In an ideal world, a patient who presents with kidney failure had prior nephrology follow-up, during which he or she was prepared for a planned dialysis start with a functional dialysis access. However, in real life, up to a third of incident dialysis patients did not have prior nephrology follow-up and moreover, unplanned dialysis start also occurs in patients with prior nephrology care. This results in a suboptimal dialysis start in up to 50% of incident dialysis patients. These patients start dialysis without prior dialysis modality education, and they start hemodialysis (HD) using a (non-) tunneled central venous catheter or require an urgent-start of peritoneal dialysis (PD).Each dialysis center should organize its PD access program to ensure that PD access is available for both planned and unplanned dialysis starters. A timely and successful insertion of PD catheters is a prerequisite for increasing the long-term use of peritoneal dialysis.Surgically inserted PD catheters, especially when inserted using an advanced laparoscopy approach, are associated with good functional outcomes and low rates of procedural and infectious complications. Nevertheless, many centers and nephrologists struggle with surgeon and anesthesiologist’s availability, and operating room capacity. Also, patients with medical contraindications for general anesthesia might benefit from an alternative approach not requiring general anesthesia.Using a modified Seldinger technique, PD catheters can be inserted “percutaneously” at the bedside under local anesthesia. Different variants of percutaneous PD catheter insertion vary in the specialty of the operator, whether or not image guidance by fluoroscopy or ultrasound is used, in incision site (subumbilical or paramedian) and whether or not low dose sedation is applied.The general principles of percutaneous PD catheter insertion are:(i) Puncture of the peritoneal cavity,(ii) Prefill of the retro-uterine or retro-vesical pouch using saline, dialysis fluid or a contrast solution,(iii) Insertion of a guidewire through the needle into the peritoneal cavity and directed towards the pelvis,(iv) Dilator with overlying peel-away sheath is advanced through the fascia over the guidewire,(v) After removing the guidewire and dilator, the catheter is inserted through the peel-away sheath, advancing the deep cuff to the level of the fascia,(vi) After testing catheter flow function, the catheter is tunneled subcutaneously to the selected exit site. Percutaneous PD catheter
S35journal officiel du Registre de Dialyse Péritonéale de Langue Française Volume 4, supp, november 2023 ISSN 2607-9917Abstract EuroPD congress - Bruges - 2023insertion is associated with good success rates and good catheter survival. Observational data show that percutaneous PD catheter insertion is safe in terms of mechanical and infectious complications compared to surgical PD catheter insertion.Although the ISPD guidelines suggest limiting percutaneous PD catheter insertion to patients with no history of abdominal surgery or peritonitis, the UK Renal Association recognizes its value in creating timely PD access even in patients with previous abdominal surgery or peritonitis.A percutaneous PD access program provides flexible availability for PD access and supports the timely creation of PD access. In particular, a percutaneous PD catheter insertion can facilitate the use of PD in urgent or unplanned dialysis starters and in frail patients with comorbidities that are not suitable for safe use of general anesthesia
Originele taal-2English
Aantal pagina's2
TijdschriftBulletin de la Dialyse à Domicile
Nummer van het tijdschrift3
StatusPublished - 13 nov 2023
EvenementEUROPD 2023: European peritoneal dialysis meeting - Brugge, Belgium
Duur: 20 nov 202330 nov 2023


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