A change to radiological peritoneal dialysis catheter insertion: three-month outcomes.
BACKGROUND
Best practices for peritoneal dialysis (PD) catheter insertion call for timely placement of catheters to reduce complications and increase the likelihood of a successful initiation of PD. The purpose of our study was to assess if a change in approach to PD catheter insertion, including a switch to radiological insertion of PD catheters and introduction of a dialysis access nurse to coordinate all patient care, was associated with more outpatient procedures and achievement of guideline-based outcomes, including timelier PD starts. ♢


METHODS
We conducted a single-center retrospective chart review of all patients that had their first PD catheter inserted at our center over a 7-year period ending in 2007. ♢


RESULTS
PD catheters were placed in 88 patients by interventional radiology and in 125 patients by surgical insertion during an earlier period. Insertion of PD catheters by interventional radiology was significantly associated with a higher rate of outpatient procedures (70% vs 32%, p < 0.0001) than surgical placement. At PD start, 82% of patients that underwent radiological insertions had an estimated glomerular filtration rate of over 8 mL/minute/1.73 m(2) and their mean serum albumin level was 38.2 g/L. ♢


CONCLUSIONS
The new procedure of radiological insertion of PD catheters, coordinated by a dedicated dialysis access nurse, was associated with more outpatient procedures than the earlier surgical method and allowed patients to receive a PD catheter with timing consistent with clinical practice recommendations.
Brunier
Gillian
G
Division of Nephrology and Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. gillian.brunier@sunnybrook.ca
Hiller
Joyce A
JA
Drayton
Shirley
S
Pugash
Robyn A
RA
Tobe
Sheldon W
SW
D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D010530:Peritoneal Dialysis / Q000295:instrumentation* / Q000379:methods / Q000451:nursing*; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D013041:Specialties, Nursing; D013997:Time Factors; D016896:Treatment Outcome