peritonitis episodes occurred. Three patients were transferred to hemodialysis. Six patients were on PD treatment without any problem at the end of the first year of their follow-up. Two patients underwent kidney transplantation. Four patients were still on chronic PD treatment at the end of the study period. Conclusion: When performed by an experienced nephrologist, the performance of partial omentectomy by percutaneous route, when required, is an easy, safe and efficient therapeutic procedure in children on chronic PD treatment.     

Laparoscopic peritoneal dialysis catheter insertion using a Quinton percutaneous insertion kit.

OBJECTIVE: We assessed a unique technique of laparoscopic peritoneal dialysis (PD) catheter insertion which can minimize catheter dysfunction. METHODS: We performed a retrospective review of patients undergoing laparoscopic PD catheter placement with a Quinton percutaneous insertion kit between July 2000 and December 2004. RESULTS: Thirty-one catheters were placed laparoscopically. The mean operating time was 52 minutes. Adhesiolysis was required in 9 (29%) and omentectomy or omentopexy in 3 (10%) cases. Late complications included catheter dysfunction in 2 patients (6.5%), debilitating abdominal pain requiring catheter removal in 1 patient, and 1 trocar-site hernia. The mean follow-up was 17 months. CONCLUSIONS: Laparoscopic PD catheter insertion using a Quinton percutaneous insertion kit is safe, reproducible, and effective. It facilitates placement of the catheter tip into the pelvis and allows adhesiolysis, omentectomy, or omentopexy when necessary. Utilization of this technique results in a low rate of PD catheter dysfunction.     

Intrapartum epidural fixation methods: a randomised controlled trial of three different epidural catheter securement devices

This randomised controlled trial investigated the efficacy of Epi‐Fix^?, LockIt Plus^® and Tegaderm^? as fixation devices for intrapartum epidural catheters. One hundred and sixty‐five women requesting intrapartum epidural analgesia were randomised to receive different fixation devices to secure their epidural catheter. The amount of epidural catheter migration (measured to the nearest 0.5 cm) was analysed for three devices: Epi‐Fix (n = 55); LockIt Plus (n = 54); and Tegaderm dressing (n = 51). Median (IQR [range]) catheter migration for Epi‐Fix was 1.0 cm (0.0–2.0 [?2.0 to 9.5]), vs 0.0 cm (0.0–0.5 [?1.0 to 5.5]) for LockIt Plus and 0.5 cm (0.0–1.8 [?1.5 to 8.0]) for Tegaderm (p = 0.003). Thirty‐eight (69.1%) epidural catheters secured with Epi‐Fix migrated < 2.0 cm, compared with 49 (90.7%) with LockIt Plus and 40 (78.4%) with Tegaderm. Sixteen epidural catheters required resiting due to failure of analgesia of which 12 (75.0%) occurred in patients with epidural catheters that had migrated ≥ 2.0 cm. This study shows that intrapartum epidural catheters secured with the LockIt Plus device exhibit less catheter migration compared with fixation with Epi‐Fix and Tegaderm.     

Complications and catheter survival with prolonged embedding of peritoneal dialysis catheters.

BACKGROUND: Our centre uses a modification of the Moncrief technique of embedding peritoneal dialysis (PD) catheters. We undertook this study to test the hypothesis that catheter survival on PD is a function of the time a catheter is left embedded prior to use. METHODS: Data were retrospectively abstracted from review of patient records of those who received a first PD catheter over a 5-year period. Patients were divided into tertiles based on the number of days between insertion of the catheter and exteriorization to create three equal groups representing early (group 1, 11-47 days), mid (group 2, 48-133 days) and late (group 3, 134-2041 days) exteriorization strategies. RESULTS: 435 embedded PD catheters were inserted, 349 were exteriorized and total observation period was 5624 patient-months. Time to catheter loss was shortest in group 1 and longest in group 2 (P = 0.04). The overall rate of primary catheter failure was 6% and was significantly different in the three groups (6.9% in group 1, 1.7% in group 2 and 9.4% in group 3, P = 0.04). The time to first episode of peritonitis was longest in group 3 and shortest in group 1 (group 1 versus group 3, P = 0.009; group 2 versus group 3, P = 0.03). Adjusted peritonitis rates, however, were not different between the three groups. CONCLUSIONS: Mechanical complications and catheter loss are associated with the length of time a catheter is embedded. We recommend insertion 6 weeks to 5 months ahead of the need for PD to maximize catheter survival.     

