Pneumoperitoneum needle vs. introducer needle: Comparison of complications and short‐term outcomes in percutaneously inserted peritoneal dialysis catheters in naïve abdomens

• Published in: Therapeutic apheresis and dialysis Vol. 26; no. 1; pp. 212 - 219
• Main Authors: Dogra, Pavitra Manu, Nair, Ranjith K., Sood, Vivek, Datt, Bhaskar, Katyal, Amit, Jairam, Ananthram, Hooda, Ashok, Mendonca, Satish, Mukherjee, Debabrata, Chauhan, Parikshit, Murari, Tomala
• Format: Journal Article
• Language: English
• Published: Kyoto, Japan John Wiley & Sons Australia, Ltd 01.02.2022
• Subjects: CAPD; Catheters, Indwelling - adverse effects; Female; Humans; India; Intestines - injuries; Male; mechanical complications; Middle Aged; Needles; patient survival; percutaneous insertion; Peritoneal Dialysis, Continuous Ambulatory - instrumentation; Peritoneal Dialysis, Continuous Ambulatory - methods; Pneumoperitoneum; Retrospective Studies; technical survival; Veress needle; India; mechanical complications; patient survival; technical survival; Veress needle; pneumoperitoneum; percutaneous insertion; CAPD
• ISSN: 1744-9979; 1744-9987
• DOI: 10.1111/1744-9987.13688

Percutaneous peritoneal dialysis catheter (PDC) insertion for continuous ambulatory peritoneal dialysis (CAPD) entails a higher risk of complications such as bowel injury, vascular injury, and catheter migration compared to the surgical insertions. We conducted a comparative analysis of two techniques of peritoneal entry for PDC insertion by Seldinger technique. We performed a retrospective review of 426 percutaneously inserted PDCs in nonobese naïve abdomens for CAPD at two tertiary care teaching hospitals in India over 6 years. Comparison of various mechanical complications, and short‐term catheter survival was done between use of introducer needle (Group “I”) and spring‐loaded pneumoperitoneum (Veress) needle (Group “V”). Group “I” to “V” patient ratio was 277:149. Group “I” had heavier patients (p = 0.03) whereas “V” group had a dominance of diabetes (p = 0.009) and prior hemodialysis patients (p = 0.03). At 3 months, the odds of mechanical complications (OR = 0.27, p = 0.004), PDC migration (OR = 0.18, p = 0.02), and omental wrapping (OR = 0.13, p = 0.04) were less in “V” group. No bowel injury occurred with Veress needle use. At 6 months, “V” group had higher odds of event‐free sustained PDC tip position (OR = 0.39, p = 0.003), and catheter survival (p = 0.03), and the cumulative events were lesser too (p = 0.002). Refractory peritonitis and deaths with functioning catheter were comparable between both the groups. In this first‐of‐its‐kind study, spring‐loaded Veress pneumoperitoneum needle use was safer, entrusted sustained PDC tip position in pelvis, and had a better catheter survival compared to use of introducer needle for peritoneal entry in percutaneously inserted PDCs. These findings should be confirmed by a randomized controlled study.