title: Vertical Tunnel-based Low-site Peritoneal Dialysis Catheter Implantation Decreases the Incidence of Catheter Malfunction.
abstract: Peritoneal dialysis (PD) is often complicated by catheter dysfunction. We designed a PD catheter implantation technique to reduce catheter dysfunction. Between June 2008 and 2012, 89 patients with end-stage renal disease were enrolled into a prospective study and randomly assigned to receive traditional catheter implantation by open surgery (n = 41) or vertical tunnel-based low-site PD catheter implantation (n = 48). Both procedures used Baxter straight double-cuffed Tenckhoff catheters. The novel implantation technique involves a low-site (7 cm above the midpoint of the pubic symphysis), individually tailored intra-abdominal segment, and increased vertical subcutaneous tunnel. Patients were followed for 1-year after procedure. The vertical tunnel-based low-site method implanted catheters were 3.7 ± 0.9 cm long, with an 11.3 ± 0.9 cm intra-abdominal segment. The incidence of postoperative bleeding, PD fluid leakage, outer cuff extrusion, inflow or outflow pain, peritonitis, tunnel inflammation, or exit-site infection did not differ significantly between the two surgical techniques; however, the incidence of catheter displacement and noncatheter displacement malfunctions after the novel technique (4.2%) was significantly lower than that in traditional open surgery (19.5%, P < 0.05). In conclusions, vertical tunnel-based low-site PD catheter implantation can significantly reduce the occurrence of PD catheter malfunction, particularly catheter displacement.
authors.affiliation: Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu Province, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Sun
authors.forename: Miao
authors.initials: M
authors.lastname: Zhang
authors.forename: Chunming
authors.initials: C
authors.lastname: Jiang
mesh_terms: D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D011897:Random Allocation; D016896:Treatment Outcome