Tenckhoff catheter salvage by closed stiff-wire manipulation without fluoroscopic control.

OBJECTIVE

To describe the results of Tenckhoff catheter salvage by a modified, closed, stiff-wire manipulation technique without the use of general anesthesia or fluoroscopy, and compare this with previously described techniques.

DESIGN

Retrospective study in patients treated with continuous ambulatory peritoneal dialysis (CAPD) over a 41-month period.

SETTING

Renal unit in an inner city hospital.

PATIENTS: Eighteen patients using CAPD who had 22 episodes of outflow failure due to radiologically confirmed malposition of straight two-cuff Tenckhoff catheters.

INTERVENTIONS: Closed stiff-wire manipulation of malpositioned Tenckhoff catheter without the use of general anesthesia or fluoroscopy.

MAIN OUTCOME MEASURES: Initial success rate of manipulation, catheter and technique (CAPD) survival, and procedure-related complications.

RESULTS

Catheter manipulation was technically successful in 21 of 22 cases. An additional six episodes of malposition occurred ranging from 2 to 630 days after the primary manipulation (median 7 days). A second manipulation was carried out in four cases that resulted in long-term success in two. Three patients were forced to discontinue CAPD for reasons other than catheter malposition, and the overall success rate at 1 month (patient successfully performing CAPD) was 59.1% (+/-0.1%). No major complications were experienced during the procedure and no episodes of peritonitis occurred.

CONCLUSION

The technique described is relatively straightforward, does not require fluoroscopy or general anesthetic, and its success is comparable to previously reported methods of Tenckhoff catheter salvage. We would recommend this technique of catheter salvage in patients with Tenckhoff catheter malposition in whom conservative treatment has failed.