Percutaneous peritoneal lavage in blunt trauma patients: a safe and accurate diagnostic method

We reviewed the records of 395 patients seen from January 1983 through May 1988, who after sustaining blunt thoracoabdominal trauma had diagnostic peritoneal lavage (DPL) performed percutaneously by the Seldinger wire technique of Lazarus and Nelson. The test was considered grossly positive if 10 cc of blood were aspirated from the catheter immediately after its insertion into the peritoneal cavity. Microscopic criteria for positivity included more than 100,000 RBC or 500 WBC/cc of lavage return, elevated amylase or bilirubin, or the presence of vegetable fibers or bacteria. Seventy-two (18%) of the patients were true positives and 315 (80%) were true negatives. There were four false positives (1.3%) and one false negative (0.2%), giving the test a sensitivity of 99% and a specificity of 98%. Complications occurred in three patients, for a rate of 0.8%, and included catheter insertion into a large ovarian dermoid cyst, needle perforation of the ileum, and needle perforation of the sigmoid colon. This technique of DPL can consistently be performed much more rapidly than the open method. Therefore we conclude that percutaneous DPL is as accurate as, as safe as, and quicker than open DPL for determining intra-abdominal injury in blunt trauma patients.     

A prospective randomized trial of the Lazarus-Nelson vs. the standard peritoneal dialysis catheter for peritoneal lavage in blunt abdominal trauma

One hundred consecutive injured patients with blunt abdominal trauma requiring peritoneal lavage were prospectively randomized to placement of lavage catheters with an open or percutaneous technique. The Lazarus-Nelson catheter, placed by Seldinger wire technique, was compared to a standard dialysis catheter, placed by direct visualization and incision of the peritoneum. Placement of the catheter was consistently faster using the percutaneous method; no difference was noted in time of lavage, volume recovered, or complications. When not contraindicated, the percutaneous technique was widely preferred by study participants.     

Open versus closed diagnostic peritoneal lavage in the evaluation of abdominal trauma

Two hundred forty-two patients underwent diagnostic peritoneal lavage (DPL) over a 12-month period. One hundred sixteen patients (48%) were randomized to an open lavage technique and 126 (52%) to a percutaneous (closed) guide wire procedure. The closed procedure required an average of 16 minutes to complete with one operator, whereas the open method required two operators and an average time of 26 minutes (p less than 0.001). Technical complications occurred in 31 patients undergoing closed lavage (25%) and 4 patients undergoing open lavage (3%) (p less than 0.01). Fifty-eight percent of the closed lavage complications were related to fluid return and 42% to guide wire placement. All the open lavage complications were caused by inadequate fluid return. These data do not support the initial use of percutaneous lavage. The open technique is favored and certainly used when the closed method fails or when direct visualization of the peritoneal cavity is indicated. Physicians involved in the management of abdominal trauma must be familiar with both methods of DPL.     

A prospective, randomized comparison between open and closed peritoneal lavage techniques

We randomized 327 blunt trauma patients to compare the open peritoneal lavage technique with the percutaneous (Seldinger wire) technique. The open and closed lavage groups were similar with respect to accuracy and safety. There were one complication in the percutaneous group and two in patients treated by the open method. The incidence of positive lavage was similar in each group. There was one false positive in the percutaneous group and none in the open method group. False negative results did not occur by either method. The percutaneous lavage method required less time for performance, had better patient tolerance, and only required one surgeon to perform the procedure. Percutaneous diagnostic peritoneal lavage (DPL), in the hands of trauma surgeons, is a safe and acceptable alternative to the open DPL method and actually had several advantages as mentioned above.     

Modified minimally invasive laparoscopic peritoneal dialysis catheter insertion with internal fixation

