presentazione di powerpoint - dialisiperitoneale.org · •break-in e volumi intraaddominali ......
TRANSCRIPT
SMARSUPIALIZZAZZIONE DEL CATETERE PERITONEALE
The Moncrief-Popovich catheter A new peritoneal access technique for patients on peritoneal dialysis
Moncrief JW Popovich RP ASAIO J 1993 Jan-Mar 39(1) 62-5
bull There was a rate of one exit site infection every 1257 patients-months
bull The Moncrief-Popovich catheter and implantation technique result in a substantial decrease in the incidence of peritonitis for patients using the standard spike exchange system
Modificazioni del catetere marsupializzato
Moncrief-Popovich catheter and technique
Subcutaneous burial of the external segment of the catheter to prevent colonization of the catheter by skin bacteria and promote attachment of the cuff to the tissue prior to exteriorization has been described and recently tested by several experienced clinicians
with encouraging results
The initial reports by the developers claimed a reduction in the rate of peritonitis and
colonization of bacterial biofilms in the catheter segments between the two cuffs
However a controlled randomized study failed to confirm these claims14 A possible reason for the failure to reduce the incidence of infectious complications may be the inability of the body to provide an effective ldquosealrdquo around the external cuff Therefore upon exteriorization of the catheter the process of healing starts all over again
Prischl et al have also reported a high incidence of seromas subcutaneous hematomas and fibrin thrombi postoperatively with this technique15
analisi SWOT
StrenghtsbullTempi intervento chirurgico posizionamento non incrementatibullSchema corporeo immodificatobullPaziente ldquoambulatorialerdquobullIncremento pool Pazienti peritonealebullBreak-in e volumi intraaddominalibullRiduzione complicanze meccaniche peri-inserzionebullSeparazione intervento da addestramento
WeaknessesbullTecnica chirurgica nuova (curva di apprendimento)bullIntervento chirurgico in due tempibullNon operativitagrave sul catetere impiantatobull impianto precoce
OpportunitiesbullDialisi incrementalebullReclutamento pazienti pre-dialisibullReclutamento pazienti acutibullRiduzione incidenza CVC
ThreatsLetteraturaAmbiente interno
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intra-addominali
Break-in
Cheng 1996
86 cateteri tecnica chirurgicabull 40 -gt break-in HD (gruppo A)bull 60 subito ( B)
Follow-up di 6 mesi -lrsquoincidenza di leakage era significativamente piugrave alta nel gruppo B (0 vs 13 p lt 005) tra i pazienti diabetici (71 vs 22 p lt 005) - pazienti positivi per leakage piugrave alta incidenza di esteriorizzazione della cuffia esterna (57 vs 7 p lt 0005)
Jo 2007
Studio prospettico osservazionale su 51 pazienti tecnica percutanea modificata ed il suo utilizzo avveniva senza un periodo di break-in
(chirurgico fino alla fascia anteriore del muscolo retto poi per raggiungere la cavitagrave peritoneale attraverso il muscolo si utilizzavano dei dilatatori la cuffia interna veniva ancorata con una borsa di tabacco sul versante muscolare della fascia esterna del retto)
rarr 2 di leakage e 6 di dislocazione
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intraaddominali
Riduzione complicanze meccaniche peri-inserzione
malposizionamentodislocazione
Casistica 12236 rarr 5
How to start the late referred ESRD patient urgently on chronic APD
Povlsen JV Ivarsen P
NDT 2006 Jul 21 Suppl 2 ii56-9
Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (lt24 h) PD catheter placement and comparing short-term (3 months)
The number and type of infectious complications were equal in both the groups
The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P lt 005)
Consequently the need for surgical replacement of catheters was also significantly higher in the study group (P lt 002)
Fluoroscopic placement of peritoneal dialysis catheters a harvest of the low-hanging fruits
Crabtree JH PDI 2008 Mar-Apr28(2)134-7
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
The Moncrief-Popovich catheter A new peritoneal access technique for patients on peritoneal dialysis
Moncrief JW Popovich RP ASAIO J 1993 Jan-Mar 39(1) 62-5
bull There was a rate of one exit site infection every 1257 patients-months
bull The Moncrief-Popovich catheter and implantation technique result in a substantial decrease in the incidence of peritonitis for patients using the standard spike exchange system
Modificazioni del catetere marsupializzato
Moncrief-Popovich catheter and technique
