PERITONEAL-DIALYSIS CATHETERS - A COMPARISON BETWEEN PERCUTANEOUS ANDCONVENTIONAL SURGICAL PLACEMENT TECHNIQUES

Percutaneous peritoneal dialysis catheter (PDC) placement is a well-to lerated, rapidly performed side-room procedure that allows the rapid i nitiation of dialysis without the delay imposed in co-ordinating a sur geon, theatre time, and theatre staff. We retrospectively reviewed the clinical outcome of 230 PDC inserted over a 30-month period. Fifty we re placed percutaneously (group P) and 180 were placed using conventio nal surgical techniques, 107 in patients commencing CAPD (group A) and 73 in patients previously established on CAPD (group B). Total experi ence accumulated was 2563 patient months: 270 patient months group P, 1381 patient months group A, 912 patient months group B. Percutaneous PDC insertion was non-elective, and reserved for patients unfit for ge neral anaesthesia or haemodialysis. Group P patients were older (P<0.0 01) and had increased early mortality (P < 0.005) due to underlying pa thology. Death and early mechanical failure contributed to a shorter m ean duration of catheter use in group P (9.0 +/- 2.3 months compared t o 15.3 +/- 9.6 months group A and 17.3 +/- 9.7 group B) (P < 0.05). Th e peritonitis rate was similar in group P (1 per 6.75 patient months) and group B (1 per 7.4 patient months) but significantly lower in grou p A (1 per 15.7 patient months) (P < 0.01). We conclude that percutane ous PDC placement provides a safe, reliable access for peritoneal dial ysis and is especially suitable for ill patients who would not tolerat e general anaesthesia.