Abstract: TH-PO850

Percutaneous Re-Positioning of PD Catheter Accidentally Placed in the Subcutaneous Space Leaving the Tunnel and Exit-Site Intact – A Novel Idea

Session Information

  • Peritoneal Dialysis - I
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Author

  • Varughese, Santosh, Christian Medical College, Vellore, Tamil Nadu, India
Background

Peritoneal dialysis (PD) catheter insertion by blind bedside percutaneous technique is a simple procedure. Rarely, the intra-abdominal portion of the catheter may accidentally be placed in the subcutaneous space if the introducer needle does not enter the peritoneal cavity during the initial part of the procedure. If this happens, the catheter insertion has to be redone either percutaneously or surgcially. The catheter often has to be replaced as part of it has been externalized and the external portion is unsterile.

Methods

A 70 year old man with end stage renal disease underwent PD catheter insertion by blind bedside percutaneous technique. Unfortunately, the cathteter was accidentally placed in the subcutaneous space. There was inflow and outflow of PD fluid as the subcutaneous space had expanded with the PD fluid infused during the procedure, but the outflow rate was slow. On CT scan, the intra-abdominal portion of catheter was seen to be lying in the subcutaneous space.
A novel technique of repositioning was attempted in which the exit site and tunnel were untouched. The abdomen was scrubbed and cleaned. The skin sutures and subcutanous sutures at the original insertion site were removed. The deep cuff of the catheter was dissected free of the surrounding tissue. The intra-abdominal part of the cathteter was exteriorized. A Veress needle was advanced till it reached the peritoneal space. The track was dilated using a peel-away sheath-dilator assembly. The dilator was removed and the intra-abdominal portion of the catheter (that had just been exteriorized) was slid in and the peel-away sheath was removed. The wound was closed in layers after ensuring good inflow and outflow. Peritoneal dialysis exchanges were begun the same day and was the patient was continued on continuous ambulatory peritoneal dialysis successfully.

Conclusion

This novel technique allows for a simple bedside repositioning technique of a PD catheter accidentally placed in the subcutanous space without change of catheter or disruption of the tunnel or exit-site. Compared to a repeat PD catheter insertion, this procedure has the advantages of saving operating room time, reducing costs, reducing duration of hospital stay and possibly avoiding unnecessary hemodialysis.