Subcutaneous burial of the external segment of the catheter to prevent colonization of the catheter by skin bacteria and promote attachment of the cuff to the tissue prior to exteriorization has been described and recently tested by several experienced clinicians
with encouraging results
The initial reports by the developers claimed a reduction in the rate of peritonitis and
colonization of bacterial biofilms in the catheter segments between the two cuffs
However a controlled randomized study failed to confirm these claims14 A possible reason for the failure to reduce the incidence of infectious complications may be the inability of the body to provide an effective ldquosealrdquo around the external cuff Therefore upon exteriorization of the catheter the process of healing starts all over again
Prischl et al have also reported a high incidence of seromas subcutaneous hematomas and fibrin thrombi postoperatively with this technique15
analisi SWOT
StrenghtsbullTempi intervento chirurgico posizionamento non incrementatibullSchema corporeo immodificatobullPaziente ldquoambulatorialerdquobullIncremento pool Pazienti peritonealebullBreak-in e volumi intraaddominalibullRiduzione complicanze meccaniche peri-inserzionebullSeparazione intervento da addestramento
WeaknessesbullTecnica chirurgica nuova (curva di apprendimento)bullIntervento chirurgico in due tempibullNon operativitagrave sul catetere impiantatobull impianto precoce
OpportunitiesbullDialisi incrementalebullReclutamento pazienti pre-dialisibullReclutamento pazienti acutibullRiduzione incidenza CVC
ThreatsLetteraturaAmbiente interno
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intra-addominali
Break-in
Cheng 1996
86 cateteri tecnica chirurgicabull 40 -gt break-in HD (gruppo A)bull 60 subito ( B)
Follow-up di 6 mesi -lrsquoincidenza di leakage era significativamente piugrave alta nel gruppo B (0 vs 13 p lt 005) tra i pazienti diabetici (71 vs 22 p lt 005) - pazienti positivi per leakage piugrave alta incidenza di esteriorizzazione della cuffia esterna (57 vs 7 p lt 0005)
Jo 2007
Studio prospettico osservazionale su 51 pazienti tecnica percutanea modificata ed il suo utilizzo avveniva senza un periodo di break-in
(chirurgico fino alla fascia anteriore del muscolo retto poi per raggiungere la cavitagrave peritoneale attraverso il muscolo si utilizzavano dei dilatatori la cuffia interna veniva ancorata con una borsa di tabacco sul versante muscolare della fascia esterna del retto)
rarr 2 di leakage e 6 di dislocazione
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intraaddominali
Riduzione complicanze meccaniche peri-inserzione
malposizionamentodislocazione
Casistica 12236 rarr 5
How to start the late referred ESRD patient urgently on chronic APD
Povlsen JV Ivarsen P
NDT 2006 Jul 21 Suppl 2 ii56-9
Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (lt24 h) PD catheter placement and comparing short-term (3 months)
The number and type of infectious complications were equal in both the groups
The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P lt 005)
Consequently the need for surgical replacement of catheters was also significantly higher in the study group (P lt 002)
Fluoroscopic placement of peritoneal dialysis catheters a harvest of the low-hanging fruits
Crabtree JH PDI 2008 Mar-Apr28(2)134-7
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Modificazioni del catetere marsupializzato
Moncrief-Popovich catheter and technique
Subcutaneous burial of the external segment of the catheter to prevent colonization of the catheter by skin bacteria and promote attachment of the cuff to the tissue prior to exteriorization has been described and recently tested by several experienced clinicians
with encouraging results
The initial reports by the developers claimed a reduction in the rate of peritonitis and
colonization of bacterial biofilms in the catheter segments between the two cuffs
However a controlled randomized study failed to confirm these claims14 A possible reason for the failure to reduce the incidence of infectious complications may be the inability of the body to provide an effective ldquosealrdquo around the external cuff Therefore upon exteriorization of the catheter the process of healing starts all over again
Prischl et al have also reported a high incidence of seromas subcutaneous hematomas and fibrin thrombi postoperatively with this technique15
analisi SWOT
StrenghtsbullTempi intervento chirurgico posizionamento non incrementatibullSchema corporeo immodificatobullPaziente ldquoambulatorialerdquobullIncremento pool Pazienti peritonealebullBreak-in e volumi intraaddominalibullRiduzione complicanze meccaniche peri-inserzionebullSeparazione intervento da addestramento
