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Introduction: Ultrasound has been found to facilitate early identification of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods: A retrospective analysis was carried out to evaluate the effectiveness of ultrasonography‐guided removal of the Tenckhoff catheter in reducing complications like a shift to hemodialysis or death in CAPD patients. Results: The "peritonitis rescue plan" supported timely decision‐making for the removal of the infected catheter and resulted in a lower peritonitis episode per patient per month ratio (from 1:36 to 1:122) in 2021, a lower death rate (from 19% to 6.6%) and lower incidences of shifts to hemodialysis (from 2%–9% to 0%) as compared to that before the implementation of the plan in 2019. Conclusion: The implementation of the "peritonitis rescue plan" and the removal of the infected catheter within 3 days of peritonitis being detected was successful in improving the standard of care for patients undergoing CAPD. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the impact of peritoneal dialysis catheter (PDC) tail‐end design variations on PDC‐related complications. Method: Effective data were extracted from databases. The literature was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions, and a meta‐analysis was conducted. Results: Analysis revealed that the straight‐tailed catheter was superior to the curled‐tailed catheter in minimizing catheter displacement and complication‐induced catheter removal (RR = 1.73, 95%CI:1.18–2.53, p = 0.005). In terms of complication‐induced PDC removal, the straight‐tailed catheter was superior to the curled‐tailed catheter (RR = 1.55, 95%CI: 1.15–2.08, p = 0.004). Conclusion: Curled‐tail design of the catheter increased the risk of catheter displacement and complication‐induced catheter removal, whereas the straight‐tailed catheter was superior to the curled‐tailed catheter in terms of reducing catheter displacement and complication‐induced catheter removal. However, the analysis and comparison of factors such as leakage, peritonitis, exit‐site infection, and tunnel infection did not reveal a statistically significant difference between the two designs. [ABSTRACT FROM AUTHOR]

Aim: To study benefits and complications of continuous ambulatory peritoneal dialysis (CAPD) catheter placement laparoscopically with suture fixation technique. Patients and methods: A total of 41 cases of end-stage renal disease [chronic kidney disease (CKD) - Stage V] were admitted in Jehangir Hospital, Pune. Patients were evaluated, after explaining the procedure, the risks and benefits they were prepared for the procedure. Patients were assessed for complications and mortality as well as the reason for discontinuation of CAPD. Results: Of 41 cases studied, 39 (95.2%) had CAPD started, in 1 (2.4%) CAPD was not started and 1 (2.4%) did not have CAPD inserted. Of 41 cases studied, 28 (68.3%) had CAPD continued successfully for 2 years. Of 41 cases studied, 4 (9.8%) had catheter outflow block, 4 (9.8%) had peritonitis, 6 (14.6%) had ultrafiltration failure, 3 (7.3%) had exit site leak, 1 (2.4%) had catheter malposition/kinking, none had incisional hernia, 2 (4.9%) had hemoperitoneum. A total of 10 patients (24.4%) had catheter removed at the end of the study. Conclusion: Approximately, 68% of patients, that is 28 patients out of 41 continued CAPD for 2 years after the catheter was inserted laparoscopically. Out of the 41 patients, 20 patients developed minor complications. Out of the 20 patients, 10 patients developed major complications and needed the catheter to be removed. Mortality was 9.8%, out of which two patients died of sepsis and 2 died of comorbidity-related complications. Clinical significance: Laparoscopic CAPD catheter placement is an effective method and has good success rate with less complications and better patient tolerability. [ABSTRACT FROM AUTHOR]

