Double purse-string craft around the inner cuff: a new technique for an immediate start of CAPD

Abstract

Background: In order to minimize the risk of leakage and displacement, international guidelines recommend that catheter insertion should be performed at least 2 weeks before beginning CAPD. However, the optimal duration of the break-in period is not defined yet. 

Methods: From January 2011 to December 2018, 135 PD catheter insertions in 125 patients (90 men and 35 women, mean age 62,02 ± 16,7) were performed in our centre with the double purse-string technique. Seventy-seven straight double-cuffed Tenckhoff catheter were implanted semi-surgically on midline under umbilicus by a trocar and 58 were surgically implanted through rectus muscle. In all patients CAPD was started within 24 hours from catheter placement, without a break-in procedure. We recorded all mechanical and infective catheter-related complications during the 3 first months after initiation of CAPD and the catheter survival rates.

Results: During the first 3 months the overall incidence of peri-catheter leakages, catheter dislocations, peritonitis and exit-site infections was 2,96% (4/135), 1,48% (2/135), 10.3% (14/135) and 2.96% (4/135), respectively. No bleeding events, bowel perforations or hernia formations were reported. The catheter survival censored for deaths, kidney transplant, loss of ultrafiltration and inability was 74,7% at 48 months. There was no difference in the incidence of any mechanical or infectious complications and catheter survival between the semi-surgical and the surgical groups. 

Conclusions: Double purse-string technique allows an immediate start of CAPD both with semi-surgical and surgical catheter implantation. This technique is a safe and feasible approach in all patients who refer to peritoneal dialysis. 

 

Keywords: continuous ambulatory peritoneal dialysis, CAPD, peritoneal catheter, break-in time, infective catheter-related complications, double purse-string technique

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Introduzione

Sebbene la dialisi peritoneale ambulatoriale continua (CAPD) possieda diversi benefici rispetto all’emodialisi (HD), quali una maggiore adattabilità agli stili di vita individuali, una più lunga conservazione della diuresi residua [1,2], una maggiore sopravvivenza nei primi anni di terapia [3,4] e un minore costo economico [5,6], in Italia solo il 13% circa dei pazienti incidenti sono trattati mediante dialisi peritoneale (PD), mentre la prevalenza si attesta intorno al 9.5% [7]. I più recenti dati USA riportano un’incidenza e una prevalenza perfino minori, 9.7% e 7%, rispettivamente [8]. Le ragioni di questo sottoutilizzo sono molteplici: la poca dimestichezza ed esperienza con la metodica da parte dei professionisti, l’errata credenza di inferiorità della CAPD in termini di morbilità e mortalità (elevato timore delle complicanze infettive e convinzione della ridotta sopravvivenza del paziente), la percezione dell’inadeguatezza depurativa delle piccole molecole e infine, in termini economici, un minor rimborso per le strutture sanitarie se confrontato con l’emodialisi.  

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