WeaknessesbullTecnica chirurgica nuova (curva di apprendimento)bullIntervento chirurgico in due tempibullNon operativitagrave sul catetere impiantatobull impianto precoce
OpportunitiesbullDialisi incrementalebullReclutamento pazienti pre-dialisibullReclutamento pazienti acutibullRiduzione incidenza CVC
ThreatsLetteraturaAmbiente interno
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intra-addominali
Break-in
Cheng 1996
86 cateteri tecnica chirurgicabull 40 -gt break-in HD (gruppo A)bull 60 subito ( B)
Follow-up di 6 mesi -lrsquoincidenza di leakage era significativamente piugrave alta nel gruppo B (0 vs 13 p lt 005) tra i pazienti diabetici (71 vs 22 p lt 005) - pazienti positivi per leakage piugrave alta incidenza di esteriorizzazione della cuffia esterna (57 vs 7 p lt 0005)
Jo 2007
Studio prospettico osservazionale su 51 pazienti tecnica percutanea modificata ed il suo utilizzo avveniva senza un periodo di break-in
(chirurgico fino alla fascia anteriore del muscolo retto poi per raggiungere la cavitagrave peritoneale attraverso il muscolo si utilizzavano dei dilatatori la cuffia interna veniva ancorata con una borsa di tabacco sul versante muscolare della fascia esterna del retto)
rarr 2 di leakage e 6 di dislocazione
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intraaddominali
Riduzione complicanze meccaniche peri-inserzione
malposizionamentodislocazione
Casistica 12236 rarr 5
How to start the late referred ESRD patient urgently on chronic APD
Povlsen JV Ivarsen P
NDT 2006 Jul 21 Suppl 2 ii56-9
Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (lt24 h) PD catheter placement and comparing short-term (3 months)
The number and type of infectious complications were equal in both the groups
The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P lt 005)
Consequently the need for surgical replacement of catheters was also significantly higher in the study group (P lt 002)
Fluoroscopic placement of peritoneal dialysis catheters a harvest of the low-hanging fruits
Crabtree JH PDI 2008 Mar-Apr28(2)134-7
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Moncrief-Popovich catheter and technique
Subcutaneous burial of the external segment of the catheter to prevent colonization of the catheter by skin bacteria and promote attachment of the cuff to the tissue prior to exteriorization has been described and recently tested by several experienced clinicians
with encouraging results
The initial reports by the developers claimed a reduction in the rate of peritonitis and
colonization of bacterial biofilms in the catheter segments between the two cuffs
However a controlled randomized study failed to confirm these claims14 A possible reason for the failure to reduce the incidence of infectious complications may be the inability of the body to provide an effective ldquosealrdquo around the external cuff Therefore upon exteriorization of the catheter the process of healing starts all over again
Prischl et al have also reported a high incidence of seromas subcutaneous hematomas and fibrin thrombi postoperatively with this technique15
analisi SWOT
StrenghtsbullTempi intervento chirurgico posizionamento non incrementatibullSchema corporeo immodificatobullPaziente ldquoambulatorialerdquobullIncremento pool Pazienti peritonealebullBreak-in e volumi intraaddominalibullRiduzione complicanze meccaniche peri-inserzionebullSeparazione intervento da addestramento
WeaknessesbullTecnica chirurgica nuova (curva di apprendimento)bullIntervento chirurgico in due tempibullNon operativitagrave sul catetere impiantatobull impianto precoce
OpportunitiesbullDialisi incrementalebullReclutamento pazienti pre-dialisibullReclutamento pazienti acutibullRiduzione incidenza CVC
ThreatsLetteraturaAmbiente interno
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intra-addominali
Break-in
Cheng 1996
86 cateteri tecnica chirurgicabull 40 -gt break-in HD (gruppo A)bull 60 subito ( B)
Follow-up di 6 mesi -lrsquoincidenza di leakage era significativamente piugrave alta nel gruppo B (0 vs 13 p lt 005) tra i pazienti diabetici (71 vs 22 p lt 005) - pazienti positivi per leakage piugrave alta incidenza di esteriorizzazione della cuffia esterna (57 vs 7 p lt 0005)
Jo 2007
Studio prospettico osservazionale su 51 pazienti tecnica percutanea modificata ed il suo utilizzo avveniva senza un periodo di break-in
