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Abstract: FR-PO529

Local Anaesthesia Peritoneal Dialysis Catheter Insertion: A Single-Centre Tertiary Care Renal Unit Experience from the United Kingdom

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Perren, Benjamin, St Helier Hospital, London, United Kingdom
  • Sharma, Abhay, St Helier Hospital, London, United Kingdom
  • Somalanka, Subash, St Helier Hospital, London, United Kingdom
  • Sood, Bhrigu Raj, St Helier Hospital, London, United Kingdom
Background

Peritoneal dialysis [PD] is one of the modalities for renal replacement therapy and requires inserting a PD catheter[PDC] into the peritoneal space and is traditionally a surgically assisted PD catheter insertion[SPDCI] under general anaesthesia[GA]. CKD5 patients are at high risk for GA. Local anaesthesia PDC insertion [LPDCI] has been done in those without previous abdominal surgery[PAS]. Peritoneal adhesions due to previous surgery can complicate insertions. We share our experience of LPDCI vs SPDCI from a tertiary care renal unit in the UK.

Methods

Retrospective data was collected from April 2017 to April 2018 and retrieved from electronic patient records and peritoneal dialysis unit notes. The analysis was performed using Microsoft Excel 2010.

Results

A total of 86 catheters were inserted in 83 patients. 35% (29) have diabetes. Figure 1 shows the procedure group characteristics.

Conclusion

Physician-led LPDCI is usually performed in patients without PAS. In our cohort, 43% who underwent LPDCI had PAS. Some of these cases were performed under fluoroscopy guidance. There was no significant difference in immediate complications and catheter function. Peritonitis after six months of LPDCI was higher but unrelated to PAS and LPDCI. PDC loss and modality change were high due to patient choice and infections and is being addressed by further improvements in patient education on hand hygiene and assessment of PDC care. Peritonitis should be treated promptly and where possible PDC should be reconsidered if clinically appropriate. LPDCI is a safe and effective way of providing definitive access to PD. It is cost-effective, performed in a shorter time, spares surgical theatre time and space, improves patient satisfaction by reducing patient stay and avoids the risk of GA.

Comparative analysis of physician-led [LPDCI] vs surgeon-led [SPDCI] peritoneal dialysis catheter insertions has been shown in figure 1.