SP757PERITONEOSCOPIC PERITONEAL DIALYSIS CATHETER INSERTION AS A MEDICAL DAYCASE PROCEDURE: PATIENT SATISFACTION AND PATIENT REPORTED OUTCOME MEASURES

Abstract

Introduction and Aims: A nephrologist-led peritoneoscopic peritoneal dialysis catheter (PDC) insertion service has been established on our unit since 2007. PDC are inserted under sedation as a daycase procedure. Since commencement of the service 359 PDC have been inserted. There have been no instances of bowel perforation, primary PDC failure rates are <10%, rates of peri-PDC leaks and exit site infections are <5%. In this study we randomly surveyed 44 patients who underwent daycase PDC insertion over a 24 month period to review tolerability, acceptability and patient reported outcome scores. Methods: Patients were approached by the hospital daycase staff and 44 patients were randomly surveyed prior to discharge following PDC insertion. The survey was anonymous and explored the patient experience, peri-procedural pain and nausea, the effectiveness of pre-and post procedure information and whether the whole process was tolerable, acceptable and aligned with their expectations. Patients were also asked whether based on their experience they would recommend the procedure to a friend or whether they themselves would have the procedure in the same way again, or whether they would prefer to have a general anaesthetic if they required another PDC tube in the future. Results: 91% of patients were satisfied with the pre-procedural information they had received and felt it prepared them well for what to expect. Similarly 91% of patients felt they had received enough information after the procedure to know what to expect on discharge. 98% of patients said they would recommend having the procedure in the same way to a friend, with 82% of patients saying they would elect to have the procedure in the same way should they need a further tube in the future. 34% of patients experienced pain during the procedure, with amean pain score of 2.1 (range 0-10), suggesting only mild pain. 73% of patients experienced pain after the procedure, with a mean pain score 3.4 (range 0-10) and 54% of patients required extra analgesia post procedure to ease their pain. Only 1 patient experienced post-procedure nausea and this was only mild. Individual additional problems immediately after PDC insertion included feelings of "trapped wind", feeling faint, difficulty passing urine and general weakness. 91% of patients reported being "happy" or "very happy" with the experience overall, with only 1 patient reporting feeling "unhappy". Conclusions: Peritoneoscopic daycase PDC insertion is well tolerated by patients. This technique avoids the risks associated with general anaesthesia and reduces overnight admissions. Complication rates from nephrologist-led PDC insertion are low, with comparable success rates in terms of PDC function when compared to surgical PDC insertion.We recommend that nephrologist-led PDC insertion should be considered where available for all patients requiring PDC insertion in the first instance, unless there are surgical or medical factors that require general anaesthetic and insertion in theatre.