Background: Dialysate leakage, a major complication in peritoneal dialysis (PD), causes difficulty in continuing PD. However, literature evaluating risk factors for leakage in detail and the appropriate break-in period to avoid leakage in pediatric patients is scarce. Methods: We conducted a retrospective study on children aged < 20 years who underwent Tenckhoff catheter placement between April 1, 2002, and December 31, 2021, at our institution. We compared clinical factors between patients with and without leakage within 30 days of catheter insertion. Results: Dialysate leakage occurred in 8 of 102 (7.8%) PD catheters placed in 78 patients. All leaks occurred in children with a break-in period of < 14 days. Leaks were significantly more frequent in patients with low body weight at the catheter insertion, single-cuffed catheter insertion, a break-in period ≤ 7 days, and a long PD treatment time per day. Only one patient who had leakage with a break-in period > 7 days was neonate. PD was suspended in four of the eight patients with leakage and continued in the others. Two of the latter had secondary peritonitis, one of whom required catheter removal, and leakage improved in the remaining patients. Three infants had serious complications from bridge hemodialysis. Conclusions: A break-in period of > 7 days and if possible 14 days is recommended to avoid leakage in pediatric patients. Whereas infants with low body weight are at high risk of leakage, their difficulty in inserting double-cuffed catheter, hemodialysis complications, and possible leakage even under long break-in period make prevention of leakage challenging. [ABSTRACT FROM AUTHOR]

Peritoneal dialysis is a renal replacement therapy modality used in patients with end-stage chronic kidney disease. Peritoneal dialysis catheters can present complications such as infections, leaks, catheter kinking, and mechanical obstruction. The obstruction can be caused by fibrin, adhesions, or entrapment of intraperitoneal organs; among them, the most frequent is the omentum. Entrapment of the fallopian tube fimbriae is an extremely rare complication, requiring early surgical attention. We present the case of a 65-year-old woman with chronic kidney disease on home peritoneal dialysis, who had a Tenckhoff catheter placed three months earlier. She presented to the Emergency Department with abdominal pain and decreased outflow from her catheter. An abdominal CT scan showed a catheter located in the right iliac fossa, mechanical obstruction was suspected, and open abdominal surgery was performed. During the surgery, the fimbriae of the right fallopian tube were found to be trapped in the Tenckhoff catheter. The fallopian tube was freed, and the catheter was adequately repositioned. The patient evolved satisfactorily; peritoneal dialysis was reestablished after two weeks, with no recurrence of long-term entrapment., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gómez-Arciniega et al.)

Background: Minimally invasive insertion of catheters for peritoneal dialysis can be performed laparoscopically or percutaneously under image guidance. In Geelong (Victoria, Australia) both methods are used. Our aim was to analyse the outcomes of all catheters inserted by both laparoscopic and percutaneous techniques and compare them against published studies from tertiary referral centres. Methods: Data were collected retrospectively on all patients who had their catheter inserted (since 2006) within the Geelong regional service. We compared the outcomes of percutaneous catheter insertion under image guidance (percutaneous group, n = 29) with the laparoscopic catheter placement technique (laparoscopic group, n = 61). Perioperative, follow‐up and catheter outcome data were collected. There were no exclusion criteria. Analysis was performed using the unpaired student t‐test and chi‐squared test. Results: Ninety catheters were inserted between 2006 and 2017 in mostly male patients (63%) with a mean age of 60 ± 0.4 years. The most common aetiology of chronic kidney disease was diabetic nephropathy (34%). Percutaneous insertion required less operative time, shorter hospital stay and earlier initiation of peritoneal dialysis. In the longer term, percutaneous catheters were more likely to migrate and laparoscopic catheters were more durable but more often associated with peritonitis. Thirty‐day complication rates did not differ between both groups. No Clavien‐Dindo grade 3 or 4 complication was reported. Conclusions: Laparoscopic insertion of peritoneal dialysis catheters at our centre is performed safely and with patient outcomes comparable to published literature. Percutaneous insertion represents a safe and effective alternative based on the study findings. [ABSTRACT FROM AUTHOR]

Correct implantation of a peritoneal dialysis (PD) catheter, among many factors, is the main aspect of the success of this method of renal replacement therapy and the avoidance of complications associated with dialysis access and its mechanical function. There are many types of peritoneal catheters: a simple Tenckhoff catheter, a catheter with a coiled spiral-shaped intraperitoneal part of the coli type, a catheter with a curved extraperitoneal part of the swan-neck type, a self-positioning catheter, a pre-bridge catheter. The article describes implantation techniques for peritoneal dialysis (PD) catheters in renal replacement therapy. Complications associated with Tenckoff's catheter still cause significant morbidity and mortality, necessitating the transition to hemodialysis (HD) treatment.