(chirurgico fino alla fascia anteriore del muscolo retto poi per raggiungere la cavitagrave peritoneale attraverso il muscolo si utilizzavano dei dilatatori la cuffia interna veniva ancorata con una borsa di tabacco sul versante muscolare della fascia esterna del retto)
rarr 2 di leakage e 6 di dislocazione
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intraaddominali
Riduzione complicanze meccaniche peri-inserzione
malposizionamentodislocazione
Casistica 12236 rarr 5
How to start the late referred ESRD patient urgently on chronic APD
Povlsen JV Ivarsen P
NDT 2006 Jul 21 Suppl 2 ii56-9
Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (lt24 h) PD catheter placement and comparing short-term (3 months)
The number and type of infectious complications were equal in both the groups
The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P lt 005)
Consequently the need for surgical replacement of catheters was also significantly higher in the study group (P lt 002)
Fluoroscopic placement of peritoneal dialysis catheters a harvest of the low-hanging fruits
Crabtree JH PDI 2008 Mar-Apr28(2)134-7
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
analisi SWOT
StrenghtsbullTempi intervento chirurgico posizionamento non incrementatibullSchema corporeo immodificatobullPaziente ldquoambulatorialerdquobullIncremento pool Pazienti peritonealebullBreak-in e volumi intraaddominalibullRiduzione complicanze meccaniche peri-inserzionebullSeparazione intervento da addestramento
WeaknessesbullTecnica chirurgica nuova (curva di apprendimento)bullIntervento chirurgico in due tempibullNon operativitagrave sul catetere impiantatobull impianto precoce
OpportunitiesbullDialisi incrementalebullReclutamento pazienti pre-dialisibullReclutamento pazienti acutibullRiduzione incidenza CVC
ThreatsLetteraturaAmbiente interno
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intra-addominali
Break-in
Cheng 1996
86 cateteri tecnica chirurgicabull 40 -gt break-in HD (gruppo A)bull 60 subito ( B)
Follow-up di 6 mesi -lrsquoincidenza di leakage era significativamente piugrave alta nel gruppo B (0 vs 13 p lt 005) tra i pazienti diabetici (71 vs 22 p lt 005) - pazienti positivi per leakage piugrave alta incidenza di esteriorizzazione della cuffia esterna (57 vs 7 p lt 0005)
Jo 2007
Studio prospettico osservazionale su 51 pazienti tecnica percutanea modificata ed il suo utilizzo avveniva senza un periodo di break-in
(chirurgico fino alla fascia anteriore del muscolo retto poi per raggiungere la cavitagrave peritoneale attraverso il muscolo si utilizzavano dei dilatatori la cuffia interna veniva ancorata con una borsa di tabacco sul versante muscolare della fascia esterna del retto)
rarr 2 di leakage e 6 di dislocazione
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intraaddominali
Riduzione complicanze meccaniche peri-inserzione
malposizionamentodislocazione
Casistica 12236 rarr 5
How to start the late referred ESRD patient urgently on chronic APD
Povlsen JV Ivarsen P
NDT 2006 Jul 21 Suppl 2 ii56-9
Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (lt24 h) PD catheter placement and comparing short-term (3 months)
The number and type of infectious complications were equal in both the groups
The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P lt 005)
Consequently the need for surgical replacement of catheters was also significantly higher in the study group (P lt 002)
Fluoroscopic placement of peritoneal dialysis catheters a harvest of the low-hanging fruits
Crabtree JH PDI 2008 Mar-Apr28(2)134-7
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intra-addominali
Break-in
Cheng 1996
86 cateteri tecnica chirurgicabull 40 -gt break-in HD (gruppo A)bull 60 subito ( B)
Follow-up di 6 mesi -lrsquoincidenza di leakage era significativamente piugrave alta nel gruppo B (0 vs 13 p lt 005) tra i pazienti diabetici (71 vs 22 p lt 005) - pazienti positivi per leakage piugrave alta incidenza di esteriorizzazione della cuffia esterna (57 vs 7 p lt 0005)
Jo 2007
Studio prospettico osservazionale su 51 pazienti tecnica percutanea modificata ed il suo utilizzo avveniva senza un periodo di break-in
(chirurgico fino alla fascia anteriore del muscolo retto poi per raggiungere la cavitagrave peritoneale attraverso il muscolo si utilizzavano dei dilatatori la cuffia interna veniva ancorata con una borsa di tabacco sul versante muscolare della fascia esterna del retto)
rarr 2 di leakage e 6 di dislocazione
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intraaddominali
Riduzione complicanze meccaniche peri-inserzione
malposizionamentodislocazione
Casistica 12236 rarr 5
How to start the late referred ESRD patient urgently on chronic APD