Laparoscopic omentectomy for salvage of peritoneal dialysis catheters

BACKGROUND AND PURPOSE: Maintaining long-term peritoneal catheter function for peritoneal dialysis is commonly threatened by problems with catheter obstruction. Multiple methods have been used to salvage nonfunctioning catheters, including omentopexy, catheter repositioning, and omentectomy. We report on our experience with a laparoscopic method of omentectomy and catheter fixation for salvage of nonfunctioning peritoneal dialysis catheters. PATIENTS AND METHODS: Thirteen patients with nonfunctioning peritoneal dialysis catheters underwent 16 laparoscopic procedures with the intent to restore function. Clinically, all patients presented with outflow obstruction. At initial presentation, all patients underwent diagnostic laparoscopy and a definitive procedure. In 12 patients, catheters were enveloped by omentum, and we performed laparoscopic omentectomy and catheter fixation to the anterior pelvic wall. In one patient, we identified a broken catheter and performed a laparoscopic omentectomy at the time of catheter replacement. One 10-mm and two 5-mm trocars were utilized. Omentectomy was performed using either endo-GIA stapled resection (2 patients) or the Harmonic Scalpel (11 patients). All trocar incisions (including the 5-mm site) were closed with a suture-passing (Carter-Thomason) device to provide water-tight closure in anticipation of immediate return to peritoneal dialysis. Patients were followed postoperatively for an average of 17 months (range 4-35 months). RESULTS: All patients' catheter function was restored intraoperatively with laparoscopic omentectomy and catheter fixation. Eight catheters remained functioning following omentectomy without further intervention. Five patients (38%) experienced repeat catheter malfunction and underwent laparoscopic exploration. Of these, three catheters (60%) were restored to function with laparoscopic manipulation alone. Three catheters were found encased in extensive adhesions. Laparoscopic adhesiolysis was successful in one patient and unsuccessful in one patient, who converted to hemodialysis. One patient failed laparoscopic salvage and required open laparotomy and fibrin clot removal to restore catheter function. One catheter was found to be obstructed within a pericolic hematoma. One catheter was found within residual omentum at the hepatic flexure. Both of these catheters were freed laparoscopically and continued to function at 12 and 16 months' follow-up. Complications included one episode of peritonitis, one case of postoperative ileus, and one trocar site hernia necessitating repair. The nephrologists were instructed that they could begin peritoneal dialysis on postoperative day 1. Seven patients resumed peritoneal dialysis without leak from trocar sites. The remaining patients received temporary hemodialysis through a central venous catheter and returned to peritoneal dialysis at the discretion of their nephrologists. CONCLUSIONS: Laparoscopic omentectomy with catheter fixation is a minimally invasive means of salvaging peritoneal dialysis catheters with outflow obstruction. Complications are few, and closure of laparoscopic incisions in water-tight fashion allows rapid return to peritoneal dialysis.     

Laparoscopic omental fixation technique versus open surgical placement of peritoneal dialysis catheters

Background: Continuous ambulatory peritoneal dialysis (CAPD) is an effective form of treatment for patients with end-stage renal disease. Open insertion of peritoneal dialysis (PD) catheters is the standard surgical technique, but it is associated with a relatively high incidence of catheter outflow obstruction and dialysis leak. Omental wrapping is the most common cause of mechanical problems. The purpose of this study was to determine the efficacy of the laparoscopic omental fixation technique to prevent the obstruction caused by omental wrapping and also to compare this laparoscopic technique with open peritoneal dialysis catheter insertion with respect to postoperative discomfort, complication rates, and catheter survival. Methods: Between March 1998 and October 2001, 42 double-cuff, curled-end CAPD catheters were placed in 42 patients. The outcomes of the 21 patients in whom the PD catheters were placed laparoscopically with omental fixation technique were compared with those of the 21 patients in whom the catheters were placed with open surgical technique. Recorded data included patient demographics, catheter implantation method, early and late complications, catheter survival, and catheter outcome. Results: Early peritonitis episodes occurred in 8 of 21 patients (38.0%) in the open surgical group (OSG) versus 2 of 21 patients (9.5%) in the laparoscopic omental fixation group (LOFG) (p < 0.05); late peritonitis episodes occurred in 3 of 21 patients (14.2%) in the OSG versus 1 of 21 patients (4.7%) in the LOFG (p < 0.05). Early exit site infection occurred in 8 of 21 patients (38.0%) in the OSG versus 4 of 21 patients (19.0%) in the LOFG (p < 0.05), with many catheter-related problems in the conventional surgical group. There was no outflow obstruction in the LOFG. The conventional procedure was faster than the laparoscopic omental fixation technique. Analgesic requirements and hospital stay were less in the laparoscopic group. Laparoscopic surgery also enabled diagnosis of intraabdominal pathologies and treatment of the accompanying surgical problems during the same operation. Occult inguinal hernia was diagnosed in 2 patients, inguinal hernioplasty was performed in 4 patients, adhesiolysis was performed in 8 patients who had previous abdominal surgery, and liver biopsy was taken in 2 patients. Ovarian cystectomy was performed in another patient during laparoscopic CAPD catheter placement. Conclusion: The laparoscopic omental fixation technique (described by Öünç and published in 1999) is a highly effective and successful method for preventing obstruction due to omental wrapping with a better catheter survival. Laparoscopic surgery also allows the diagnosis and treatment of the accompanying surgical pathologies during the same operation.     

