Clinical experience of REcanalisation and balloon-oriented puncture for Re-insertion of long- term dialysis catheter in nonpatent central veins / 中华肾脏病杂志

It is difficult to insert long-term dialysis catheters after severe stenosis or occlusion of the internal jugular vein and innominate vein. We used REcanalisation and balloon-oriented puncture for Re-insertion of dialysis catheter in nonpatent central veins (REBORN) in seven patients with severe central venous lesions, and all patients were inserted with long-term dialysis catheters successfully. None had severe complications such as pneumothorax, hemothorax, or pulmonary embolism during operation. All catheters functioned well after postoperative follow-up of 2 months. REBORN provides a novel approach to establish difficult dialysis pathways.

Mal-positioning of dialysis catheter in anomalous left superior pulmonary vein in a patient with acute type a dissection, a case report

Abstract The partial anomalous pulmonary vein drainage is a rare congenital defect. The pulmonary vein drains in to a systemic vein instead of draining in to the left atrium. In this rare birth defect, the right sided pulmonary vein involvement is more prevalent than the left sided pulmonary veins. We present a case where the anomalous left superior pulmonary vein was diagnosed when a renal dialysis catheter (size = 12F x 16cm) was mal-positioned in to the Anomalous left superior pulmonary vein, demonstrating confusing blood results. We describe how a systematic multidisciplinary approach and use of advanced imaging techniques can recognise and deal with this rare clinical dilemma.

Laparoscopic peritoneal dialysis catheter implantation in peritoneal chemotherapy for gastric cancer with peritoneal metastasis / 中华胃肠外科杂志

Objective@#To investigate the clinical value of laparoscopic peritoneal dialysis catheter implantation in peritoneal chemotherapy for gastric cancer with peritoneal metastasis.@*Methods@#From January 2019 to June 2019, the clinical data of 6 patients diagnosed as gastric cancer with peritoneal metastasis were retrospectively analyzed in the Gastrointestinal Surgery Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Five were male and 1 was female. The median age was 69.5 (28-77) years. The median body mass index (BMI) was 22.8 (19.6-23.5). All procedures were performed under general anesthesia with endotracheal intubation. The patient′s body position and facility layout in the operating room were consistent with those of laparoscopic gastrectomy. The operator′s position: the main surgeon was located on the right side of the patient, the first assistant stood on the left side of the patient, and the scopist stood between the patient′s legs. Surgical procedure: (1) trocar location: three abdominal trocars was adopted, with one 12 mm umbilical port for the 30° laparoscope (point A). Location of the other two trocars was dependent on the procedure of exploration or biopsy as well as the two polyester cuff position of the peritoneal dialysis catheter: Usually one 5 mm port in the anterior midline 5 cm inferior to the umbilicus point was selected as point B to ensure that the distal end of the catheter could reach the Douglas pouch. The other 5 mm port was located in the right lower quadrant lateral to the umbilicus to establish the subcutaneous tunnel tract, and the proximal cuff was situated 2 cm away from the desired exit site (point C).(2) exploration of the abdominal cavity: a 30° laparoscope was inserted from 12 mm trocar below the umbilicus to explore the entire peritoneal cavity. The uterus and adnexa should be explored additionally for women. Once peritoneal metastasis was investigated and identified, primary laparoscopic peritoneal dialysis catheter implantation was performed so as to facilitate subsequent peritoneal chemotherapy. Ascites were collected for cytology in patients with ascites. (3) peritoneal dialysis catheter placement: the peritoneal dialysis catheter was introduced into the abdominal cavity from point A. Under the direct vision of laparoscopy, 2-0 absorbable ligature was reserved at the expected fixation point of the proximal cuff (point B) for the final knot closure. Non-traumatic graspers were used to pull the distal cuff of peritoneal dialysis catheter out of the abdominal cavity through point B. The 5-mm trocar was removed simultaneously, and the distal cuff was fixed between bilateral rectus sheaths at the anterior midline port site preperitoneally. To prevent subsequent ascites and chemotherapy fluid extravasation, the reserved crocheted wire was knotted. From point C the subcutaneous tunnel tract was created before the peritoneal steath towards the port site lateral to the umbilicus. Satisfactory catheter irrigation and outflow were then confirmed. Chemotherapy regimen after peritoneal dialysis catheterization: all patients began intraperitoneal chemotherapy on the second day after surgery. On the 1st and 8th day of each 3-weeks cycle, paclitaxel (20 mg/m2) was administered through peritoneal dialysis catheter, and paclitaxel (50 mg/m2) was injected intravenously. Meanwhile, S-1 was orally administered twice daily at a dose of 80 mg·m-2·d-1 for 14 consecutive days followed by 7-days rest. To observe the patients′ intraoperative and postoperative conditions.@*Results@#All the procedures were performed successfully without intraoperative complications or conversion to laparotomy. No 30 day postoperative complications were observed. The median operative time was 33.5 (23-38) min. The median time to first flatus was 1(1-2) days, and the median postoperative hospital stay was 3 (3-4) days, without short-term complications within 30 days postoperatively. The last follow-up was up to July 10, 2019, and the patients were followed for 4(1-6) months. No ascites extravasation was observed and no death occurred in the 6 patients. There was no catheter obstruction or peritoneal fluid extravasation during and after chemotherapy.@*Conclusion@#Laparoscopic peritoneal dialysis catheter implantation was safe and feasible for patients with peritoneal metastasis of gastric cancer. The abdominal exploration, tumor staging and the abdominal chemotherapy device implantation can be completed simultaneously, which could simplify the surgical approach, improve the quality of life for patients and further propose a new direction for the development of abdominal chemotherapy.

