Safety and efficacy of percutaneous insertion of peritoneal dialysis catheters under sedation and local anaesthetic

Background. Success of peritoneal dialysis (PD) is partially dependent on the ease of insertion of the catheter. We have been inserting PD catheters percutaneously in a majority of our patients under local anaesthetic and sedation by physicians, and detail here the outcomes for 283 catheters inserted in this manner, and 150 patients with surgical catheter insertion by laparotomy or laparoscopy. Methods. Data were collected prospectively on all patients having PD catheters inserted between 1999 and 2008, including success of insertion, complications and infections. Results. A total of 283 catheters were inserted percutaneously using a Seldinger technique under sedation and local anaesthesia, and 150 surgically under general anaesthetic. Eighty-six percent of the percutaneous catheters and 66% surgical catheters were first catheters. No major complications occurred. In 7% of the percutaneous patients and 5% surgical patients, the procedure failed or was abandoned. Poor initial drainage occurred in 21% insertions but resolved in most cases and resolved dialysate leak in 6%. Wound infections or peritonitis occurred in 9% and 4% of percutaneous insertions. Only 13% of patients could not use their catheter at I month after percutaneous insertion, and 83% of the patients remained on PD using the original catheter at 6 months. Conclusions. Percutaneous PD catheter insertion was associated with a very low complication rate and high primary success rate, and was highly efficient in use of resources and avoided the need for general anaesthesia.