title: Simultaneous non-surgical removal and insertion of peritoneal dialysis catheters for defective drainage: a bedside, day case technique.
abstract: BACKGROUND
  Outflow failure of peritoneal dialysis catheters is a commonly encountered problem. It may be possible to reposition the catheter by a variety of means, but this can be problematical and has variable long-term success. Commonly surgical catheter exchange is utilized, entailing inconvenience, expense and often, a reliance on temporary hemodialysis. We describe a technique allowing exchange of poorly functioning catheters with a relatively simple outpatient/day case percutaneous technique, allowing the continuation of peritoneal dialysis.
  
  
  METHODS
  We report percutaneous exchange of 25 peritoneal dialysis catheters in 21 patients. The exchanges were performed under local anesthesia with a degree of sedation (if required). It involved the dissection down the distal cuff of the catheter and mobilization of the catheter below it. This was followed by division of the catheter, allowing passage of a guide wire into the peritoneal cavity and insertion of a further peel away sheath and insertion of a new catheter. The new catheter was tunneled out of the existing exit site after removal of the extraperitoneal portion of the old catheter by traction.
  
  
  RESULTS
  Outflow failure was associated with fecal loading and malposition of the catheter in 14 out of the 21 patients. Exchange of catheter was successful in all the patients with good pelvic positioning of the replacement catheter in all but 1 of the cases. The mean period until the reinstitution of peritoneal dialysis was 5.1 days (range 0-14 days). Temporary hemodialysis was not required for any of the patients. One patient exhibited a small leak of peritoneal dialysis fluid after insertion, but this had spontaneously resolved within 6 days. Protracted satisfactory function of the peritoneal dialysis catheters was obtained in all but 1 of the patients (mean follow-up 51 weeks, range 11-73 weeks).
  
  
  CONCLUSIONS
  We conclude that exchange of peritoneal dialysis catheters for problems with dialysate drainage, utilizing a non-invasive percutaneous technique is both effective and safe.
authors.affiliation: Department of Renal Medicine, Derby City General Hospital, Derby, UK. chris-mcintyre@lineone.net
authors.forename: C W
authors.initials: CW
authors.lastname: McIntyre
authors.forename: R J
authors.initials: RJ
authors.lastname: Fluck
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D002404:Catheterization / Q000379:methods*; D020878:Device Removal / Q000379:methods*; D004322:Drainage / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D019095:Point-of-Care Systems; D013997:Time Factors