Bullous pemphigoid (BP), a chronic autoimmune subepidermal blistering skin disease, has been described in end-stage renal disease patients requiring dialysis after the placement of an artero-venous fistula. We report a case of a novel onset of BP following a peritoneal dialysis abdominal Tenckhoff catheter placement. The 3-month treatment with systemic doxycycline and topical clobetasol propionate allowed a rapid disappearing of the blisters and left the patient free of symptoms in the follow-up. To our knowledge, this is the first case describing a new BP onset after a peritoneal dialysis catheter placement.

Omental bleeding may occur due to the rupture of an omental blood vessel. Some case associated with trauma, neoplasms, omental torsion, varicose veins, aneurysms, and vasculitis. A case of 27 years old female with nephritis lupus, hypertension, and end-stage kidney disease on routine hemodialysis who came up to Tenckhoff Catheter placement for continuous ambulatory peritoneal dialysis with Bandung technique. She was diagnosed with lupus for 11 years. She got omental bleeding after Tenckhoff catheter placement. This patient had no signs of trauma, vascular injury, or hematoma after an exploratory laparotomy to find the cause and source of bleeding. [ABSTRACT FROM AUTHOR]

Percutaneous insertion of a peritoneal dialysis (PD) catheter has inherent risks of complications, more so if done “blind” (without fluoroscopy and ultrasound guidance). Despite the perceived disadvantages, there are very few reported cases of mechanical complications after PD catheter insertion. We present an 81-year-old man who underwent percutaneous insertion of dual-cuffed coiled Tenckhoff PD catheter under local anesthesia by a trained nephrologist. The procedure was uneventful, and the patient was discharged 45 min later in a stable state. A day later, he noticed a decline in the urine output. A week later at a scheduled clinic visit, upon unclamping the PD catheter, there was a sudden gush of amber colored fluid. A diagnostic CT scan confirmed the presence of PD catheter entering the abdominal cavity inferior to the umbilicus and the distal end coiled in the urinary bladder. This case illustrates the need for prophylactic Foley catheterization in individuals at high risk for a distended bladder either as a consequence of a mechanical obstruction from an enlarged prostate or due to a neurogenic bladder while undergoing “blind” percutaneous placement.

The practice of irrigating - or flushing - Tenckhoff catheters following insertion varies greatly both within Australia and internationally. The variations in practices range from no routine flushing, to various weekly, fortnightly and monthly regimes. However, there appear to be no specific studies that provide outcome measures to support the practice. Tenckhoff catheter insertion at our unit commenced approximately 10 years ago and over 100 catheters have been inserted to date. None of the catheters have been routinely flushed during the postoperative period prior to use for peritoneal dialysis (PD) therapy. Routine auditing of all catheters inserted has been undertaken, including patency at the time of first use and the monitoring of post-insertion complications. The purpose of this paper is to provide a review of the literature regarding postoperative flushing of Tenckhoff catheters and to provide an analysis of one unit's data where the practice is not routinely undertaken. Data from our unit shows that 98% of catheters functioned appropriately at the time of first use, without any routine flushing. Whilst this would appear to indicate that the practice is unwarranted, there is a need for greater investigation, with stronger study designs to better inform PD practices globally. [ABSTRACT FROM AUTHOR]

Background: With the introduction of laparoscopic Tenckhoff catheter insertion in the early 1990s, catheter malposition resulting in malfunction remains a frequent complication, often requiring surgical or radiological intervention. In this pioneer study, we describe the technique of suturing the Tenckhoff catheter using an EndoClose (Medtronic, Macquarie Park, NSW, Australia) device to the anterior abdominal wall during laparoscopic insertion and compare its outcomes with those not sutured. Methods: This is a retrospective study of all patients who underwent laparoscopic Tenckhoff catheter insertion at Western Health from January 2013 to June 2018. All procedures were undertaken or supervised by one surgeon. The primary outcome was catheter malposition requiring surgical revision. Secondary outcomes were time to malposition and complications. Peri‐ and post‐operative factors were analysed to adjust for confounders using the Cochran–Mantel–Haenszel test. Results: There were 82 patients in the sutured group and 63 patients in the non‐sutured group. Catheter malposition occurred in 7.32% in the sutured group and 19.05% in the non‐sutured group (P = 0.034; 95% confidence interval for the difference 0.007–0.237). There was an overall reduction in the odds of catheter malposition of 63% in favour of the sutured group. The median time‐to‐malposition was 128 and 182 days for the non‐sutured and sutured group, respectively, but not statistically different. No differences were found for the number of post‐operative complications. Conclusion: Suturing of Tenckhoff catheter with an EndoClose device to the anterior abdominal wall during laparoscopic insertion is a simple, safe and useful method of reducing catheter malposition. [ABSTRACT FROM AUTHOR]

