Modification of the peritoneoscopic technique of peritoneal dialysis catheter insertion

Experience of an interventional nephrology program

Arif Asif, Jan Tawakol, Tasnim Khan, Cristovao F. Vieira, Patricia M Byers, Florin Gadalean, Rene Hogan, Donna Merrill, David Roth

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Bowel perforation is a well-recognized complication of peritoneal dialysis catheter insertion and is associated with increased morbidity and cost of medical care. In this article we describe our 2-year experience (August 2001-October 2003) with a modified peritoneoscopic technique of peritoneal dialysis catheter insertion to minimize the incidence of bowel perforation. Seventy patients underwent 82 consecutive peritoneal dialysis catheter insertions using the innovative technique. The modified technique is very similar to the traditional peritoneoscopic procedure except for the following differences. To gain access to the peritoneal cavity, a Veress insufflation needle (Ethicon Endo-Surgery Inc., Cincinnati, OH) is utilized instead of the trocar. In contrast to the sharp tip of the trocar, the Veress needle has a blunt, self-retracting end. In addition, the Veress needle is only 14 gauge as opposed to the 2.2 mm diameter of the trocar. Upon introduction of the Veress needle into the abdominal cavity, two "pops" are discerned similar to the trocar. After introduction, 400-500 cc of air are infused and the needle is removed. The infusion of air creates a space between the peritoneal surface of the anterior abdominal wall and the bowel loops. At this point, the cannula with trocar is inserted into the space created. The rest of the steps of the procedure are the same as the traditional peritoneoscopic technique. Utilizing the innovative technique, all 82 catheter insertions were performed successfully without a single bowel perforation. No other complications except for catheter migration (n = 2) were noted. The extra cost of the needle ($35) should be viewed in the context of the costs associated with management of a bowel perforation. Large-scale studies are needed to confirm the superiority of this innovative technique over the traditional peritoneoscopic insertion found in our case series. In the interim, however, the increased morbidity and cost associated with bowel perforation calls for logical measures to be taken to avoid this dreaded complication.

Original languageEnglish
Pages (from-to)171-173
Number of pages3
JournalSeminars in Dialysis
Volume17
Issue number2
DOIs
StatePublished - Mar 1 2004

Fingerprint

Nephrology
Peritoneal Dialysis
Needles
Surgical Instruments
Catheters
Costs and Cost Analysis
Air
Morbidity
Insufflation
Abdominal Cavity
Peritoneal Cavity
Abdominal Wall
Health Care Costs
Incidence

ASJC Scopus subject areas

  • Nephrology

Cite this

Modification of the peritoneoscopic technique of peritoneal dialysis catheter insertion : Experience of an interventional nephrology program. / Asif, Arif; Tawakol, Jan; Khan, Tasnim; Vieira, Cristovao F.; Byers, Patricia M; Gadalean, Florin; Hogan, Rene; Merrill, Donna; Roth, David.

In: Seminars in Dialysis, Vol. 17, No. 2, 01.03.2004, p. 171-173.

Research output: Contribution to journalArticle

Asif, Arif ; Tawakol, Jan ; Khan, Tasnim ; Vieira, Cristovao F. ; Byers, Patricia M ; Gadalean, Florin ; Hogan, Rene ; Merrill, Donna ; Roth, David. / Modification of the peritoneoscopic technique of peritoneal dialysis catheter insertion : Experience of an interventional nephrology program. In: Seminars in Dialysis. 2004 ; Vol. 17, No. 2. pp. 171-173.
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