Femoral Venous Catheterization Is a Major Risk Factor for Central Venous Catheter-Related Bloodstream Infection

Background: Bloodstream infection is a major complication associated with central venous catheters (CVCs). However, there have been few studies of the risk factors for catheter-related bloodstream infection in patients who undergo colorectal surgery (CRS). Purpose: To disclose the risk factors for catheter-related bloodstream infection in CRS. Methods: Catheter-related bloodstream infection was evaluated retrospectively from a database of patients who had undergone CRS. Results: Three hundred-fifty patients received 423 CVCs for a total of 7,760 catheter days. Thirty-nine cases of catheter-related bloodstream infection (5.03 per 1,000 catheter days) were diagnosed. There were no significant differences in background between patients with or without catheter-related bloodstream infection, with the exception of the term of catheter insertion (24.6 ± 7.0 days vs.17.7 ± 0.6 days, P =. 0151). However, univariate analysis using factors of sex, age, insertion difficulty, length of the inserted catheter, term of catheter insertion, administration of chemotherapy, administration of total parenteral nutrition (TPN), kind of disinfectant, degree of surgical insult, and type of catheter revealed that use of a femoral venous catheter was an independent risk factor for catheter-related bloodstream infection (odds ratio [OR] = 3.175; 95% confidence interval [CI], 1.103–9.139; P =. 0322). Conclusions: Use of femoral venous catheters is a major risk factor for catheter-related bloodstream infection in CRS.     

Do AshSplit haemodialysis catheters provide better flow rates in the long term?

BACKGROUND: Recently, interventional radiologists have adopted an increasingly prominent role in the placement and management of hemodialysis catheters, as well as in the research and development of new and better catheters. The purpose of this study was to evaluate the viability and hemodialysis efficiency of the AshSplit catheter and the Permcath catheter. METHODS: 204 consecutive patients requiring radiological insertion of hemodialysis catheters were followed, retrospectively, over a 42-month period. Both hemodialysis catheters were placed using a combination of ultrasonic and fluoroscopic guidance and tunneled appropriately. Information collected included catheter insertion sites, insertion complications, catheter duration, and final outcome. RESULTS: Over the study period of two years, 269 catheters were placed into 204 patients with end stage renal failure. Patients received either an AshSplit (101 patients, 127 catheters) or a Permcath (103 patients, 142 catheters). Vascular access route of choice was the right internal jugular vein (67% AshSplit, 71% Permcath). Insertion complications occurred in 18 patients overall (6.6%), with only 1 requiring further intervention (hemopneumothorax). Flow rates averaged 259 mls/min for AshSplits and 248 mls/min for Permcaths (p < 0.001). Follow-up of catheter viability for 42 months yielded a mean AshSplit catheter duration of 246 days (range 6-932) and 239 days (range 1-1,278) for Permcath (p = 0.46). Reasons for catheter failure and elective catheter removal were similar in both groups; however, Permcaths required significantly more thrombolysis than AshSplits, p < 0.001. CONCLUSION: The AshSplit provides significantly better flow rates and less thrombolysis compared to the Permcath, with similar catheter dwell times.     