Bullous pemphigoid (BP), a chronic autoimmune subepidermal blistering skin disease, has been described in end-stage renal disease patients requiring dialysis after the placement of an artero-venous fistula. We report a case of a novel onset of BP following a peritoneal dialysis abdominal Tenckhoff catheter placement. The 3-month treatment with systemic doxycycline and topical clobetasol propionate allowed a rapid disappearing of the blisters and left the patient free of symptoms in the follow-up. To our knowledge, this is the first case describing a new BP onset after a peritoneal dialysis catheter placement. [ABSTRACT FROM AUTHOR]

Introduction: End-stage renal disease has high prevalence in Taiwan, and peritoneal dialysis (PD) is one of the effective treatments. Although the open catheter placement method is more popular, the laparoscopic method is proven to be superior. We present our initial experience with laparoscopic PD catheter insertion. Materials and Methods: We set one 5-mm trocar over the periumbilicus with another assisting 5-mm trocar in a region about 3 cm lateral to the umbilicus. Abdominal exploration using laparoscopy is performed, and enterolysis is also performed if needed. The PD catheter is inserted through the assisted trocar deep into the Douglas pouch under vision. Finally, we check the final condition under laparoscopy and close the wound. Results: A total of thirty patients (median age 56.5 years old, 15 women) underwent this procedure. No intraoperative complications were noted, and the mean operation time was 32 min. Two postoperative complications were found (2/30, 6.7%). Delayed bleeding was noted due to abdominal wall vessel injury while setting the trocar. The vessel was sutured under laparoscopy, which stopped the bleeding. The other complication was tube dysfunction due to omentum wrapping. Laparoscopic revision of the tube was performed. All the complications could be resolved, and the PD was continued. The mid-term tube function at follow-up (at least 16 months) was acceptable in all cases. Conclusions: Laparoscopic-assisted PD catheter insertion is a feasible procedure that can reduce wound pain with acceptable PD function.

A few reports have described cutaneous allergic reactions to peritoneal dialysis catheters during continuous ambulatory peritoneal dialysis (CAPD).[[1]] Here, we report a rare case of subcutaneous granulomatous reaction with eosinophil infiltration caused by a peritoneal dialysis catheter, and confirmed by skin tests. To the best of our knowledge, no similar case of subcutaneous granulomatous reaction with eosinophil infiltration caused by a peritoneal dialysis catheter has been reported, which was histologically confirmed by eosinophilic infiltration in skin tests. Because a catheter infection clinically resembles a subcutaneous allergic reaction, it is important to suspect CAPD catheter-related reactions if patients do not respond to antibiotics. [Extracted from the article]

Peritoneal dialysis (PD) is an effective renal replacement therapy for the treatment of end-stage renal disease. Patients on PD undergoing abdominal open surgery often fail to resume PD. Laparoscopic surgery has recently become a serious alternative to open surgery in patients on PD to treat different abdominal pathologies. However, only a few studies have reported successful procedures without Tenckhoff catheter removal. The aim of this review is to describe how a laparoscopic technique can allow PD patients to deal with abdominal surgery without shifting to hemodialysis. Only 50 cases of laparoscopic surgical intervention in PD patients have been published to our knowledge. These case series largely concern laparoscopic cholecystectomies, appendectomies, nephrectomies, colectomies, and bariatric procedures. The reported cases show how laparoscopic surgery can be accepted as a valid option for several abdominal surgical procedures in patients on PD with good outcomes and early resumption of PD. [ABSTRACT FROM AUTHOR]

