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The Choice of Peritoneal Dialysis Catheter Implantation Technique by Nephrologists

DOI: 10.1155/2013/940106

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Abstract:

Peritoneal dialysis catheter (PDC) is the lifeline of peritoneal dialysis (PD) patients. One of the critical issues for successful PD is a well-functioning PDC which is timely inserted. It is the implantation technique rather than the catheter design that determines the outcome of the catheter. Dedication in acquiring the appropriate technique is vital to the success of a PD program. In this paper, we discuss the pros and cons of various techniques used for PDC implantation. A detailed description of PDC implantation by using the minilaparotomy method is presented. We strongly recommend mini-laparotomy as the method of choice for PDC implantation by nephrologists. Peritoneal dialysis (PD) is a well-established technique of renal replacement therapy in patients with end-stage renal disease (ESRD). The advantages of PD include preservation of residual renal function, better patient survival in the first few years, better quality of life and cost-effectiveness over hemodialysis [1–4]. Thus, PD is well suited to act as a first-line renal replacement therapy in an integrated approach to end-stage renal failure care. In Hong Kong, “PD-first” policy has been adopted since mid-1980s. Currently, up to 80% of ESRD patients on maintenance dialysis are on PD. It has provided a successful model for the PD first policy. For a PD program to succeed, access to peritoneal dialysis catheter (PDC) implantation must be timely and the procedure must be performed by an experienced operator with low catheter failure rates and complications. PDC can be implanted percutaneously or by open surgery (Table 1). The standard percutaneous placement includes the “trocar and cannula” method and the Seldinger technique, with variations like fluoroscopy-assisted or peritoneoscopy-assisted placement. Open surgical approach includes minilaparotomy and laparoscopic placement. Table 1: Comparison of different methods of peritoneal dialysis catheter implantation. In many centers, PDC is implanted by surgeons, either by minilaparotomy or laparoscopic approach. However, referral to surgeons usually causes delay in initiating PD therapy, for both the waiting time to see a surgeon and the time required to arrange the operation afterwards. The date of implantation is often not under the control of nephrologists and this may make timely implantation of a PDC an impossible dream. Some patients may be forced to remain on hemodialysis with a central venous catheter, which is associated with an accelerated decrease in residual renal function and high rates of bacteremia and mortality. Survival data

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