FLUOROSCOPIC MANIPULATION OF TENCKHOFF CATHETERS - OUTCOME ANALYSIS

Wire manipulation under fluoroscopic control can correct malposition o f peritoneal catheters in a fast and safe manner. This study was perfo rmed to evaluate the success rate of wire manipulation and identify fa ctors that may predict outcome. Material and methods. Data were prospe ctively collected between January 1, 1986 and June 30, 1996 among all patients with peritoneal catheter malfunction requiring manipulation a t a single center. Manipulations were performed using a flexible guide wire under aseptic fluoroscopic control. All patients had flat plates of the abdomen pre and post manipulation and received antibiotics aft er the procedure. The direction of the subcutaneous tunnel at the poin t of entry into the peritoneal cavity was calculated from the X-rays b y measuring the angle formed by the horizontal and the distal subcutan eous tunnel. Success was defined as adequate peritoneal catheter funct ion at three months. The success rate was correlated with type of cath eter, patient weight and the subcutaneous tunnel orientation. Results. 1250 Tenckhoff double-cuff peritoneal catheters were inserted and 69 (5.5%) were manipulated (59 straight and IO curled). The median for ti me elapsed between peritoneal catheter insertion and wire manipulation was 18 days (range 1 day - 5 years). The overall success rate was 60. 9% (61% for straight and 60% for curled peritoneal catheters). The mea n patient weight for successes was 71.4 +/- 12.4 and 84.0 +/- 17.2 kg for failures (p < 0.005). Subcutaneous tunnel orientation between 30 a nd 120 degrees was associated with the highest success and those beyon d 120 degrees with the highest failure rate. No complications were obs erved. Conclusion: Wire manipulation under fluoroscopic control of Ten ckhoff peritoneal catheter in the treatment of malfunction is a safe a nd highly effective procedure. Obesity and cephalad orientation of the subcutaneous tunnel were associated with less favorable outcome.