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Abstract: PO1299

Fluoroscopic-Guided Peritoneal Catheter Insertion: Radiology Anthropometric Analysis for Determining Optimal Catheter Position

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Clark, David, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
  • Kutky, Meherzad, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
  • Tennankore, Karthik K., Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
  • Jain, Arsh, Western University, London, Ontario, Canada
Background

Placement of a functioning peritoneal catheter requires optimal catheter positioning. Traditionally the pubis symphysis has been used as a landmark for the true pelvis and referenced for catheter-tip positioning. This practice is based on physical-exam methods without the benefit of fluoroscopic imaging.

Methods

Retrospective cohort of adult, peritoneal dialysis patients in London, Ontario, who underwent percutaneous peritoneal catheter insertion using fluoroscopy spanning Feb 1, 2013 - Aug 1, 2017. Pre-specified anthropometric measures: 1) distance between deep pelvic space (outlined by caudal border of pooled radiocontrast injected intra-procedure) and cranial border of pubis symphysis; 2) distance between catheter-tip and cranial border of pubis symphysis - were measured using Citrix software of stored images. Anthropometric measures were contrasted according to sex via t-tests (p<0.05) and multivariable regression analyses, assessing relationships of potential predictors (age, BMI, prior abdominal surgery).

Results

295 patients (69% male) underwent fluoroscopic catheter insertion during the study period. Average age was 60 + 16 years (std. dev.), BMI 28 + 5 kg/m2. 52% of patients had no prior surgical history, 30% had 1 prior abdominal surgery, 18% had >2 prior surgeries. Average distance between deep pelvic space and pubis symphysis was 2.9 + 1.5 cm, with females having a larger distance (3.4 + 1.7 cm) compared to males (2.8 + 1.4 cm; P=0.001); Female sex being associated with a 0.6 + 0.2 cm, (P=0.03) increase in distance between the pubis symphysis and deep pelvic space as compared to males, adjusted for age, BMI, and number of prior abdominal surgeries. Stratified by sex: age, BMI, number of prior abdominal surgeries was not associated with distance between the pubic symphysis and deep pelvic space. Catheter-tip to pubis symphysis distance was 3.8 + 1.7 cm and similar across sexes.

Conclusion

Fluoroscopic methods of outlining the deep pelvic space for peritoneal catheter positioning approximate traditional methods. Differences observed in the distance between the pubic symphysis and deep pelvic space according to sex may reflect the impact of anatomical differences and/or type of abdominal surgeries. However, catheter tip positioning remained unaffected.