Initial subcutaneous embedding of the peritoneal dialysis catheter-a critical appraisal of this new implantation technique

Background: The objectives of this open non-randomized study were to evaluate the impact of a new peritoneal catheter placement technique on catheter maintenance, and complications possibly related to the access, e.g. leakage, infectious complications, or drainage failure. Method: In a routine clinical setting, a two-cuff swan-neck catheter was implanted surgically, but its external segment was embedded in a subcutaneous pouch initially without exit site to enable uncontaminated wound healing and tight ingrowth of the cuffs. After 4 weeks at the earliest the distal catheter tip was set free by a small incision under local anaesthesia, and CAPD was started. Results: Using this technique, 26 catheters were implanted in 17 males and nine females (mean age 52.3±17.4, range 19-83 years). The catheters were buried subcutaneously for a median of 79.5 (mean±SD 132.2±157.2, range 28-675) days, and were activated in 21 patients. No leaks were seen, and only one abdominal wall abscess secondary to a haematoma was found. Long-term follow up (mean duration of CAPD 467.0±338.1, range 32-1320 days) revealed a very low overall incidence of infectious complications, i.e. 0.80 per patient-year (1 episode per 14.9 patient-months), and the incidence of catheter-related peritonitis amounted to 0.036 per patient-year (1 episode per 27.2 patient-years), only. However, the postoperative course was complicated by seromas in two of 26, and subcutaneous haematomas in 12 of 26 patients, five of which were revised surgically. At catheter activation, fibrin thrombi were found in nine of 21 patients and two had to be operated. Omental catheter obstruction was diagnosed in four patients, and followed by omentectomy. No relationship was seen between thrombus formation and omental obstruction and duration of subcutaneous embedment (P=0.27 and P=0.5 respectively) or patient age (P=0.06 and P-0.13 respectively; Mann-Whitney-test). There was also no relationship with primary omentectomy or haematoma. Conclusion: We conclude that although the very low incidence of infectious episodes favours the new technique, further improvement is necessary to decrease the unacceptable rate of perioperative complications. Subcutaneous embedding of the catheter may then be considered in patients with expected problems of wound healing, and those who wish to be prepared for peritoneal dialysis in time.     

Laparoscopic placement of peritoneal dialysis catheters in children

Background

Peritoneal dialysis (PD) is preferred over hemodialysis. The aim of this study was to evaluate our experience with laparoscopic PD catheter placement and omentectomy in children.

Methods

We reviewed all children (N = 21) who underwent laparoscopic placement of PD catheters and omentectomy. Ages ranged from 3 months to 16 years. Five children had previous major abdominal surgery and required extensive lysis of adhesions. During the same intervention, other surgical procedures were performed using laparoscopy or open technique, including umbilical hernia repair in 3, bilateral inguinal hernia repair in 3, ventral hernia repair in 2, gastrostomy in 4, kidney biopsy in 2, and cholecystectomy in 1.

Results

Thirteen children received successful kidney transplantation and no longer needed dialysis. Two children still have functioning PD catheters. One patient developed membrane failure and was converted to hemodialysis. Four patients recovered enough renal function and no longer need dialysis. There were no complications related to the laparoscopic procedure.

Conclusion

Laparoscopy is ideal for PD catheter placement. It facilitates omentectomy, and it allows for the catheter to be placed in the proper position under direct vision and for lysis of adhesions to increase peritoneal surface. Other abdominal procedures can be performed laparoscopically at the same time.     

Early removal of catheters in an Enhanced Recovery Pathway (ERP) with intrathecal opioid injection does not affect postoperative urinary outcomes

BackgroundPostoperative urinary retention (POUR) and catheter-associated urinary tract infections (CAUTI) are associated with significantly longer hospital length-of-stay and increased costs.¹ This study investigates the effect of early removal of urinary catheters on POUR and CAUTI in patients undergoing an ERP with a preoperative intrathecal injection.MethodsRetrospective cohort study of a prospectively maintained database of patients who underwent elective colorectal surgery in an Enhanced Recovery pathway was compared to historical National Surgical Quality Improvement Program cohort of patients. Primary outcomes measured are 30-day POUR and postoperative CAUTI rates.ResultsThe overall POUR rate of ERP patients compared to non-ERP patients was significantly less (8% vs. 13%, p < 0.05). CAUTI rates were not significantly different between pre-ERP and ERP patients (1.2 vs 2.3%, p = 0.19).ConclusionsFor patients undergoing ERP with a preoperative intrathecal opioid injection, early removal of urinary catheter significantly decreased POUR and did not significantly affect CAUTI rates.SummaryThe effect of early removal of urinary catheters on postoperative urinary retention and catheter-associated UTI rates in patients undergoing an ERP with a single preoperative intrathecal opioid injection was studied. Early urinary catheter removal after intrathecal injection was associated with decreased rates of POUR and equivalent CAUTI rates.     