BackgroundLaparoscopic technique is widely used in peritoneal dialysis (PD) catheter placement. We developed a modified minimally invasive laparoscopic PD catheter (PDC) insertion with internal fixation and evaluated the early results by observing the intraoperative and postoperative conditions of the novel technique with those of conventional open surgery.MethodsRetrospective research was performed on 59 patients who underwent PDC insertion from June 2019 to January 2022, including 23 patients who received open surgery and 36 patients who received modified minimally invasive laparoscopic surgery. Information such as preoperative conditions, operation time, incision length, incidence of intraoperative complications, time from operation to starting PD, time from operation to discharge, and incidence of catheter-related complications were collected and analyzed.ResultsThe incision length, intraoperative blood loss, catheter migration rates and the total incidence of complications 6 months after operation in the laparoscopic group were lower than those in the conventional group. There were no statistically significant differences between the two groups in operation time, time from operation to starting PD, time from operation to discharge and the incidence of catheter blockage, leakage, exit-site infection, peritoneal dialysis associated peritonitis and hernia.ConclusionsModified minimally invasive laparoscopic PDC insertion and internal fixation method achieved direct vision and reliable fixation of the catheter, significantly reduced incision length and blood loss. The incidence of catheter migration was significantly lower than that of open surgery. Our primary findings reveal that modified minimally invasive laparoscopic PDC insertion with internal fixation is safe, effective and beneficial for PD patients.     

Wang's Forceps‐Assisted Percutaneous Insertion and Fixation of Peritoneal Dialysis Catheter

Percutaneous insertion of peritoneal dialysis catheters is theoretically most preferred by nephrologists because of the advantages of bedside performing, surgery independence, and minimal injury over other procedures of catheter placement such as open surgical dissection or laparoscopic operation. However, blindly placing catheters in the percutaneous procedure brings the risk of catheter malposition or bowel perforation; this largely retarded it's implementation. We had previously developed a novel technique termed “Wang's forceps‐assisted catheter insertion and fixation,” which had been successfully applied in the open surgical catheter insertion and displaced catheter reposition in our center. In this study, we further explored the possibility of applying the Wang's forceps in the procedure of percutaneous catheter insertion both in porcine model and patients with end stage renal disease (ESRD). A total of three miniature pigs successfully received percutaneous catheter insertion using Seldinger's technique with Wang's forceps assistance. The catheters were all placed in the right position and functioning well in dialysate drainage. This novel method of percutaneous catheter insertion was then performed on 20 ESRD patients. The procedure showed effective time‐saving with the average operating time of 29.2 ± 3.53 min and was well tolerated by patients with minimal pain and injury. During a follow‐up time of 6 months, no complications of catheter displacement, leakage, or blockade occurred. Our preliminary observation demonstrates that utilization of Wang's forceps in a percutaneous procedure conferred benefits of accurately placing and fixing catheters while preserving the merits of minimal invasion and simple performance.     

Limitations of computed tomography in the evaluation of acute abdominal trauma: a prospective comparison with diagnostic peritoneal lavage

There has been recent enthusiasm for computed tomography (CT) to supplant diagnostic peritoneal lavage (DPL) in the detection of abdominal injuries. We prospectively compared CT to DPL following acute blunt trauma or stab wound to the abdomen. Patients with hemodynamic instability or overt signs of intraperitoneal pathology underwent urgent laparotomy and were excluded from study. Those with indications for DPL had lavage catheter insertion via open technique and attempted aspiration for gross blood. This was followed by contrast CT of the abdomen with a Technicare 2010 scanner. Lavage fluid, when required, was then instilled, recovered, and analyzed. CT interpretations were made in a blind fashion by a single staff radiologist. Decision for laparotomy was based on clinical, DPL, and CT data. In blunt trauma (N = 65), DPL detected 5/5 (100%) injuries discovered at laparotomy and CT 2/5 (40%). Following stab wounds (N = 35), DPL was true positive in 7/7 (100%) and CT in 1/7 (14.3%), with one false positive CT leading to negative laparotomy and one false positive DPL which prompted unnecessary celiotomy. Overall, the sensitivity of DPL was 100% versus 25% for CT and specificity 98.9% for both DPL and CT. In particular, CT missed seven solid visceral (five liver, two spleen), five hollow visceral, one major vascular, and three diaphragmatic lesions requiring operative intervention. In our experience, CT demonstrated an alarming incidence of false-negative studies. Given the widespread variability of CT equipment and personnel we would argue strongly against the use of CT alone in the evaluation of acute abdominal trauma and continue to support DPL as the most accurate and reliable instrument of detection.     