Povlsen JV Ivarsen P
NDT 2006 Jul 21 Suppl 2 ii56-9
Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (lt24 h) PD catheter placement and comparing short-term (3 months)
The number and type of infectious complications were equal in both the groups
The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P lt 005)
Consequently the need for surgical replacement of catheters was also significantly higher in the study group (P lt 002)
Fluoroscopic placement of peritoneal dialysis catheters a harvest of the low-hanging fruits
Crabtree JH PDI 2008 Mar-Apr28(2)134-7
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intra-addominali
Break-in
Cheng 1996
86 cateteri tecnica chirurgicabull 40 -gt break-in HD (gruppo A)bull 60 subito ( B)
Follow-up di 6 mesi -lrsquoincidenza di leakage era significativamente piugrave alta nel gruppo B (0 vs 13 p lt 005) tra i pazienti diabetici (71 vs 22 p lt 005) - pazienti positivi per leakage piugrave alta incidenza di esteriorizzazione della cuffia esterna (57 vs 7 p lt 0005)
Jo 2007
Studio prospettico osservazionale su 51 pazienti tecnica percutanea modificata ed il suo utilizzo avveniva senza un periodo di break-in
(chirurgico fino alla fascia anteriore del muscolo retto poi per raggiungere la cavitagrave peritoneale attraverso il muscolo si utilizzavano dei dilatatori la cuffia interna veniva ancorata con una borsa di tabacco sul versante muscolare della fascia esterna del retto)
rarr 2 di leakage e 6 di dislocazione
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intraaddominali
Riduzione complicanze meccaniche peri-inserzione
malposizionamentodislocazione
Casistica 12236 rarr 5
How to start the late referred ESRD patient urgently on chronic APD
Povlsen JV Ivarsen P
NDT 2006 Jul 21 Suppl 2 ii56-9
Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (lt24 h) PD catheter placement and comparing short-term (3 months)
The number and type of infectious complications were equal in both the groups
The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P lt 005)
Consequently the need for surgical replacement of catheters was also significantly higher in the study group (P lt 002)
Fluoroscopic placement of peritoneal dialysis catheters a harvest of the low-hanging fruits
Crabtree JH PDI 2008 Mar-Apr28(2)134-7
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Break-in
Cheng 1996
86 cateteri tecnica chirurgicabull 40 -gt break-in HD (gruppo A)bull 60 subito ( B)
Follow-up di 6 mesi -lrsquoincidenza di leakage era significativamente piugrave alta nel gruppo B (0 vs 13 p lt 005) tra i pazienti diabetici (71 vs 22 p lt 005) - pazienti positivi per leakage piugrave alta incidenza di esteriorizzazione della cuffia esterna (57 vs 7 p lt 0005)
Jo 2007
Studio prospettico osservazionale su 51 pazienti tecnica percutanea modificata ed il suo utilizzo avveniva senza un periodo di break-in
(chirurgico fino alla fascia anteriore del muscolo retto poi per raggiungere la cavitagrave peritoneale attraverso il muscolo si utilizzavano dei dilatatori la cuffia interna veniva ancorata con una borsa di tabacco sul versante muscolare della fascia esterna del retto)
rarr 2 di leakage e 6 di dislocazione
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intraaddominali
Riduzione complicanze meccaniche peri-inserzione
malposizionamentodislocazione
Casistica 12236 rarr 5
How to start the late referred ESRD patient urgently on chronic APD
Povlsen JV Ivarsen P
NDT 2006 Jul 21 Suppl 2 ii56-9
Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (lt24 h) PD catheter placement and comparing short-term (3 months)
The number and type of infectious complications were equal in both the groups
The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P lt 005)
Consequently the need for surgical replacement of catheters was also significantly higher in the study group (P lt 002)
Fluoroscopic placement of peritoneal dialysis catheters a harvest of the low-hanging fruits
Crabtree JH PDI 2008 Mar-Apr28(2)134-7
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Strenghts
Tempi intervento chirurgico posizionamento non incrementati
Schema corporeo immodificato
Paziente ldquoambulatorialerdquo
Incremento pool Pazienti peritoneale
Break-in e volumi intraaddominali
Riduzione complicanze meccaniche peri-inserzione
malposizionamentodislocazione
Casistica 12236 rarr 5
How to start the late referred ESRD patient urgently on chronic APD
Povlsen JV Ivarsen P
NDT 2006 Jul 21 Suppl 2 ii56-9
Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (lt24 h) PD catheter placement and comparing short-term (3 months)
