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Abstract: FR-PO675

Bedside Peritoneal Dialysis Catheter Repositioning - A Novel Technique

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Varughese, Santosh, Christian Medical College, Vellore, Tamil Nadu, India
  • Alexander, Suceena, Christian Medical College, Vellore, Tamil NADU, India
  • Valson, Anna T., Christian Medical College, Vellore, Tamil NADU, India
  • Jacob, Shibu, Christian Medical College, Vellore, Vellore, India
  • Kakde, Shailesh Tulshidas, Christian medical college, Vellore. Tamil Nadu, India
  • Mohapatra, Anjali, Christian Medical College, Vellore, Vellore, India
  • David, Vinoi George, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Introduction

Malfunction of peritoneal dialysis (PD) catheters usually need surgical repositioning, requiring anaesthesia, operating time, longer hospital stay and surgical expertise. This novel technique obviates need for surgical intervention.

Case Description

The abdomen is scrubbed and cleaned. PD catheter distal to exit site is meticulously cleaned, titanium adaptor and transfer set removed, the former soaked in povidone-iodine. A guidewire is passed through catheter into peritoneal cavity. A 5mm incision is made over previous healed incision scar. Soft tissue is dissected until deep cuff is visible. With blunt dissection, cuff is gently separated from subcutaneous tissue where it had become anchored.
Taking care to retain guide wire’s position inside peritoneum, intra-peritoneal part of PD catheter is removed. External portion of guidewire is advanced through PD catheter till free from catheter. Proximal end of guidewire is in peritoneum and distal end free. PD catheter is searched for occluding clots, and if present, are gently milked out and catheter flushed with saline.
A dilator is advanced along guidewire to ensure adequate space for PD catheter at linea alba. Peel-away sheath and dilator are then advanced into peritoneum. The dilator and guide wire are removed leaving only sheath in place. The catheter is then re-introduced into peritoneum through the sheath, which is separated leaving catheter in place. Peritoneal cavity is filled with PD fluid and good inflow and outflow are ensured. Subcutaneous tissue and skin are closed in layers.
In the 18 patients so far. we have had an immediate technical success of 100% and a month later 12 catheters were functioning well (66.67%). Six months later, the catheters remained functional except in one patient who died due to heart disease.

Discussion

This novel technique allows for preservation of the catheter, exit site and tunnel. This reduces costs and duration of hospital stay and does not require specialized surgical expertise, operating room time or a dedicated anaesthetist.

Steps of repositioning