Rectus sheath block in peritoneal dialysis catheter implantation / 临床麻醉学杂志

Objective To observe anesthetic effects of ultrasound-guided rectus sheath block (RSB)in peritoneal dialysis catheter implantation in patients with end-stage renal disease. Methods A total of 75 uremic patients (38 males,37 females,aged 18-65 years,BMI 18.5-24 kg/m2,ASA physical status Ⅲ),scheduled for elective peritoneal dialysis catheterization,were randomly divided into three groups (n=25 each)using a random number table:group A:total intra-venous anesthesia;group B:rectus sheath block,0.5% ropivacaine 15 ml were injected into the lat-eral rectus sheath;group C:local infiltration anesthesia was performed with 1% lidocaine and 0.5% ropivacaine.The mean arterial pressure and heart rate at the point of entering the operating room (T0),10 min after anesthesia induction (T1),at the beginning of operation (T2),20 min after the beginning of operation(T3),and at the end of the operation(T4)were recorded.The VAS score and Ramsay score at 2,4,8,12,24 h after surgery were recorded.The duration of operation and the oc-currence of adverse reactions were recorded.Results In group A,compared with T0,MAP and HR at T1-T3decreased significantly (P<0.05).In group B,there were no difference among T0-T4.In group C,compared with T0,T1and T4,MAP and HR at T2,T3increased significantly(P<0.05). Compared with group C,the duration of operation time in group A and group B decreased significantly (P<0.05).Compared with group A and group C,the VAS score at each point of group B was lower (P<0.05).Compared with group B,the total number of remediation analgesia in group C increased significantly(P<0.05).There was no adverse reaction in all three groups.Conclusion Ultra-sound-guided rectus sheath block anesthesia is safe and effective in peritoneal dialysis catheter implanta-tion patients with end-stage renal disease,and is worthy of clinical promotion.

Central venous catheter malposition due to dialysis catheter: a case report / 대한마취과학회지

A 56-year-old man on maintenance hemodialysis was admitted to the intensive care unit with septic shock and coagulopathy. As there was a dialysis catheter in the right internal jugular vein, the left internal jugular vein was cannulated with a central venous catheter to initiate vasopressor therapy. A chest X-ray showed formation of a catheter loop inside the left brachiocephalic vein, probably due to hindrance by the dialysis catheter. This report describes the hurdles encountered, repeated cannulation attempts, and serial chest X-ray findings required to obtain acceptable placement of the catheter tip.