Purpose Malignant peritoneal mesothelioma (MPM) is a rare disease with about 300 new cases per year in the USA. Its natural history is described as local progression within the peritoneal space in the absence of liver metastases or systemic disease. Methods Cytoreductive surgery (CRS) is a series of peritonectomy procedures and visceral resections with a goal of complete removal of all visible disease from the abdomen and pelvis. Over 20 years, three protocols investigating increasing efficacy of additional chemotherapy treatments added to CRS have been initiated. Initially, hyperthermic perioperative chemotherapy (HIPEC) with doxorubicin and cisplatin was used in the operating room. Then, early postoperative intraperitoneal chemotherapy (EPIC) with paclitaxel was added for the first 5 days after CRS. The third protocol employed HIPEC, then EPIC, and then long-term intraperitoneal (IP) paclitaxel or IP pemetrexed plus intravenous (IV) cisplatin as a adjuvant normothermic intraperitoneal chemotherapy (NIPEC). Result The 5-year survival of 42 patients treated with CRS and HIPEC was 44%, for 58 patients treated with EPIC and HIPEC was 52% and 29 patients who received HIPEC, EPIC, and NIPEC was 75% (p = 0.0374). Prognostic variables of age, gender, treatment administered, peritoneal cancer index (PCI) and completeness of cytoreduction were significant by univariate analysis and treatments administered and completeness of cytoreduction significant by multivariate analysis. Conclusions Long-term regional chemotherapy was associated with improved survival in patients with MPM. In this rare disease, additional phase 2 investigations are suggested. [ABSTRACT FROM AUTHOR]

The success of peritoneal dialysis as renal-replacement therapy depends on a well-functioning peritoneal catheter. Knowledge of best practices in catheter insertion can minimize the risk of catheter complications that lead to peritoneal dialysis failure. The catheter placement procedure begins with preoperative assessment of the patient to determine the most appropriate catheter type, insertion site, and exit site location. Preoperative preparation of the patient is an instrumental step in facilitating the performance of the procedure, avoiding untoward events, and promoting the desired outcome. Catheter insertion methods include percutaneous needle-guidewire with or without image guidance, open surgical dissection, peritoneoscopic procedure, and surgical laparoscopy. The insertion technique used often depends on the geographic availability of material resources and local provider expertise in placing catheters. Independent of the catheter implantation approach, adherence to a number of universal details is required to ensure the best opportunity for creating a successful long-term peritoneal access. Finally, appropriate postoperative care and catheter break-in enables a smooth transition to dialysis therapy. [ABSTRACT FROM AUTHOR]

Richter's hernia is a rare type of hernia that occurs when the antimesenteric intestinal wall protrudes through a defect in the abdominal fascia leading to ischaemia, gangrene, bowel perforation and enterocutaneous fistulae. In this article, we describe a rare case of enterocutaneous fistula due to a Richter's hernia after a Tenckhoff catheter removal. This type of complication has not been previously reported in the literature. An 82-year-old man presented with a 1-day history of enteric content at the Tenckhoff catheter insertion site. Seven weeks earlier, the catheter was removed due to peritonitis. Removal was performed using open technique, and the fascia was not closed. Computed tomography revealed a small incarcerated hernia and subcutaneous fluid collection at the previous catheter insertion site. He underwent laparoscopy, which showed a Richter's hernia with perforation of the ileum causing an enterocutaneous fistula. A laparoscopic enterectomy was performed using a primary mechanical anastomosis. The hernia was repaired by primary suture without a mesh because of wound enteral contamination and the small size of the hernia. Richter's hernia has a misleading clinical presentation and contributes to high rates of morbidity and mortality. A secure myofascial closure during catheter removal may reduce the chances of this complication.

