Peritoneal Dialysis International, Vol. 30, pp. 524-527 doi:10.3747/pdi.2009.00145 0896-8608/08 $3.00 + .00 Copyright © 2010 International Society for Peritoneal Dialysis 524 TENCKHOFF CATHETER INSERTION BY NEPHROLOGISTS: OPEN DISSECTION TECHNIQUE Kai Ming Chow, Cheuk Chun Szeto, Chi Bon Leung, Bonnie Ching Ha Kwan, Wing Fai Pang, and Philip Kam-tao Li Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, PR China ♦ Background: The practice of Tenckhoff catheter insertion by nephrologists remains uncommon in most countries. ♦ Methods: We report our single-center experience of Tenckhoff catheter insertion by nephrologists using the open dissection surgical technique in a dedicated ward- based procedure room. ♦ Results: Between November 2005 and September 2008, 250 peritoneal catheters were inserted by 6 nephrologists with varying levels of experience. Surgical dissection fol- lowed by exposure of the peritoneum under direct vision was performed under local anesthesia. Primary catheter failure, as defined by catheters that failed to function within 1 month after insertion, occurred in 2.8% of cases. Within 1 month of catheter insertion, 20 patients developed infec- tious complications: 9 (3.6%) peritonitis, and 11 (4.4%) exit-site infections; none of these complications led to catheter removal. Mean technique survival for the catheters was 41.2 months (95% confidence interval: 39.5 months to 42.9 months). Catheter survival rates at 1 and 2 years were 92.7% and 87.2% respectively. ♦ Conclusions: We reported an encouraging outcome for Tenckhoff catheters inserted by nephrologists in an open surgical manner, with a 2-year catheter survival of 87.2% and a good safety profile. Perit Dial Int 2010; 30:524-527 www.PDIConnect.com epub ahead of print: 08 Apr 2010 doi:10.3747/pdi.2009.00145 KEY WORDS: Tenckhoff catheter; nephrologists; tech- nique survival. I n recent years, the practice of peritoneal dialysis (PD) catheter insertion by nephrologists has been advo- cated to enhance PD penetration (1,2); an increase in center size, in turn, has been associated with salutary effect on technique success rates and PD patient survival (3–6). Nevertheless, the practice of catheter insertion by nephrologists is by and large an exception rather than the rule in most countries. According to a recently published survey about PD access practices involving 43 renal units in the United Kingdom (7), consultant sur- geons placed 71.7% of peritoneal catheters (as compared with 19.3% of placements by consultant nephrologists). Furthermore, nephrologists more often practice blind percutaneous insertion of the catheter, rather than open surgical insertion. Here, we report the safety and efficacy of Tenckhoff catheter insertion by nephrologists using the open surgical technique with the patient under local anesthesia. PATIENTS AND METHODS In this study, we report outcomes for 250 consecutive Tenckhoff catheter insertions by nephrologists between November 2005 and September 2008 in a single dialysis unit. All Tenckhoff catheters were inserted by neph- rologists in our unit using the open dissection surgical technique, after informed consent. Six nephrologists were responsible for the insertion procedure: 2 had nephrology practice experience of more than 10 years; another 2, experience of between 5 and 10 years; and the remaining 2, experience of less than 5 years. Patients with previous uncomplicated abdominal operations— such as cholecystectomy, hysterectomy, caesarean section, previous Tenckhoff catheter removal—were not excluded. The procedure was carried out in a dedicated ward-based procedure room. Intravenous cefazolin was routinely used as prophy- lactic antibiotic, except in patients with a penicillin or cephalosporin allergy. Nasal swabs were not routinely requested to identify nasal carriage of Staphylococcus aureus. All catheter insertions were preceded by emptying Correspondence to: K.M. Chow, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, PR China. Chow_Kai_Ming@alumni.cuhk.net Received 20 July 2009; accepted 26 November 2009. This single copy is for your personal, non-commercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact Multimed Inc. at marketing@multi-med.com by guest on June 19, 2020 http://www.pdiconnect.com/ Downloaded from