Open or closed diagnostic peritoneal lavage for abdominal trauma? A meta-analysis

OBJECTIVES: To perform a meta-analysis of prospective, randomized controlled trials comparing the closed and open technique of diagnostic peritoneal lavage (DPL) in trauma patients to determine whether there are any difference in outcomes. METHODS: A search of MEDLINE database of English language articles published from 1977 to 1999 was conducted by using the terms diagnostic peritoneal lavage, trauma, and randomized controlled trials. A manual search and Cochrane Library database search was also conducted. Seven randomized controlled trials, including a total of 1,126 patients were identified that compared closed versus open technique. Two reviewers assessed the trials independently. Trial quality was critically appraised by using the Jadad Instrument, a validated published quality scale. Data extraction of major complications, technical difficulties, procedure times, and false-negative and false-positive rates was carried out. The fixed effects model was used for statistical analysis. The Peto odds ratio (OR), weighted mean differences and 95% confidence intervals (95% CI) were calculated. RESULTS: The overall quality of studies was poor (mean, 2.4/7). Major complications did not differ significantly between closed versus open technique (OR, 0.65; 95% CI, 0.15 to 2.92. Technical failures and difficulties were significantly higher in the closed group, i.e., OR 4.33 (95% CI, 1.96 to 9.56) and OR 4.19 (95% CI, 2.842 to 6.19), respectively. Accuracy of closed and open DPL was comparable with no difference in false-negative or false-positive rates between the two techniques. Procedure time was consistently lower in the closed technique. CONCLUSIONS: The closed DPL technique is comparable to the standard open DPL technique in terms of accuracy and major complications. The advantage of reduced time to perform the closed DPL is offset by the increased technical difficulties and failures of this group. Therefore, any significant benefit of routine closed DPL in improving outcomes can be excluded with more confidence based on pooled data than by the individual trials alone.     

A novel minimally invasive technique for insertion of peritoneal dialysis catheter

The placement of a continuous ambulatory peritoneal dialysis (CAPD) catheter by conventional open surgical or trocar technique may cause a number of complications such as infection, hemorrhage, leakage, incisional hernia, and visceral organ perforation. Most complications are related to open surgery or insertion of the catheter with the guidewire without direct visualization. Insertion of the catheter laparoscopically under direct visualization has been previously described. The authors who described this technique used two or three ports for the camera and instruments. In this study we describe a laparoscopic technique for insertion of the peritoneal dialysis catheter under direct visualization with use of one-camera port and an accessory 2-mm umbilical incision. This prospective study was performed with the approval of the ethics committee of the Gazi University Hospital, in Ankara, Turkey. There were a total of eight patients: five males and three females, with an average age of 34.3 years (range, 11-54), who underwent laparoscopic CAPD insertion between 1997 and 2000. The catheter was inserted into the abdominal cavity 2 cm below the umbilicus. The subcutaneous tunnel was made with the assistance of a specially designed L-shaped trocar. All patients did well after the operation and had excellent cosmetic results. There was one leak in the early postoperative period, which was treated conservatively. The average operating time was 34.7 minutes (range, 25-45 minutes). The laparoscopic approach for peritoneal dialysis catheter insertion, for management of transmigrated CAPD catheters, and to resolve omental occlusions should be considered as an alternative to open surgery, especially for patients who have peritoneal adhesions secondary to a history of abdominal surgeries or recurrent peritonitis.     

Clinical uses of diagnostic peritoneal lavage in stab wounds of the anterior abdomen: a prospective study.

OBJECTIVE: To evaluate patients with stab wounds of the anterior abdomen with diagnostic peritoneal lavage (DPL), by using initial aspiration of gross blood from the lavage catheter of more than 10 ml or red blood cell (RBC) count in the lavage fluid of more than 10,000/mm3 as criteria for exploratory laparotomy. DESIGN: Prospective study. SETTING: University hospital, Thailand. PATIENTS: 40 patients who had stab wounds of the anterior abdomen penetrating through the peritoneum but had no obvious indications for immediate exploratory laparotomy. INTERVENTIONS: Diagnostic peritoneal lavage (DPL), exploratory laparotomy. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of positive DPL as an indication for exploratory laparotomy. RESULTS: In 27 patients (68%) the DPL was positive and in 13 (33%) it was negative. In 18 patients (67%) the initial aspiration of gross blood was more than 10 ml and in 9 (33%) the RBC count in lavage fluid was more than 10,000/mm3. These 27 patients had exploratory laparotomies, 2 of which were negative. All 13 patients who had negative DPL were observed and discharged home uneventfully. The sensitivity of DPL for positive laparotomy was 100%, the specificity was 87%, the PPV was 93%, the NPV was 100% and the accuracy was 95%. When operative findings of bleeding from the stab wound into the peritoneal cavity were considered as a "negative" laparotomy (n = 7) the sensitivity, the specificity, the PPV, the NPV and the accuracy became 100%, 59%, 67%, 100%, and 78%, respectively. CONCLUSION: The use of DPL in patients with stab wounds of the anterior abdomen, using initial aspiration of gross blood from the lavage catheter of more than 10 ml or RBC count in the lavage fluid of more than 10,000/mm3 as positive criteria for exploratory laparotomy, is safe and practical.     