Objective: To evaluate the dysfunction rate of Tenckhoff catheter insertion for end stage renal disease patients at Sardjito General Hospital Yogyakarta. Material & method: Data were collected from medical record retrospectively for all chronic kidney disease (CKD) patients underwent continuous ambulatory peritoneal dialysis (CAPD), by open surgery at Sardjito General Hospital Yogyakarta, from January 2010 until Desember 2013. The cause of CKD and dysfunction rate was studied. Data was analyzed using SPSS ver 18.0 (IBM corp, USA). Results: There were 43 CKD patients underwent Tenckhoff cateter placement using open surgery. Tenckhoff catheter dysfunction was found in 11.7% patients. Disfunction was caused by blockage of the catheter by omentum (6.9%) and catheter migration (4.8%). Peritonitis complication was found in 2.3% patients. The cause of CKD at Sardjito General Hospital Yogyakarta was diabetes mellitus (53.5%), hypertension (44.2%), and glomerulonefritis (2.3%). There were no correlation of dysfunction rate with gender and the cause of CKD. Conclusion: Tenckhoff catheter placement by open surgery at Sardjito General Hospital Yogyakarta have good outcome.

Background: Laparoscopic techniques for the placement of peritoneal dialysis catheters are becoming increasingly popular. Recently, with the improvements in laparoscopic surgery, various methods for the insertion of peritoneal dialysis catheters have been reported, indicating that the laparoscopic insertion is preferred over the open and percutaneous techniques. The aim of this study was to introduce and assess a simplified laparoscopic method for the insertion of peritoneal dialysis catheters in continuous ambulatory peritoneal dialysis (CAPD) patients.Methods: We enrolled 79 consecutive end-stage renal patients (46 men and 33 women) with a mean age of 50 years (range: 19-83 years) in this study. During the surgery, a 5-mm trocar was placed in the left upper quadrant for the optics and another 5-mm trocar was placed to the left of the umbilicus. Using the second trocar, a tunnel was formed 2 cm left of the umbilical plane for the insertion of a Tenckhoff catheter. Under direct vision, the catheter was advanced into the abdomen. The catheter was tested for patency. Catheters of all subjects were capped for two weeks before dialysis initiation.Results: The mean duration of the operation was 15 minutes. Ten patients died during the follow-up period, all due to other medical problems, and six patients underwent renal transplantation; however, no deaths or complications were observed during surgery. Early onset complications were seen in 12 patients (15.1%). The most frequent late-onset medical and mechanical complications were peritonitis (6.3%) and hernia (3.7%). During a follow-up period of four years, removal of the catheter was required in two patients as a result of peritonitis.Conclusion: We obtained a low complication rate and a high catheter survival rate with this laparoscopic insertion of the Tenckhoff catheter. We believe future experience will encourage the use of this safe, simple and quick procedure.

Background: The removal techniques for peritoneal dialysis (PD) catheters are open surgical dissection (OD) and the 'pull technique' (PT). The latter is limitedly used because of uncertainty about its feasibility and safety. This study aimed to compare the outcomes and complications between the two techniques., Methods: This retrospective study included patients who underwent PD catheter removal from January 2015 to January 2021 in four PD centres in China. The patients were grouped according to the different removal techniques and were followed up to observe the potential complications., Results: The demographic characteristics of patients in the PT ( n = 68) and OD ( n = 44) groups showed no significant difference. The indications for PD catheter removal were similar between the two groups, except for a higher frequency of peritonitis in the OD group ( p = 0.010). In the PT group, the main complications were broken catheter (7.4%), superficial cuff infection (4.8%) and subcutaneous bleeding (4.8%). In the OD group, the main complications were death (9.1%) and subcutaneous bleeding (4.6%)., Conclusion: PT might be a safe and reliable technique for PD catheter removal compared to OD. Considering its simple and non-invasive nature, PT should be recommended as the alternative to OD in suitable PD patients.