Comparison of the Laparoscopic and Open Peritoneal Dialysis Catheter Insertion in Children

The aim of this study was to compare peritoneal dialysis catheter insertion by the open method to the laparoscopic method. Twenty four laparoscopic and 10 open peritoneal dialysis catheter placements were performed in children between 2001 and 2008. Patient characteristics, operation related data, procedural complications and clinical outcome were compared. Although there were no cases of catheter obstruction, exit site infection or bleeding in the laparoscopic group, compared to the open method, there was no statistically significant difference between the two groups. Catheter removal rate due to complication was high in the open group and catheter survival rate was high in the laparoscopic group. We concluded that laparoscopic peritoneal dialysis catheter placement is feasible in children of all age groups with at least equivalent functional results compared to the open method. An advantage of laparoscopic catheter insertion is removal of the great omentum and easy fixation of the catheter to the abdominal wall.

Catheter meaning for the adolescents in dialysis / Significado del catéter para los(as) adolescentes en diálisis

Goal: Terminal renal failure affects all the person’s life dimensions. The impact of this illness during adolescence is quite dramatic because the adolescent must live with the illness demands and the demands from this crucial developmental stage. Knowledge regarding the impact of the dialysis catheter on the adolescent’s life is spare. Methodology: A phenomenological study was carried out with 8 female and male adolescents that were in dialysis. Findings: The adolescents had to learn to live with the dialysis catheter in their body. The catheter became an obstacle to achieve their identity and deteriorated their physical appearance and peer relationships.

Objetivo: La insuficiencia renal terminal afecta todas las dimensiones de la vida de las personas. El impacto de esta enfermedad durante la adolescencia es más dramático debido a que el(a) adolescente debe además de superar las demandas de esta etapa de la vida, vivir según las demandas de la enfermedad. El conocimiento sobre el impacto del catéter para la diálisis en la vida de los (as) adolescente es escaso. Metodología: Se realizó un estudio fenomenológico con 8 jóvenes de ambos sexos que estaban en diálisis. Resultados: Los(as) jóvenes tuvieron que aprender a vivir con el catéter en su cuerpo. El catéter les generó deterioro de la apariencia física y de las relaciones con los pares, además se constituyó en un obstáculo para lograr la identidad.

Comparison of Early Complications after Peritoneal Dialysis Catheter Implantation by Laparoscopic Surgery and Conventional Surgery in Children

PURPOSE: To assess the early complication of laparoscopic peritoneal dialysis catheter implantation in children. METHODS: Medical record review was carried out on 21 laparoscopic and 16 conventional peritoneal dialysis catheter implantations which were performed in 31 children under 18 years of age between 2002 and 2006. All medical records were retrospectively analyzed. The patients were followed until 2 months after catheter placement. Patient characteristics and catheter-related complications, such as significant bleeding, leakage, obstruction, migration, insertion site infection and peritonitis during the first 60 days after implantation were recorded. RESULTS: After conventional operation, dialysate leakage occurred in 2 of 16 cases and all cases improved after conservative management. In 1 case, significant bleeding occurred and re-operation was performed. Three cases of obstruction due to migration were reported, 2 cases underwent reoperation and 1 case improved without intervention. After laparoscopic surgery, outflow obstruction occurred in 1 out of 21 cases, which was caused by adhesion after several reinsertions of the catheter and recurrent peritonitis. No migration was noted after laparoscopic surgery. There was no significant difference in the complication rate between the two groups. CONCLUSION: Laparoscopic peritoneal dialysis catheter placement is feasible in children of all age groups, with at least equivalent functional results compared to conventional surgery. The additional advantage of laparoscopic catheter insertion is the option to identify and eliminate anatomical risk factors, such as intra-abdominal adhesions, and to perform partial omentectomy without additional incisions.

A Case of Visible Alternaria spp. Colonization on Peritoneal Dialysis Catheter without Peritonitis in a CAPD Patient / 대한신장학회잡지

Visible fungal colonization on peritoneal dialysis catheter is a rare complication and it was not reported yet in Korea. We here report a case of Alternaria spp. colonization on peritoneal dialysis catheter without peritonitis. A 58-year-old man on continuous ambulatory peritoneal dialysis for 2 years, noticed 3-4 mm sized two black-brown immobile fungal colonization plaque on peritoneal catheter lumen (15 cm distal from catheter exit site). The dialysate effluent was clear and culture for fungus and bacteria was negative. Peritoneal catheter was removed and culture from the plaque revealed saprophytic fungus, Alternaria species. The catheter removal alone was sufficient for the treatment. He is on hemodialysis thereafter.