Trouble shooting PD catheter dysfunction from Nephrologist view

1. 1

2. Choice matters:
trouble shooting
PD catheter Dysfunction
Kamol Khositrangsikun M.D.
Maharaj Nakhonsithammarat Hospital
2

3. Ideal PD access
3

4. Ideal PD access
¡ Surgical handling
¡ Minimal trauma / pain
¡ Maintain stable position without extrusion of cuffs
¡ Hydraulic function
¡ Rapid fluid infusion without pain
¡ Allow complete drain
4

5. Ideal PD access
¡ Biocompatibility
¡ No induction of inflammation, sclerosis &
adhesion of peritoneal membrane
¡ Resistance to infection
¡ Allow PD therapy for many years
¡ Affordable
5

6. PERITONEAL DIALYSIS

7. Before
insertion
Catheter
within
Trouble shooting PD catheter Dysfunction

8. Before
insertion
Trouble shooting PD catheter Dysfunction

9. Contraindication to PD
¡ Contraindications to percutaneous catheter
insertion were
! Open abdominal surgery other than
appendectomy or cesarean section
! A bleeding tendency
! Pre- existing hernia requiring simultaneous repair
▪ Otherwise, the chosen method of insertion depended
largely on the caring physician’s preference and operator
availability.
9Perit Dial Int 2012; 32(6):628-635

10. 10Perit Dial Int 2010; 30:424–429
PRACTICE GUIDELINES FOR PERITONEAL ACCESS

11. PRACTICE GUIDELINES FOR PERITONEAL ACCESS
¡ Guideline 1 : The access team
¡ Guideline 2: Timing & coordination of referral
& surgery
¡ Guideline 3 : Implantation protocol
¡ Guideline 4 : The implantation technique
¡ Guideline 5 : Facilities for PD catheter insertion
¡ Guideline 6 : Training for PD catheter insertion
¡ Guideline 7 : Audit of PD catheter insertion
11Perit Dial Int 2010; 30:424–429

12. PRACTICE GUIDELINES FOR PERITONEAL ACCESS
¡ Guideline 1 : The access team
¡ Guideline 2: Timing & coordination of referral
& surgery
¡ Guideline 3 : Implantation protocol
¡ Guideline 4 : The implantation technique
¡ Guideline 5 : Facilities for PD catheter insertion
¡ Guideline 6 : Training for PD catheter insertion
¡ Guideline 7 : Audit of PD catheter insertion
12Perit Dial Int 2010; 30:424–429

13. PRACTICE GUIDELINES FOR PERITONEAL ACCESS
¡ Guideline 1 : The access team
¡ Guideline 2: Timing & coordination of referral
& surgery
¡ Guideline 3 : Implantation protocol
¡ Guideline 4 : The implantation technique
¡ Guideline 5 : Facilities for PD catheter insertion
¡ Guideline 6 : Training for PD catheter insertion
¡ Guideline 7 : Audit of PD catheter insertion
13Perit Dial Int 2010; 30:424–429

14. The access team
14

15. PRACTICE GUIDELINES FOR PERITONEAL ACCESS
¡ Guideline 1 : The access team
¡ Guideline 2: Timing & coordination of referral
& surgery
¡ Guideline 3 : Implantation protocol
¡ Guideline 4 : The implantation technique
¡ Guideline 5 : Facilities for PD catheter insertion
¡ Guideline 6 : Training for PD catheter insertion
¡ Guideline 7 : Audit of PD catheter insertion
15Perit Dial Int 2010; 30:424–429

16. PRACTICE GUIDELINES FOR PERITONEAL ACCESS
¡ Guideline 1 : The access team
¡ Guideline 2: Timing & coordination of referral
& surgery
¡ Guideline 3 : Implantation protocol
¡ Guideline 4 : The implantation technique
¡ Guideline 5 : Facilities for PD catheter insertion
¡ Guideline 6 : Training for PD catheter insertion
¡ Guideline 7 : Audit of PD catheter insertion
16Perit Dial Int 2010; 30:424–429

17. Methods of placement TK catheters
¡ Percutaneous, blind (with/without fluroscopy)
¡ Direct visualization
! Peritoneoscopic
! Open , surgical dissection
! Laparoscopic
17

18. Open, Surgical dissection
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19. Open, Surgical dissection
¡ In 1968, Dr. Henry Tenckhoff developed the
indwelling peritoneal catheter, which was
placed via an open surgical technique
www.pdiconnect.com/content/3/1/47.full.pdf
19