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Background: In a patient population with a limited life expectancy, malignant pleural effusion can significantly impact quality of life (QoL). Different treatment options are available, each with its own effect on QoL. T o date, satisfaction with treatment options has not been evaluated. Purpose: T o evaluate QoL and satisfaction with treatment using patient-reported outcomes for four different treatment strategies. Design: A prospective, cohort study that compared four treatment options: indwelling pleural catheter (IPC); video assisted thoracic surgery (VATS) and IPC; chest tube and talc slurry; and VATS talc poudrage. Setting: A total of 104 participants were treated across four acute care teaching hospitals in a large Canadian city. Measurements: Patient-reported outcomes were assessed using functional assessment of chronic illness therapy--palliative (FACIT--PAL), London Chest Activity of Daily Living scale and FACIT--treatment satisfaction questionnaires. Results: No significant difference was identified between the four treatments based on patient-reported outcomes. VATS talc poudrage provided the most durable improvement. At the 6-week post-treatment time point, the highest patient satisfaction was noted in patients who received VATS and talc pleurodesis, lowest satisfaction in patients with chest tube and talc pleurodesis; however, the differences were not statistically significant (p=0.20). VATS and talc pleurodesis had the highest scores at 6 weeks for recommendation of treatment to others; however, the comparison with other treatment groups was not statistically significant (p=0.22). For FACIT -PAL, total scores when analysed as one group, there was a statistically significant increasing trend (indicating improvement) (p<0.0001). Breathlessness, measured using the London Chest Activity of Daily Living scale, indicated a statistically decreasing trend, suggesting an improvement (p=0.0003). There was no statistically significant difference in trends over time between the four treatment groups. Conclusions: While all treatment options addressed the patients' symptoms and relieved dyspnoea, an IPC offered effective treatment with minimal discomfort and time in hospital yet still high satisfaction. [ABSTRACT FROM AUTHOR]

Various methods of peritoneal dialysis (PD) catheter insertion are available. The purpose of this study was to evaluate a percutaneous insertion technique using ultrasound (US) and fluoroscopy performed under conscious sedation and as day case procedure. Data of 87 percutaneous inserted dialysis catheters were prospectively collected, including patients' age, gender, body mass index, history of previous abdominal surgery and cause of end stage renal failure. Length of hospital stay, early complications and time to first use were also recorded. Institutional review board approval was obtained. A 100% technical success rate was observed. Early complications included bleeding (n = 3), catheter dysfunction (n = 6), exit site infection (n = 1) and exit site leakage (n = 1). All cases of catheter dysfunction and one case of bleeding required surgical revision. Median time of follow-up was 18 months (range 3-35), and median time from insertion to first use was days 14 (1-47). Of the 82 patients who started dialysis, 20 (23%) ceased PD at some stage during follow-up. Most frequently encountered reasons include deteriorating patient cognitive or functional status (n = 5), successful transplant kidney (n = 4) and pleuro-peritoneal fistula (n = 4). Sixty-two (71%) PD catheter insertions were performed as day case. The remaining insertions were performed on patients already admitted to the hospital. Percutaneous insertion of dialysis catheter using US and fluoroscopy is not only safe but can be performed as day case procedure in most patients, even with a medical history of abdominal surgery and/or obesity. [ABSTRACT FROM AUTHOR]

Tenckhoff catheter placement is a well established procedure to facilitate continuous ambulatory peritoneal dialysis (CAPD) in end-stage renal disease (ESRD) management. The removal and replacement of the catheter following complications adds morbidity in an already immunocompromised patient of ESRD. A salvage procedure with partial replacement was undertaken in four patients on CAPD. By catheter repositioning, the complications of catheter removal (like wound hematoma, abscess, need of break-in period hemodialysis) and of reinsertion (like leak, obstruction, migration, infection and failure) are avoided. It also reduced the economic burden of insertion in a new catheter.

Background: Benchmarking infection rates for peritoneal dialysis (PD) catheter-related infections is mandatory for good patient care. There is no current established benchmark for PD exit site infections (ESIs).The Royal Hobart Hospital (RHH) PD unit established our own benchmark at 1/25 patient-months and in 2009 the PD ESIs reached 1/21 patient-months, which prompted investigation into our current exit site (ES) care routine. Method: A quality improvement process was used to implement a more structured approach to the existing ES care plan. Particular changes included pre-Tenckhoff catheter insertion nasal swabs for the patient and primary carer, treatment for Staphylococcus aureus incidence using mupirocin, emphasis and education on hand hygiene, and a change to chlorhexidine body wash around the ES during showering, with medihoney applied around the ES, and regular review of our infection rates with the consultant infectious diseases and consultant nephrologist. Results: ESI rates improved from 1/20.8 patient-months to currently 1/203 patient-months in March 2014. Development of a protocol on care of the adult with a Tenckhoff catheter was the culmination of this quality improvement activity. Conclusion: A structured, quality improvement approach was beneficial to the success of this project. Continuous monitoring of outcomes to patient care against a benchmark is essential to any unit's quality improvement programme. [ABSTRACT FROM AUTHOR]

