Clinical outcomes of physician placed tenckhoff catheters: a review of 134 consecutive catheters over 2 years

Abstract

Introduction: Tenckhoff catheter (TC) is essential for chronic peritoneal dialysis. Insertion of the TC was performed by dedicated physicians in our centre in most of the patients. Most of the TC insertion was performed by the modified pre-peritoneal approach with Seldinger technique. We examined the clinical outcomes in the present study. Method: We retrospectively reviewed 138 consecutive TC insertions among 134 patients (mean age 47.9, 47% diabetics and 47% male) from 1998 to 1999 with follow-up till 30th June, 2002 (mean follow-up 35 months). One hundred and twenty TC insertions were performed by the modified pre-peritoneal approach with Seldinger technique. Clinical outcomes of early and late catheter related complications and catheter and patient survival were examined. Results: We failed to insert 5 TCs with 4 of them due to suspected omental rapping and the last case had the procedure abandoned due to significant intra-abdominal bleeding. Two TC insertions were complicated by internal bleeding requiring emergency laporatomy (ovarian vein or inferior epigastric artery laceration.) Four cases (3%) were complicated by leakage within 17 days after TC insertion and were managed conservatively. Eight catheters (6%) were complicated by malposition with 1 catheter requiring surgical intervention for reposition. Thirty-three (25%) catheters were lost (55% due to infective complication, 9% mechanical complication of malposition or poor outflow, 6% due to hernia repair of the TC site or TC erosion to skin, 3% due to peritoneal failure, 3% due to switch to Haemodialysis, 21% due to transplantation). Catheter loss in less than 1 month occurred in 5 cases (4%). Three of them were due to mechanical complication, 1 due to transplantation & 1 had recurrent fungal peritonitis. Pre-CAPD training peritonitis & ESI rates were 5% and 25% respectively. These early complications were associated with no catheter loss. Sixtyseven (50.4%) catheters were complicated by peritonitis and 98 (74%) catheters were complicated by exit site infection (ESI). The peritonitis & ESI rates were 22.6 & 13.1 patient-months/episode respectively. The first & second year catheter survival rates were 81% & 61% respectively and 91% & 80% respectively if death censored. The first & second year patient survival rates were 90% & 87% respectively (tables 1 and 2). Conclusion: Physician placement of Tenckhoff catheter was associated with low operative risks and low long term infective & mechanical complications.