EARLY MANAGEMENT OF ABDOMINAL TRAUMA THE ROLE OF DIAGNOSTIC PERITONEAL LAVAGE

This report reviews the contemporary value of diagnostic peritoneal lavage (DPL) in the assessment of abdominal trauma, and reports the methods and results of its application within one trauma centre (Washington Hospital Center). DPL was reserved for those patients where doubt existed as to the presence of intraabdominal injury, and gave a very accurate assessment of intraperitoneal injury. The complication rate was 0.4% and the accuracy of DPL was 97.7%. Except for laparotomy, DPL is the most sensitive indicator of haemoperitoneum available. It was first introduced with the aim of reducing the number of missed diagnoses of abdominal injury and it performs this task excellently when a low threshold for positivity is used. The open technique is safest and gives fewer false positive results, and the colorimetric method of analysis of lavage fluid is recommended, with strict adherence to advised criteria for negativity. A clinical algorithm is described, utilizing DPL, aimed at early diagnosis of all intra-abdominal injuries. This was extremely sensitive and failed in only one case in 384 (0.3%). The attendant, non-therapeutic laparotomy rate was 19%, and is regarded as acceptable within the aims of early diagnosis. In this series, there was no mortality or morbidity attached to the use of DPL or from non-therapeutic laparotomy, and there was only one delayed diagnosis in the entire series. No bowel, bladder, diaphragmatic, duodenal or pancreatic injuries were missed or diagnosed late.     

Early management of abdominal trauma: the role of diagnostic peritoneal lavage

This report reviews the contemporary value of diagnostic peritoneal lavage (DPL) in the assessment of abdominal trauma, and reports the methods and results of its application within one trauma centre (Washington Hospital Center). DPL was reserved for those patients where doubt existed as to the presence of intra-abdominal injury, and gave a very accurate assessment of intraperitoneal injury. The complication rate was 0.4% and the accuracy of DPL was 97.7%. Except for laparotomy, DPL is the most sensitive indicator of haemoperitoneum available. It was first introduced with the aim of reducing the number of missed diagnoses of abdominal injury and it performs this task excellently when a low threshold for positivity is used. The open technique is safest and gives fewer false positive results, and the colorimetric method of analysis of lavage fluid is recommended, with strict adherence to advised criteria for negativity. A clinical algorithm is described, utilizing DPL, aimed at early diagnosis of all intra-abdominal injuries. This was extremely sensitive and failed in only one case in 384 (0.3%). The attendant, non-therapeutic laparotomy rate was 19%, and is regarded as acceptable within the aims of early diagnosis. In this series, there was no mortality or morbidity attached to the use of DPL or from non-therapeutic laparotomy, and there was only one delayed diagnosis in the entire series. No bowel, bladder, diaphragmatic, duodenal or pancreatic injuries were missed or diagnosed late.     

Is diagnostic peritoneal lavage for blunt trauma obsolete?