ASDIN: Antibiotic Prophylaxis: Is it Needed for Dialysis Access Procedures?

Antibiotic prophylaxis has been employed to reduce the risk of infection. Many reports have documented the role of prophylactic antibiotics on the subsequent development of infection in patients undergoing surgical as well as a variety of percutaneous interventions including cardiac, vascular, biliary, genitourinary, and drainage of fluid collections. While prophylactic antibiotics can be critically important for certain procedures, their use can be associated with allergic reactions (including anaphylaxis), development of bacterial resistance, and increased costs of medical care. In this analysis, we report the incidence of clinical infection following minimally invasive interventions for dialysis access procedures. Hemodialysis (HD) and peritoneal dialysis (PD) patients undergoing consecutive percutaneous interventions (n = 3162) for HD and PD access were included in this study. Procedure‐related clinical infection was defined as the presence of fever/chills, tenderness, erythema, swelling within 72 hours postprocedure. The procedures included percutaneous balloon angioplasty (arterial and venous) [n = 2078 (AVF = 1310; AVG = 768)], venography for vascular mapping (n = 110), endovascular stent insertion (n = 26), intravascular coil placement (n = 31), thrombectomy for an arteriovenous fistula (n = 106), thrombectomy for an arteriovenous graft (n = 110), tunneled hemodialysis catheter (TDC) insertion and exchange (n = 283), TDC removal (n = 160), and insertion of accidentally extruded TDC through the same exit site (n = 9). There were 260 peritoneal dialysis catheter insertions and 15 repositioning procedures. Only patients undergoing TDC insertion for accidentally extruded catheter and PD catheter placement received antibiotic prophylaxis within 1–2 hours before the procedure. Extruded TDC received 1 g of cefazolin while PD catheter insertion had 1 g of intravenous vancomycin. Povidone iodine was used for skin antisepsis in all cases. One patient (0.04%) postangioplasty and one patient (0.3%) after tunneled catheter placement developed clinical infection manifested by fever, chills, and malaise within 24 hours of the procedure. Both required hospitalization. Patient with angioplasty was a diabetic with an arteriovenous graft while TDC insertion was performed in a patient with advanced HIV. Percutaneous dialysis access procedure infections are generally low and might not warrant routine administration of antibiotic prophylaxis for all cases except for PD catheters and accidentally extruded TDC.     

Estudio comparativo del grado de satisfacción del paciente en cateterismo intermitente con el uso de las sondas lofric y las de cloruro de polivinilo

PurposeTo asses the grade of satisfaction in children on intermittent catheterization with the use of LoFric and PVC conventional cathetersMaterial and methodsA total of 40 p with experience in CIC were included in this study. An anonymous questionnaire was sent to all patients after 2-months using the LoFric catheter. Patients were divided in 3 groups (bladder augmentation, artificial sphincter, Mitrofanoff) because of major differences in CIC disfomfort between these groupsResultsThe questionnaire was completed by 87.5% of the patients (35 p). In 86% (30 p) LoFric catheter training was easy or very easy but in 14% (5 p) it was difficult. Four patients had some difficulty during conventional catheter insertion, in 3 (75%) the difficulty disappeared with the use of LoFric catheter. Of the 51% (18 p) who reported some discomfort during the insertion of conventional catheter, 72% said it was eliminated when the LoFric catheter was used. Of 6 p with some discomfort when removing the conventional catheter, 5 (83%) said it disappeared with the new catheter. Th LoFric catheter was favored by 70% of patients because it reduced the discomfort caused by conventional catheters, bladder insertion was easier and smoother, and gel lubrication was not needed. The 17% of patients reported some difficulty dealing with this slippery catheterConclusionsThe use of the LoFric catheter could be justified in patients who report with conventional catheters have some discomfort. It can also be recommended in patients with artificial sphincter, bladder augmentation and Mitrofanoff procedure, in whom any complication related to CIC would have serious consequences     

Comparing long-term outcomes between early and delayed initiation of peritoneal dialysis following catheter implantation

