MIGRATION OF PERITONEAL CATHETER IN CONTI NUOUS AMBULATORY PERITONEAL-DIALYSIS (CAPD) - EXPERIENCE AND RESULTS

Migration of the peritoneal catheter is one of the main causes of malf unction in CAPD. We report a retrospective study of the migrated perit oneal catheters in our CAPD programme. The methods used to restore cat heter function and position are also described. Between May 1986 and D ecember 1991, 52 CAPD catheters (24 standard straight Tenckhoff, 28 Sw an-Neck Tenckhoff) were inserted into 38 patients. There were 16 migra tion episodes in 11 patients, a migration rate of 30%. We attempted on e or more of the following procedures: prescription of laxatives and e nemas; catheter manipulation under fluoroscopic guidance; surgical rep lacement of the same catheter; catheter removal and insertion of a new one; surgical fixation of the catheter. The use of nonsurgical proced ures was only successful in a low percentage of patients. Nevertheless , these methods may be tried in the first instance due to their simpli city. The surgical techniques without stabilization of the catheter ac hieved only partial success. Fixation created with nonabsorbable sutur es in the lateral wall of the parietal peritoneum was performed in 2 c ases by the Cerilli technique (a peritoneal tunnel through pelvis), an d in 2 other cases (one due to previous migration, and the other in th e first instance for a simultaneous repair of an umbilical hernia) by passing the catheter through the sigmoid mesocolon and leaving the tip free, without sutures, in the pouch of Douglas. These measures provid ed a definitive solution. We also found a statistically significant lo wer tip migration rate with the use of Swan-Neck catheters (p < 0,02). Finally, we propose guide-lines for the management of migration of th e tip of a peritoneal catheter.