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2015 ; 35
(5
): 545-51
Nephropedia Template TP
gab.com Text
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English Wikipedia
Embedded Catheters: Minimizing Excessive Embedment Time and Futile Placement
while Maintaining Procedure Benefits
#MMPMID25292403
Crabtree JH
; Burchette RJ
; Siddiqi RA
Perit Dial Int
2015[Sep]; 35
(5
): 545-51
PMID25292403
show ga
BACKGROUND: Embedding peritoneal catheters far in advance of anticipated need may
successfully commit patients to their modality choice and reduce central venous
catheter use but can be complicated by excessive embedment periods and futile
catheter placement. OBJECTIVE: Embedded catheter outcomes were studied to
identify factors that minimize inordinate embedment time and futile placement
while maintaining procedure benefits. METHODS: Clinical and laboratory data were
examined in 107 patients with embedded catheters that were either externalized,
remained embedded, or were futilely placed. RESULTS: Externalization of 84
catheters was performed after a median embedment period of 9.4 months. Flow
dysfunction occurred in 14.3% of externalized catheters. Overall function rate
was 98.8% after laparoscopic revision. One patient changed their mind about
modality choice. Except for 1 patient hospitalized acutely in a facility
unfamiliar with embedded catheters, none remaining on a peritoneal dialysis
pathway initiated dialysis with a central venous catheter. Including catheters
with extremely long embedment periods, the incidence of futile placement was
13.1%. Multiple regression analysis identified estimated glomerular filtration
rate (eGFR) and serum albumin as the 2 variables best associated with catheter
embedment duration (r(2) = 0.44, p < 0.0001). Diabetic nephropathy was
statistically more likely to be associated with lower serum albumin values (p <
0.0001); however, no association was noted between diabetic status and embedment
duration (p = 0.62). CONCLUSIONS: Timing of the embedment procedure should
include appraisal of both eGFR and serum albumin. Appropriate consideration of
these values together may help minimize excessive embedment periods and decrease
futile placements while preserving procedure benefits.