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Abstract: FR-PO676

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

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Author

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

Percutnaeously placement of peritoneal dialysis (PD) catheters may be accidenatly be placed in the pre-peritoneal subcutanous space if the introducer needle does not pierce the peritoneal membrane in 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 is unsterile.

Case Description

70 year old man with end stage renal disease underwent bedside PD catheter insertion. Unfortunately, the cathteter was accidetally placed in the pre-peritoneal subsutaneous space. The inflow and outflow of PD fluid was present as the pre-peritoneal subcutaneous space had expanded with the PD fluid, but was slow. The problem was identified on CT scan and PD catheter re-insertion was planned.
A week later, a novel technique was attempted in which the exit site and tunnel were untouched. The skin and subcutanousl sutured over the origical catether insertion site were undone and the deep cuff of the catheter was dissected and the intrabdominal part of the cathteter was exteriorized. A veress needle was advanced till it reached the peritoneal space, the position of which was confirmed using a guidewire. The track was dilated using a peel-away sheath-dilator assembly. The dilator was removed and the intra-abdomina portion of the catheter was slid in. The wound was closed in layers after ensuring good inflow and outflow. Peritoneal dialysis exchanges were begun the same day.

Discussion

Compared to using a new PD catheter and tunnel, this novel technique allows for a simple bedside repositioning technique, saving time, operating room time, reducing hospital stay and possibly avoiding unnecessary hemodialysis.

Steps of procedure