title: Malpositioned peritoneal dialysis catheters: a critical reappraisal of correction by stiff-wire manipulation.
abstract: Tenckhoff peritoneal dialysis (PD) catheter malposition is one of the leading causes of catheter malfunction. Fluoroscopically directed stiff-wire manipulation of malpositioned PD catheters has been advocated as a method of catheter salvage. Two hundred eighty-nine single-cuff PD catheters were placed surgically into 203 patients during this 4-year study. Thirty-three patients developed catheter malfunction attributed to malposition. Forty-eight stiff-wire manipulations were performed on these patients. Thirty-eight (78%) of the manipulations were described as successful at the time of transfer from radiology. However, only 25 (51%) and 12 (25%) resulted in functioning catheters at 1 week and 1 month, respectively. Only 11 of 33 patients who underwent manipulation had functional prolongation of catheter life beyond 1 month. The PD catheter was replaced by a column-disk PD catheter without additional catheter dysfunction in six patients. A second single-cuff Tenckhoff PD catheter was inserted in another six patients. Three of these six catheters again malpositioned. We conclude that stiff-wire manipulation is a useful and safe technique worth using on a limited basis for the initial episode of catheter malposition. Catheters that repetitively malposition should be replaced with a catheter that is resistant to malpositioning.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC 27710.
authors.forename: J S
authors.initials: JS
authors.lastname: Moss
authors.forename: S A
authors.initials: SA
authors.lastname: Minda
authors.forename: G E
authors.initials: GE
authors.lastname: Newman
authors.forename: N R
authors.initials: NR
authors.lastname: Dunnick
authors.forename: W B
authors.initials: WB
authors.lastname: Vernon
authors.forename: S J
authors.initials: SJ
authors.lastname: Schwab
mesh_terms: D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005471:Fluoroscopy; D006801:Humans; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D013997:Time Factors