COMPARISON FOR 4 TECHNIQUES OF CATHETER INSERTION IN PATIENTS UNDERGOING CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

Objective: To compare four different ways of implanting catheters for continuous ambulatory peritoneal dialysis (CAPD) in an effort to reduc e the incidence of complications. Design: Retrospective study. Setting : Teaching hospital, Taiwan. Subjects: 166 Patients who had 180 cathet ers inserted between 1985 and 1993. Interventions: 49 Catheters were i nserted through midline incisions (in 24 of which the catheter was fix ed with an additional suture) and 131 were inserted through paramedian incisions (in 88 of which the catheter was fixed with an additional s uture). Main outcome measures: Morbidity, particularly the incidence o f migration of the catheter and incisional hernia. Results: 8 68 Cathe ters migrated in patients in whom no additional fixing suture had been used, compared with 2/112 in whom an additional suture had been used (p = 0.007). There were 4 incisional hernias in 49 midline, compared w ith 0(.)131 paramedian, incisions (p < 0.0001). Significantly more cat heters had to be removed after midline than after paramedian incisions (35/49 compared with 56/131. p = 0.0008): chi square for independence 15.02, df3. p = 0.0018). Conclusion: For the implantation of catheter s for CAPD the paramedian incision is associated with significantly fe wer complications than the midline incision and the incidence is even lower if the catheter is fixed to the lower peritoneum with an additio nal suture.