Aim: The aim of this study was to compare peritonitis rates, peritoneal dialysis technique survival and patient survival between patients who started peritoneal dialysis earlier than 14 days (early starters) and 14 days or more (delayed starters) after insertion of a Tenckhoff catheter. Methods: Observational analysis was performed for all patients who underwent insertion of a Tenckhoff catheter at Far Eastern Memorial Hospital between 1 January 2006 and 31 December 2012. The patients were divided into two groups: early and delayed starters. The rate and outcomes of peritonitis were recorded. Peritoneal dialysis technique survival and patient survival were analyzed using the Kaplan–Meier method. Cox regression analysis was performed for peritoneal dialysis technique failure and patient mortality. Results: There were 80 early starters and 69 delayed starters. The peritonitis rate was 0.18 episodes per year in early starters and 0.13 episodes per year in delayed starters. There was no significant difference of peritonitis free survival (p?=?0.146), peritoneal dialysis technique survival (p?=?0.273) and patient survival (p?=?0.739) at 1, 3, 5 years between early starters and delayed starters. After adjustment with age, albumin and diabetes, early starters did not have an increased risk of peritonitis, technique failure and mortality compared to delayed starters. Conclusion: Compared to the patients who started peritoneal dialysis 14 days or more after catheter implantation, the patients who started earlier did not have an increased risk of peritonitis, peritoneal dialysis technique failure and mortality.     

Study of early complications associated with peritoneal dialysis catheters: an analysis of the New Zealand Peritoneal Dialysis Registry data

Introduction

Early peritoneal dialysis catheter (PDC)-related complications are frequent and make an important contribution to long-term PD survival. We aimed to analyse the incidence and specific causes of early PDC-related complications.

Methods

This study was conducted from January 2001 to December 2012, utilising the New Zealand PD Registry (NZPDR) data. The objectives of this study were to analyse the incidence and causes of PDC-related complications within 4 weeks and 3 months of insertion. A logistic regression analysis was conducted to analyse any demographic or clinical risk factors of early PDC-related complications.

Results

Of the 2573 PDC insertions during this period, majority 88% were surgically inserted. The number of complication within 4 weeks ranged from minimum of 20% to a maximum of 34% annually, with infections and flow dysfunctions leading the causes. There has been a minor drop in the infection rates from 19 to 16% (p?=?0.21), and flow dysfunction from 12 to 9% (p?=?0.16), from 2001 to 2012. A reduced odds of early complication was noted in elderly individuals above 60 years age, with odds ratio of (OR) of 0.73 (95% CI 0.53–0.99), while as higher odds of early complications were recorded in female gender, OR 1.41 (95% CI 1.06–1.88). Of the 10% of patients who failed to initiate PD within 90 days, flow dysfunction contributed to 32%, followed by infectious and surgical causes in 16% and 15%, respectively. The median time from insertion of PDC to initiation of PD was 17 days (interquartile range of 14–24 days)

Conclusions

Improvements in PDC insertion techniques and reduction in infection rates may result in improvements in long-term PD technique survival.

     

Inadvertent neuraxial block placement at or above the L1–L2 interspace in the super-obese parturient: a retrospective study

BackgroundIncreasing body mass index (BMI) increases the difficulty of neuraxial procedures. We hypothesized that it may put patients at risk for inappropriately high dural puncture. The accuracy of anesthesiologists’ estimates of the interspinous level in super-obese parturients has not been studied. We evaluated the frequency of inadvertently high epidural and/or intrathecal catheter placement (at or above the L1/L2 interspace) in parturients of BMI ≥50 kg/m².MethodsInclusion criteria for this retrospective study were women with a BMI ≥50 kg/m² who delivered by cesarean with an epidural or intrathecal catheter. The primary outcome was the percentage of catheters placed at or above L1/L2, determined by reviewing the retained foreign object radiograph. Secondary outcomes were agreement between the estimated and actual catheter location and subgroup analysis of catheters placed under ultrasound guidance.ResultsAfter excluding 15 cases for which the catheter location could not be determined and 10 cases for which the estimated level of insertion was not recorded, 125 cases were included. Inadvertent high placement occurred in 26/125 (21%, 95% confidence interval (CI) 15% to 29%) patients. There was poor agreement between the estimated and actual catheter location (27% accurate, unweighted κ-statistic 0.02). Eleven of 39 catheters placed with ultrasound (28%, 95% CI 17% to 44%) were at or above L1/L2 compared with 15/86 catheters placed without ultrasound (17%, 95% CI 11% to 27%, P=0.17). There were no neurological complications.ConclusionsA high rate of inadvertently high epidural or intrathecal catheter placement occurs in super-obese parturients. Ultrasound did not prevent this.