Evaluation of Medical Insertion of Peritoneal Dialysis Catheters

Background and Aims: Percutaneous insertion of peritoneal dialysis catheters (PDC) by nephrologists is gradually gaining favour due to its convenience for patients and financial benefits. This study was carried out to determine the outcomes of this procedure and to compare it with catheters inserted by surgeons during the same period.

Methods: A retrospective review of PDC insertion by percutaneous (medical) and open (surgical) techniques was carried out in a Renal Unit at a University Teaching Hospital serving a population of 450,000. All patients going onto peritoneal dialysis were considered for medical insertion of PDC, except for those with previous PDC insertions, abdominal operations or obesity. All patients who had PDC insertions for peritoneal dialysis between January 2005 and September 2008 were included and followed up to the completion of the study. The main outcome measures were technique success, primary failure (failure within the first month) and complications beyond the first month.

Results: One hundred and twenty PDCs were inserted (69 medical, 51 surgical) in 97 patients. The primary failure rate for first insertions was 16.7% for medical and 10.5% for surgical insertions, but the difference was not significant (P = 0.72). Peritonitis, the most common complication, was treated successfully in 25 of 30 patients. Secondary blockage was similar for medical (13%) and surgical insertions (12%). Exit site infections were significantly higher in the surgical group (P = 0.04), while PD peritonitis was more common with medical group (P = 0.47). The number of PDC removed due to complications was higher in the medical (23%) than the surgical group (16%), but not significantly (P = 0.38). Median survival of PDC was similar in both groups.

Conclusions: Percutaneous insertion of a PDC by a motivated and suitably experienced nephrologist offers significant advantages provided careful patient selection is applied. Medical insertion of PDC is safe and reduces pressure on precious operating theatre time.