title: Embedded Catheters: Minimizing Excessive Embedment Time and Futile Placement while Maintaining Procedure Benefits.
abstract: BACKGROUND
  Embedding peritoneal catheters far in advance of anticipated need may successfully commit patients to their modality choice and reduce central venous catheter use but can be complicated by excessive embedment periods and futile catheter placement.
  
  
  OBJECTIVE
  Embedded catheter outcomes were studied to identify factors that minimize inordinate embedment time and futile placement while maintaining procedure benefits.
  
  
  METHODS
  Clinical and laboratory data were examined in 107 patients with embedded catheters that were either externalized, remained embedded, or were futilely placed.
  
  
  RESULTS
  Externalization of 84 catheters was performed after a median embedment period of 9.4 months. Flow dysfunction occurred in 14.3% of externalized catheters. Overall function rate was 98.8% after laparoscopic revision. One patient changed their mind about modality choice. Except for 1 patient hospitalized acutely in a facility unfamiliar with embedded catheters, none remaining on a peritoneal dialysis pathway initiated dialysis with a central venous catheter. Including catheters with extremely long embedment periods, the incidence of futile placement was 13.1%. Multiple regression analysis identified estimated glomerular filtration rate (eGFR) and serum albumin as the 2 variables best associated with catheter embedment duration (r(2) = 0.44, p < 0.0001). Diabetic nephropathy was statistically more likely to be associated with lower serum albumin values (p < 0.0001); however, no association was noted between diabetic status and embedment duration (p = 0.62).
  
  
  CONCLUSIONS
  Timing of the embedment procedure should include appraisal of both eGFR and serum albumin. Appropriate consideration of these values together may help minimize excessive embedment periods and decrease futile placements while preserving procedure benefits.
authors.affiliation: Research and Evaluation Department, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena, California Visiting Clinical Faculty, Division of Nephrology and Hypertension, Harbor-University of California Los Angeles Medical Center, Torrance, California johncrabtree@sbcglobal.net.
authors.forename: John H
authors.initials: JH
authors.lastname: Crabtree
authors.affiliation: Research and Evaluation Department, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena, California.
authors.forename: Raoul J
authors.initials: RJ
authors.lastname: Burchette
authors.affiliation: Division of Nephrology, Department of Medicine, Kaiser Permanente Downey Medical Center, Downey, California.
authors.forename: Rukhsana A
authors.initials: RA
authors.lastname: Siddiqi
mesh_terms: D000328:Adult; D002404:Catheterization / Q000379:methods; D002408:Catheters, Indwelling; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D011446:Prospective Studies; D012086:Reoperation; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors
chemical_list: D012709:Serum Albumin
keywords: Moncrief-Popovich technique; buried catheter; embedded catheter