title: Fluoroscopic manipulation of peritoneal dialysis catheters: outcomes and factors associated with successful manipulation.
abstract: OBJECTIVE
  Mechanical failure of the peritoneal dialysis (PD) catheter is an important cause of technique failure. Fluoroscopic guidewire manipulation may be undertaken in an attempt to correct the failure. The purpose of this study was to determine the efficacy of fluoroscopic manipulation of previously embedded PD catheters, the factors associated with successful manipulation, and the complication rate associated with manipulation.
  
  
  METHODS
  A single-center, retrospective review of 70 consecutive PD patients undergoing fluoroscopic manipulation for mechanical failure of their PD catheter from June 2006 to February 2011 was undertaken. Logistic regression models were developed to determine the variables associated with successful manipulation.
  
  
  RESULTS
  Of the 70 manipulations, 44 were successful (62.9%). In univariate analysis, catheters located in the pelvis compared with those in the upper abdomen (73.5% versus 42.9%, P=0.01) and catheters that were previously functional compared with those that failed at exteriorization (75.0% versus 46.7%, P=0.04) were more likely to be successfully manipulated. Time embedded, previous hemodialysis, and number of intra-abdominal surgeries were not correlated with likelihood of successful manipulation. In multivariate analysis, catheters located in the pelvis (P=0.01) and those with secondary failure (P=0.01) were more likely to successfully manipulated. Two of the patients developed peritonitis (2.9%), neither requiring cessation of PD.
  
  
  CONCLUSIONS
  Fluoroscopic manipulation is an effective and safe therapy for failed PD catheters that are unresponsive to conservative treatment. Properly positioned catheters and those that were previously functional are more likely to be successfully manipulated.
authors.affiliation: Division of Nephrology, McMaster University, Hamilton, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Miller
authors.forename: Brendan
authors.initials: B
authors.lastname: McCormick
authors.forename: Susan
authors.initials: S
authors.lastname: Lavoie
authors.forename: Mohan
authors.initials: M
authors.lastname: Biyani
authors.forename: Deborah
authors.initials: D
authors.lastname: Zimmerman
mesh_terms: D000005:Abdomen; D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D010538:Peritonitis / Q000209:etiology; D012189:Retrospective Studies