Fluoroscopically-guided manipulation of malfunctioning peritoneal dialysiscatheters

Objective:To review our experience with fluoroscopic evaluation and manipul ation of malpositioned, malfunctioning, peritoneal dialysis (PD) catheters. Materials and Methods: Thirty-one patients, over a 5-year period (1 May 199 2 to 30 April 1997) with malfunctioning PD catheters, who had fluoroscopica lly-guided manipulation were reviewed. Catheters were manipulated using a m alleable aluminum bar and, if necessary, guide wires or other stiffeners. T echnical success was assessed on the basis of adequate, fluoroscopically ve rified, catheter placement at the time of the procedure and improved flows. A functional PD catheter at 30 days post manipulation was considered to be a clinically successful manipulation. Results:There were 41 manipulations [33 initial (IM) and 8 remanipulations (RM)] for malpositioned or kinked catheters. In 31 (19 male, 12 female) pat ients ranging in age from 31 to 76 years (mean age 60 years), the initial t echnical success rate was 85% for IM (n = 28/33) and 63% (n = 5/8) for RM. The overall clinical success rate, or 30-day primary patency, was 55% for I M (n = 18/33) and 63% for RM. Catheter function (combined IM and RM) contin ued for a median 869 days (95% Cl: 118, 1620). No early complications were noted. Conclusions: Fluoroscopic manipulation, including attempts at remanipulatio n, of PD catheters is a safe procedure. The technique is a simple, inexpens ive, and effective way of prolonging PD catheter life, thereby reducing the number of surgical interventions.