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2020 ; 44
(8
): 2464-2470
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gab.com Text
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Safety and Efficacy of Bedside Peritoneal Dialysis Catheter Placement in the
COVID-19 Era: Initial Experience at a New York City Hospital
#MMPMID32458021
Vigiola Cruz M
; Bellorin O
; Srivatana V
; Afaneh C
World J Surg
2020[Aug]; 44
(8
): 2464-2470
PMID32458021
show ga
INTRODUCTION: Acute kidney injury (AKI) requiring renal replacement therapy (RRT)
is common in critically ill patients with COVID-19. Unparalleled numbers of
patients with AKI and shortage of dialysis machines and operative resources
prompted consideration of expanded use of urgent-start peritoneal dialysis (PD)
and evaluation of the safety and efficacy of bedside surgical placement of PD
catheters. STUDY DESIGN: Bedside, open PD catheter insertions were performed in
early April 2020, at a large academic center in New York City. Patients with
SARS-CoV-2 infection and AKI and ambulatory patients with chronic kidney disease
and impending need for RRT were included. Detailed surgical technique is
described. RESULTS: Fourteen catheters were placed at the bedside over 2 weeks,
11 in critically ill COVID-19 patients and three in ambulatory patients. Mean
patient age was 61.9 years (43-83), and mean body mass index was 27.1 (20-37.6);
four patients had prior abdominal surgery. All catheters were placed successfully
without routine radiographic studies or intraoperative complications. One patient
(7%) experienced primary nonfunction of the catheter requiring HD. One patient
had limited intraperitoneal bleeding while anticoagulated, which was managed by
mechanical compression of the abdominal wall and temporarily holding
anticoagulation. All other catheters had an adequate function at 3-18 days of
follow-up. CONCLUSIONS: Bedside placement of PD catheters is safe and effective
in ICU and outpatient clinic settings. Our surgical protocols allowed for
optimization of critical hospital resources, minimization of hazardous exposure
to healthcare providers and a broader application of urgent-start PD in selected
patients. Long-term follow-up is warranted.