Diagnostic peritoneal lavage was 97 percent accurate, with a 2 percent false positive rate and a 1 percent false negative rate in this series of 414 patients. The ease, safety, and accuracy of diagnostic peritoneal lavage justify its continued use in evaluating these patients. Recent studies show computerized tomography (CT) can be highly accurate in detecting intra-abdominal injuries after blunt trauma. We reviewed our experience with diagnostic peritoneal lavage (DPL) to evaluate whether the accuracy, safety, speed, and cost justified its continued use. Four hundred fifteen DPLs were performed on 414 patients from February 1, 1983, through December 31, 1987. All DPLs were done by the open technique. The lavage was considered grossly positive if 10 cc gross blood were aspirated. If there were greater than 100,000 red blood cells (RBC)/mm3, greater than 500 white blood cells (WBC)/mm3, elevated amylase or bilirubin, or bacteria or vegetable fibers the lavage was microscopically positive. There were no cases with elevated bilirubin, amylase, or presence of bacteria. All four cases with "rare vegetable fibers" were false positive. Six DPLs were for penetrating trauma to the lower chest or back. There were 291 negative lavages, including five false negatives (1%), and 124 positive DPLs, including seven false positives (2%), resulting in a crude accuracy of 97 percent. Three of the five false negative lavages had a ruptured diaphragm as the only intra-abdominal injury. There was one minor complication. DPL was usually performed in the trauma resuscitation room during the secondary survey. At our institution, the total fees for DPL are +185 less than the fees for CT. DPL is accurate, rapid, safe, and avoids the disruption of patient care that results in the radiology suite. DPL remains our procedure of choice for evaluating blunt abdominal trauma in the adult.     

Experience with over 2500 diagnostic peritoneal lavages

This study was undertaken to confirm the safety and efficacy of diagnostic peritoneal lavage (DPL) for trauma patients. A prospectively maintained database of all DPLs performed in the past 75 months was analyzed. A red blood cell count of 100,000/mm(3) was considered positive for injury in blunt trauma; 10,000/mm(3) was considered positive for peritoneal penetration in penetrating trauma. Information relative to type of injury, DPL result, laparotomy result and complications, was analysed to determine if DPL was more or less suited to any specific indication or type of patient. Over a 75 month period, 2501 DPLs were performed at our urban level I trauma center. The overall sensitivity, specificity and accuracy for the above thresholds were 95, 99 and 98%. The majority (2409, 96%) were performed using percutaneous or "closed" seldinger technique. Ninety-two (4%) were performed using open technique because of pelvic fractures, previous scars and pregnancy. Open DPL was less sensitive than closed DPL in patients who sustained blunt trauma (90 vs 95%) but slightly more sensitive in determining penetration (100 vs 96%). Overall, there were 21 complications (0.8%). There was no difference in complication rate between open and closed DPL. In conclusion, DPL remains a highly accurate, sensitive and specific test with an extremely low complication rate. It can be performed either open or closed with comparable results. We recommend its use in the evaluation of both blunt and penetrating trauma.     

Robotically assisted biliary pancreatic diversion with a duodenal switch: a new technique

Background Minimally invasive surgical techniques decrease the length of hospitalization and the morbidity for general surgery procedures. Application of minimally invasive techniques to obesity surgery had previously been limited to stapled techniques used primarily for the Roux-en-Y gastric bypass and laparoscopic band placement. The authors present the technique for totally intracorporeal robotically assisted biliary pancreatic diversion with a duodenal switch (BPD/DS) using five ports. Methods After development of the technique in animal and human cadaver models, the da Vinci robot was first used in October 2000 to perform BPD/DS using five ports and a totally intracorporeal technique. Patient selection was based on standard surgery guidelines for the morbidly obese. Results This technique was applied for 47 patients with a mean body mass index (BMI) of 45 kg/m² and a mean age of 38 ± 10 years. The median operating time was 514 min (range, 370–931 min). The median operative time for the last 10 patients was 379 min (range, 370–582 min). Three patients underwent conversion to open surgery, and four patients experienced postoperative leaks with no mortality. Conclusion The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as BPD/DS is demonstrated. The BPD/DS allows for a sutured bowel anastomosis similar to the open technique using a minimal number of small access ports.     

Single trocar laparoscopically assisted placement of central nervous system-peritoneal shunts

BACKGROUND: Lumbar peritoneal and ventriculoperitoneal shunts are widely used for the treatment of hydrocephalus. In the past, the abdominal portion of these procedures required laparotomy. With the advent of minimally invasive techniques, laparoscopically assisted placement of the distal catheter has been tried. MATERIALS AND METHODS: We performed 10 shunt procedures (3 lumbar peritoneal, 6 ventriculoperitoneal, and 1 meningomyelocele-peritoneal) in 10 patients (mean age 56; age range, 30-78 years). Four patients had undergone previous open shunt placement that failed. The abdominal portion of the procedure was performed using a 5-mm trocar and a 10Fr introducer for camera and catheter insertion. In 3 cases, an additional 5-mm port was necessary for lysis of adhesions. These access punctures did not require fascial closure and caused minimal pain and limitation. RESULTS: No intra- or postoperative complications were encountered in this small patient group. At a median follow-up of 50 months (range, 3-56 months) all patients had functioning shunts. CONCLUSION: Single trocar laparoscopically assisted placement of central nervous system-peritoneal shunts is safe and simple, and should be considered the procedure of choice. This technique is also suitable for repositioning migrated catheters and other catheter-tip manipulations.     

