SP523BEDSIDE PERCUTANEOUS TENCKHOFF PERITONEAL DIALYSIS CATHETER PLACEMENT BY NEPHROLOGISTS: A SINGLE CENTRE EXPERIENCE

Abstract

Introduction and Aims: Peritoneal dialysis (PD) is one of the modes of renal replacement therapy being utilized for the management of end‐stage renal failure. Percutaneous technique for the insertion of PD catheter bedside can be a cost effective method for the catheter placement. The aim of this study was to evaluate the outcome and complications of PD in patients following bedside percutaneous Tenckhoff catheter placement during the period between January 2012 and December 2014. Methods: All patients with End Stage Renal Disease (ESRD) presenting to the hospital between January 2012 to December 2014, were given the option for CAPD. The patients who consented were taken up for bedside percutaneous Tenckhoff catheter placement under i.v. sedation and local anesthesia, using midline incision. The patients were followed up upto two years. Results: There were 52 patients included in the study, of whom 20 (38.4%) were females. The mean age was 50.7 years (Range 7‐65 years). Diabetes was the leading cause of end stage renal disease (ESRD), seen in 18 (34.1%) patients. All patients were on continuous ambulatory peritoneal dialysis (CAPD). The mean duration on PD of the study patients was 12.4 months. Pericatheter leak was observed one week following insertion in one patient (1.9%), while 2 (3.8%) patients had bleeding from the catheter following insertion, which resolved spontaneously. Of the 52 patients, two patients (14.2%) had catheter tip malposition but were functioning well; 1 (1.9%) patient had catheter block due to blood clots, which was relieved following streptokinase injection. 3 patients (5.7%) had Ultrafiltraion failure. 5 patients (9.6%) required catheter removal and switch to Hemodialysis (HD), of which 3 (5.7%) were due to ultrafiltration failure, 1 (1.9%) due to fungal peritonitis, and 1 (1.9%) due to worsening of renal failure with sepsis. 1 (1.9%) patient had expired during the course of the study due to septicemia and worsening renal failure, requiring switch over to HD. Of the 52 patients, 1 (1.9%) patient had HIV, in whom the catheter was removed after 4 months due to fungal peritonitis. 1 (1.9%) patient had Chronic Hepatitis C, in whom CAPD was performed for 10 months, following which he was switched over to HD due to ultrafiltration failure. At the end of 3 years, 47 patients are continuing on PD. The peritonitis rate was one episode per 21.6 patient‐months or 0.60 episodes per patient per year. The leading causative agent for peritonitis was Staphylococcus (32%). Exit‐site infection (ESI) rate was one episode per 58.9 patient‐months. The most common infective organism for ESI was Staphylococcus epidermidis (58.8%). There was no incidence of culture negative peritonitis. No patients had bowel perforation or significant hemorrhage. Conclusions: In our study, it was observed that there were no major complications following percutaneous catheter placement in the immediate post‐insertion period or long term during the 3 year follow up. The complication rates with the bedside percutaneous technique were comparable to the general complication rates observed with the surgical placement or placement in the operating room, and there was no increase in the rate of infection. The study shows that bedside percutaneous catheter placement is a feasible and cost effective alternative compared to placement in operating room or surgical placement, especially in the developing countries.