The number and type of infectious complications were equal in both the groups
The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P lt 005)
Consequently the need for surgical replacement of catheters was also significantly higher in the study group (P lt 002)
Fluoroscopic placement of peritoneal dialysis catheters a harvest of the low-hanging fruits
Crabtree JH PDI 2008 Mar-Apr28(2)134-7
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
malposizionamentodislocazione
Casistica 12236 rarr 5
How to start the late referred ESRD patient urgently on chronic APD
Povlsen JV Ivarsen P
NDT 2006 Jul 21 Suppl 2 ii56-9
Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (lt24 h) PD catheter placement and comparing short-term (3 months)
The number and type of infectious complications were equal in both the groups
The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P lt 005)
Consequently the need for surgical replacement of catheters was also significantly higher in the study group (P lt 002)
Fluoroscopic placement of peritoneal dialysis catheters a harvest of the low-hanging fruits
Crabtree JH PDI 2008 Mar-Apr28(2)134-7
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Casistica 12236 rarr 5
How to start the late referred ESRD patient urgently on chronic APD
Povlsen JV Ivarsen P
NDT 2006 Jul 21 Suppl 2 ii56-9
Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (lt24 h) PD catheter placement and comparing short-term (3 months)
The number and type of infectious complications were equal in both the groups
The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P lt 005)
Consequently the need for surgical replacement of catheters was also significantly higher in the study group (P lt 002)
Fluoroscopic placement of peritoneal dialysis catheters a harvest of the low-hanging fruits
Crabtree JH PDI 2008 Mar-Apr28(2)134-7
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
How to start the late referred ESRD patient urgently on chronic APD
Povlsen JV Ivarsen P
NDT 2006 Jul 21 Suppl 2 ii56-9
Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (lt24 h) PD catheter placement and comparing short-term (3 months)
The number and type of infectious complications were equal in both the groups
The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P lt 005)
Consequently the need for surgical replacement of catheters was also significantly higher in the study group (P lt 002)
Fluoroscopic placement of peritoneal dialysis catheters a harvest of the low-hanging fruits
Crabtree JH PDI 2008 Mar-Apr28(2)134-7
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Fluoroscopic placement of peritoneal dialysis catheters a harvest of the low-hanging fruits
Crabtree JH PDI 2008 Mar-Apr28(2)134-7
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
bull Separazione intervento da addestramento
Strenghts
bullTempi intervento chirurgico posizionamento non incrementati
bullSchema corporeo immodificato
bullPaziente ldquoambulatorialerdquo
bullIncremento pool Pazienti peritoneale
bullBreak-in e volumi intraaddominali
bullRiduzione complicanze meccaniche peri-inserzione
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Weaknesses
bull Tecnica chirurgica nuova (curva di apprendimento)
bull Intervento chirurgico in due tempi
bull Non operativitagrave sul catetere impiantato
bull impianto precoce
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Opportunities
bull Dialisi incrementale
bull Reclutamento pazienti pre-dialisi
bull Reclutamento pazienti acuti
bull Riduzione incidenza CVC
bull Letteratura
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Opportunities
bull Vascular catheter use was predictive of mortality
bull Both AVG and vascular catheter use in incident hemodialysis patients are associated with significant excess of total mortality
Vascular access and all-cause mortality a propensity score analysis
Polkinghorne KR J Am Soc Nephrol 2004 Feb15(2)477-86SourceThe Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Moncrief-Popovich technique is an advantageous method of peritoneal dialysis catheter implantation
Brum S NDT 2010 Sep25(9)3070-5
467 catheters rarrmini-laparotomy with MP method in 180 (385)
The MP technique was significantly associated with
bull a lower rate of early exit-site infection (ESI) (P = 002)
bull lower rate of leak (P lt 00001)
bull lower rate of obstruction (P = 0034) in spite of prolonged break-in (median 55 days range 0-991 days)
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Peritoneal dialysis catheter embedment surgical considerations expectations and
