title: Modification of the percutaneous approach to peritoneal dialysis catheter placement under peritoneoscopic visualization: clinical results in 78 patients.
abstract: The placement of percutaneous peritoneal dialysis catheters under direct peritoneoscopic visualization is a relatively new technique for establishing peritoneal dialysis access. In this study, in which a modification of the Seldinger technique was used to facilitate the placement of the peritoneoscope, the experience with 82 consecutive catheterization procedures in 78 patients is reported. In 2 (2.4%) of 82 catheterization procedures, we were unable to enter the peritoneal cavity but experienced no other complications unique to the percutaneous approach. Of the 80 successful catheterization procedures, 76 represented first-time catheter placement and constituted a population subjected to life-table analysis examining catheter survival rates, the time to first cutaneous exit site or s.c. tunnel infection, and the time to first episode of peritonitis. After a follow-up period of 50.1 patient yr, 11 catheters were lost because of catheter dysfunction. Other clinical complications included peritoneal fluid leaks at the cutaneous exit site in 11 instances (0.22/patient yr), cutaneous exit site infection in 7 instances (0.14/patient yr), s.c. tunnel infection in 2 instances (0.04/patient yr), and 34 episodes of peritonitis (0.68/patient yr). The results of this study demonstrate that the suggested modification of the percutaneous placement of peritoneal dialysis catheters, under peritoneoscopic visualization, is a viable method for establishing peritoneal access.
authors.affiliation: Department of Internal Medicine, Ohio State University, Columbus 43210.
authors.forename: N S
authors.initials: NS
authors.lastname: Nahman
authors.forename: D F
authors.initials: DF
authors.lastname: Middendorf
authors.forename: W H
authors.initials: WH
authors.lastname: Bay
authors.forename: R
authors.initials: R
authors.lastname: McElligott
authors.forename: S
authors.initials: S
authors.lastname: Powell
authors.forename: J
authors.initials: J
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002408:Catheters, Indwelling; D004868:Equipment Failure; D006801:Humans; D007231:Infant, Newborn; D010535:Laparoscopy; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D012867:Skin