血管内皮生长因子和内皮抑素在人腹膜组织的表达及其与腹膜毛细血管新生的关系

目的 检测血管内皮生长因子（VEGF）和血管内皮抑素（ES）在人腹膜组织表达,探讨两者与腹膜血管新生之间的关系。 方法 取健康对照者、尿毒症非透析患者以及腹透患者的腹膜标本,用反转录聚合酶链反应（RT-PCR）检测VEGF和ES mRNA的表达;组织免疫组化染色检测VEGF和ES蛋白质水平的表达;CD34染色计数腹膜组织毛细血管密度（MVD）。 结果 各组腹膜均有VEGF及ES表达;健康对照组、尿毒症非透析组、腹透组VEGF mRNA的相对表达量依次为0.47±0.01、0.62±0.02、0.74±0.02。VEGF免疫组化染色阳性区平均灰度值依次为95.673±2.01、117.126±2.07、140.184±2.25。ES免疫组化染色阳性区平均灰度值依次为94.902±2.38、113.380±2.33、145.489±3.05。尿毒症非透析组、腹透组VEGF mRNA和蛋白表达水平及ES蛋白表达水平表达均高于健康对照组,且腹透组升高更为明显,差异均具有统计学意义（均P < 0.05）。3组ES在mRNA水平表达量依次为0.42±0.02、0.43±0.03、0.43±0.02,各组表达差异无统计学意义（P > 0.05）。3组腹膜MVD依次为3.05±0.45、5.98±0.47、9.62±0.49,尿毒症非透析组、腹透组均高于健康对照组,且腹透组增高更为明显,差异均具有统计学意义（均P < 0.05）。 结论 腹膜透析患者腹膜组织VEGF mRNA和蛋白表达水平升高,ES蛋白表达水平也升高,这可能在长期透析所致腹膜组织新生毛细血管形成过程中发挥一定作用。     

CHANGES IN FIBRINOGEN LEVELS IN PATIENTS UNDERGOING OPEN AND LAPAROSCOPIC NISSEN FUNDOPLICATION

Background: Venous thromboembolic complications may be more common after laparoscopic surgical techniques, possibly due to changes in venous flow and blood coagulability. Methods: This study assessed fibrinogen, cross-linked fibrin degradation products (D-dimer), prothrombin international normalized ratio (INR), activated partial thromboplastin time (APTT) and platelets, during and after both open and laparoscopic Nissen fundoplication to determine whether coagulability is increased by the laparoscopic approach. Results: Seven patients underwent open and thirteen underwent laparoscopic Nissen fundoplication. Fibrinogen levels following open fundoplication fell from 2.8 ± 0.3 g/L pre-operatively to 2.0 ± 0.3 g/L following skin incision, and then increased to 4.1 ± 0.4 g/L on the first postoperative day. Similar changes in fibrinogen occurred following laparoscopic fundoplication (2.7 ± 0.2, 2.5 ± 0.2 and 3.8 ± 0.4 g/L, respectively). No significant changes in the other coagulation indices were observed. Conclusions: These results demonstrate hypercoagulability on the first postoperative day, irrespective of the operative technique. No differences between the results following laparoscopic and open fundoplication were demonstrated.     

Ultrarapid diagnostic peritoneal lavage

Diagnostic peritoneal lavage is an important adjunct in the evaluation of blunt trauma. The open technique has proven to be safer, though more time consuming, than the closed percutaneous technique. A significant time-consuming aspect of the procedure is the infusion and drainage of the peritoneal lavage fluid. With the use of cystoscopy irrigation tubing, infusion time for one liter of Ringer's lactate averaged 2.9 minutes compared to 14.4 minutes when using IV fluid tubing. Similarly, effusion time was 2.3 times rather than 9.8 minutes. These differences are significant at the 0.0001 level. The average time saved was 19 minutes, allowing more rapid assessment and treatment of these critically injured patients.     

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.