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  1. #1
    Anonymous Guest

    Default Catheter repositioning procedure

    Hello,

    My husband has been a PD patient for about 4 years now. He has been struggling with keeping the fluid off because of absorption and then not draining well. He even has been put on icodextrin for his daytime dwell. Well, the nephr. ordered an xray and the catheter is up really high behind his liver. So, the nephr. has suggested that the catheter be repositioned. I was wondering if anyone had something similar done and was still able to continue PD. I have read that it can be done as a laparascopic procedure, but I'm not sure if that is common. I know that when he had his hernias repaired we did low volume PD for a little while to allow everything to heal.

    Thanks for the help.

    Amy

  2. #2
    Join Date
    08-17-04
    Posts
    2,126

    Default

    Hi Amylynne (what a pretty name!) and welcome to Home Dialysis Central. I'm not a doctor or a patient, but I did do some research for you. This is what I found. It sounds as if surgery is not the only way to move a PD catheter that has migrated out of position. I found two studies, one from 1999 and one from 2001 about using a radiology procedure instead. Here are the abstracts--you can print this and ask your husband's doctor whether this might be an option for him.
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    Br J Radiol. 1999 May;72(857):452-6.

    The repositioning of migrated Tenckhoff continuous ambulatory peritoneal dialysis catheters under fluoroscopic control.

    Dobrashian RD, Conway B, Hutchison A, Gokal R, Taylor PM.

    We describe a non-invasive, simple technique which, under fluoroscopic control, repositions migrated Tenckhoff CAPD catheters back into the pelvis. 18 patients, who had a total of 23 manipulations, were studied retrospectively over 2 1/2 years. Technical success (successful repositioning of the catheter at screening) and clinical success (continued effective CAPD for at least 6 months thereafter) were obtained in 84% and 45% of patients respectively. The results showed this technique to be effective in restoring the correct catheter position in CAPD patients whose catheters have migrated. Clinical success was more likely to be achieved in patients who had fewer risk factors for the development of peritoneal adhesions. The use of custom-made stainless steel wires eased manipulations and significantly reduced the radiation dose to patient and operator from the procedure.
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    Am J Kidney Dis. 2000 Feb;35(2):301-5.
    *
    Role of Fogarty catheter manipulation in management of migrated, nonfunctional peritoneal dialysis catheters.

    Gadallah MF, Arora N, Arumugam R, Moles K.

    Peritoneal dialysis (PD) catheter migration to the upper abdomen is not an uncommon cause of catheter failure. We prospectively examined the role of the Fogarty catheter manipulation technique to reposition the PD catheter in the pelvis and regain patency. All patients with PD catheter malfunction caused by migration, confirmed by abdominal radiograph, underwent the same protocol. The patient was placed flat on the back, and the Fogarty was advanced into the PD catheter to a premarked point at which the end of the Fogarty was near the end of the PD catheter. The Fogarty balloon was inflated with 0.5 mL of sterile saline, and manipulation was performed by tugging movements until proper placement of the PD catheter into the pelvis was suspected. Infusion and drainage of dialysate was performed to determine patency. The return of the PD catheter into the pelvis was then confirmed by repeated radiograph. Success rates of Fogarty catheter manipulation, early and late recurrence (remigration < or =90 days or >90 days), and complications were prospectively examined in 232 patients over a 6-year period. Catheter migration occurred in 34 of 232 patients (15% incidence). All patients had curled-end, double-cuffed, non-swan-neck PD catheters. Successful repositioning occurred in 24 of 34 patients (71%). None of the 24 repositioned catheters had early recurrence, and 1 of 24 catheters (4%) had late recurrence. None of the patients had procedure-related peritonitis, bowel perforation, or exit-site trauma. These results show that PD catheter migration is relatively common (15%). The Fogarty manipulation technique is a simple, cost-effective way to prolong PD catheter life and preserve its long-term patency. This eliminates the need for surgical intervention in approximately 70% of patients with PD catheter migration.

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