20. Seldinger technique
20

21. Seldinger technique
¡ The Seldinger technique is a medical
procedure to obtain safe access to blood
vessels and other hollow organs.
http://en.wikipedia.org/wiki/Seldinger_technique#cite_note-Seldinger-1
21

22. Seldinger technique
¡ Dr. Sven-Ivar Seldinger
.: (1921-1998)
¡ Swedish radiologist from
Mora, Dalarna County,
who introduced the
procedure in 1953.
22

23. 23
Site for incision to make entry

24. 24
Abdominal wall thickness

25. New site for incision
25

26. 26Perit Dial Int 2017; 37(2):141–154
PREVENTION OF CATHETER-RELATED INFECTIONS

27. PREVENTION OF CATHETER-RELATED INFECTIONS
27Perit Dial Int 2017; 37(2):141–154

28. PRACTICE GUIDELINES FOR PERITONEAL ACCESS
¡ Guideline 1 : The access team
¡ Guideline 2: Timing & coordination of referral
& surgery
¡ Guideline 3 : Implantation protocol
¡ Guideline 4 : The implantation technique
¡ Guideline 5 : Facilities for PD catheter insertion
¡ Guideline 6 : Training for PD catheter insertion
¡ Guideline 7 : Audit of PD catheter insertion
28Perit Dial Int 2010; 30:424–429

29. PRACTICE GUIDELINES FOR PERITONEAL ACCESS
¡ Guideline 1 : The access team
¡ Guideline 2: Timing & coordination of referral
& surgery
¡ Guideline 3 : Implantation protocol
¡ Guideline 4 : The implantation technique
¡ Guideline 5 : Facilities for PD catheter insertion
¡ Guideline 6 : Training for PD catheter insertion
¡ Guideline 7 : Audit of PD catheter insertion
29Perit Dial Int 2010; 30:424–429

30. Peritoneal Dialysis Catheters
30

31. Peritoneal Dialysis Catheters
31
http://slideplayer.com/slide/9705087/
Tungsten tip

32. Peritoneal Dialysis Catheters
http://www.covidien.com/dialysiscatheter/pages.aspx?page=Products/PeritonealAccess
32

33. 33
PRACTICE GUIDELINES FOR PERITONEAL ACCESS
Perit Dial Int 2010; 30:424–429

34. PREVENTION OF CATHETER-RELATED INFECTIONS
34Perit Dial Int 2017; 37(2):141–154

35. Catheter
within
Trouble shooting PD catheter Dysfunction

36. PD catheter flow dysfunction algorithm
¡ Step 1 : Evaluate for extraluminal issues
¡ Step 2 : Evaluate for intraluminal issues
¡ Step 3 : Evaluate for catheter position
¡ Step 4 : Evaluate for anatomical interference
36
https://www.homebybaxter.com/Documents/Downloadable%20Files/AL12172A-AFP-PD-Catheter-Flow-Dysfunction-Algorithm.pdf

37. 37
PD catheter flow dysfunction algorithm
https://www.homebybaxter.com/Documents/Downloadable%20Files/AL12172A-AFP-PD-Catheter-Flow-Dysfunction-Algorithm.pdf

38. Nonsurgical approaches for the correction
of malfunctioning PD catheters
• Stiff wire manipulation
• Fluoroscopic manipulation
• Fogarty catheter manipulation
• Double guidewire method
• Non-traumatic maneuver for repositioning
38

39. Fluoroscopic manipulation
39

40. Steps in manual repositioning of a
migrated peritoneal dialysis catheter.
40Wen-Ting Tu, Perit Dial Int 2009; 29:325–329

41. Steps in manual repositioning of a
migrated peritoneal dialysis catheter.
41
Wen-Ting Tu, Perit Dial Int 2009; 29:325–329

42. Steps in manual repositioning of a
migrated peritoneal dialysis catheter.
42Wen-Ting Tu, Perit Dial Int 2009; 29:325–329

43. Surgical approaches for the correction
of malfunctioning PD catheters
• Minilaparotomy
• Laparoscopic technique
• Novel technique for repositioning
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44. Previously - try to manipulate
44

45. Previously - try to manipulate
45

46. New catheter
46

47. Back Up Hemodialysis
47

48. Trouble shooting ?
48

49. Be yourself
49

50. youtube tk nephrologist
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51. youtube tk nephrologist
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52. Thank You for Your Attention
52