complicationsCrabtree JH Burchette RJ Am J Surg 2013 Jul 12
A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period Factors influencing duration of embedment functionality upon externalization and long-term outcomes were analyzed
Mean duration of embedment was 139 months (median 94 range 5 to 685) Immediate function was exhibited in 857 of catheters Employing laparoscopic revision 988 of embedded catheters were successfully used for peritoneal dialysis
Conclusion Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed Complications are few and easily managed
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Threats
bull Letteratura
bull Ambiente interno
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Abdominal visceral perforation by buried peritoneal dialysis catheters Cause or coincidenceYao J1 Witherspoon L1 McCormick BB2 Belanger E3 Warren JE1
Semin Dial 2018 Mar 7 doi101111sdi12690
Asymptomatic Peritoneal Leukocytosis After Exteriorization of Buried Peritoneal Dialysis Catheters A Case SeriesRandah Dahlan1 Joanne M Bargman2 Mohan Biyani1 Susan Lavoie1 and Brendan B McCormick1
Perit Dial Int 2015 Jan-Feb 35(1) 103ndash105
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate exit-sitetunnel infection rate or all-cause mortality
Catheter type placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Strippoli GF Tong A Johnson D Schena FP Craig JC
SourceCochrane Renal Group Centre for Kidney Research NHMRC Centre for Clinical Research Excellence in Renal Medicine
Childrens Hospital at Westmead Locked Bag 4001 Westmead 2145 NSW Australia
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
bull Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe
bull Shorter break-in periods are not associated with more catheter-related complications
bull The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications
Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters
Yang YF PDI 2011 Sep-Oct31(5)551-7
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Subcutaneous burying of the distal catheter segment prior to starting
PD does not reduce the risk of contracting peritonitis or exit-site infection
A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection
Danielsson A PDI 2002 Mar-Apr22(2)211-9
60 randomized patients rarr 30 MP 66 patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate
Elhassan E PDI 2011 Sep-Oct31(5)558-64
bull 134 catheters were implanted and externalized rarr 122 catheters
bull break-in 405 days (range 2 - 788 days)
bull 13 catheters (107) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3) (12 -gt laparoscopically
bull Other complications incision site and tunnel infection in 2 cases (16) exit-site leak in 2 cases (16) and coagulase-negative staphylococcal peritonitis in 1 case (08)
Duration of catheter embedment before externalization did not affect catheter survival
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Time between peritoneal dialysis catheter insertion and use
Elhassan E Contribut Nephrol 2012178228-31
Such advantages may encourage wider use of the Moncrief-Popovich technique in PD units Observational studies indicate that the duration of catheter embedment between implantation and externalization does not appear to affect catheter survival
Larger studies are still awaited to further explore the optimum duration of embedment
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
n Ds range
cateteri impiantati 236
pazienti 234
Etagrave anagrafica inserzione (anni)(mediana)
73 1421 25-89
Intervallo posizionamento-smarsupializzazione (giorni) (mediana)
92 376 8- 2649
Sopravvivenza catetere (giorni) (mediana)
620 624 6-2702
Casistica (2007-2018)
32
14
decesso
infezione
altro
trapianto
trasferimento
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
Pazienti
- Uomini
- Donne
- Totale
141 (603)
93 (397)
234
Etagrave media
- Della popolazione in studio
- Allrsquoinserimento del CP73 anni (DS 15)
66 anni (DS 14)
Patologia di base
- Nefroangiosclerosi
- Glomerulonefriti
- Diabete Mellito
76 (32)
50 (214)
39 (167)
Comorbilitagrave
- Ipertensione
- Cardiopatia
- AOCPVasculopatia
180 (77)
100 (43)
70 (30)
Clearance media (creatinina-urea)
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP12 mlmin (max 25 ndash min 4 mlmin)
8 mlmin (max 23 ndash min 1 mlmin)
Diuresi residua media
- Allrsquoinserimento del CP
- Alla smarsupializzazione del CP1930 mldie
1860 mldie
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait
ldquoNon possiamo pretendere che le cose cambino se continuiamo a fare le stesse coserdquo
-Albert Einstein -
stefanomanganoasst-larianait