Background Peritoneal dialysis (PD) is an important home-based dialysis modality for patients with end-stage kidney disease (ESKD). The initiation of PD requires timely and skilled insertion of a Tenckhoff catheter (TC). At most centres, TCs are inserted laparoscopically by surgeons under general anaesthetic. This requires access to increasingly scarce surgical, anaesthetic and hospital inpatient resources. Radiological insertion of TCs performed as a day procedure under local anaesthetic allows for easier access to the TC insertion with reduced resource requirements. We report our 1-year experience following the introduction of this technique to our PD programme. Methods This is a retrospective review of the outcomes for all patients who had TCs inserted radiologically (percutaneously with the assistance of ultrasound and fluoroscopy) over the 12-month period from December 2011 to December 2012. Relevant patient demographics collected included age, gender, body mass index (BMI), previous abdominal surgery and cause of ESKD. Extended details of the insertion procedure were also obtained including length of stay, early complications and time to first use of the catheter for PD. Results Thirty Argyle™ Swan Neck TCs were inserted under radiological guidance during the study period. The mean age of patients was 56 (SD ± 14). The male-to-female ratio was 2:1. The mean BMI was 25.7 (SD ± 4.8). PD was the initial dialysis modality in 22 (73%) patients. Of the 30 patients, 14 (46.7%) had previously undergone extraperitoneal abdominal surgery. All catheters were inserted successfully as day cases except four patients (13.3%) who had catheters inserted during an inpatient hospital admission. Most catheters were not accessed for a minimum of 10 days to reduce the chance of exit site leakage, in two cases the catheters were used within 5 days without complication. There were no cases of peritonitis or exit site infection during the observation period. Catheter migration occurred in four patients (13.3%) but only one required surgical intervention. Minor pain issues were noted in six patients (20%) and bleeding around the exit site requiring suturing in two patients (6.7%). The introduction of this technique at our institution saw a 67% increase in the number of patients performing PD. Conclusions Radiological insertion of TCs for PD provided improved access to catheter insertion in a timely manner with reduced resource requirements. Over the 12-month observation period we noted a high technical success rate with very few complications. Our study supports radiological insertion of TCs under local anaesthetic as a viable alternative to catheter insertion in theatre under general anaesthetic. The relative ease of radiological TC insertion has resulted in a significant increase in patient uptake of PD at our centre. [ABSTRACT FROM PUBLISHER]

Introduction Peritoneal dialysis via Tenckhoff catheter predisposes to hernia formation due to both local and systemic factors. Another important complication of peritoneal catheter insertion includes infection, which can prompt removal of the catheter. Methods We performed a retrospective study between January 2005 and July 2011 of 61 patients who underwent laparoscopic placement of a Tenckhoff catheter and peritoneal dialysis at our institution using a single-port technique. We analysed complications of Tenckhoff insertion, specifically infection and the formation of hernias requiring operative management. Results Infections noted in our patients included peritonitis (10%) and exit-site infection (5%). Of the five patients who required re-insertion of Tenckhoff catheter, four were for infective complications. A total of seven hernias developed in five (8%) of patients, mostly inguinal or umbilical near the Hassan port entry site. Discussion With infection and hernia formation being the main contributors to failure of the procedure, actively addressing the entry site and areas predisposed to hernia formation, observing aseptic technique and meticulous attention to early signs of complications during follow-up are vital to improve success rates. The outcomes of the laparoscopic single-port insertion technique shows promise compared with conventional Tenckhoff catheter insertion techniques. [ABSTRACT FROM AUTHOR]