EXPERIENCE WITH DIFFICULT CAPD CATHETER INSERTION

1
EXPERIENCE WITH DIFFICULT CAPD CATHETER
INSERTION

• Dr.Sunil Shroff
• Dept. of Urology Transplantation,
• Sri Ramachandra Medical College Research
  Institution, Chennai, India

2
SUCCESS OF CAPD

• Long Term Success of Continuous Ambulatory
  Peritoneal Dialysis depends on Successful CAPD
  Catheter Implantation

3
CAPD CATHETER IMPLANTATION

• Meticulous Surgical Technique to perform this
  simple procedure usually successful with minimum
  morbidity

4
RELATIVE CONTR-INDICATIONS TO CAPD CATHETER
INSERTIONS

• Previous Abdominal Surgeries
• Incisional Hernias
• Obese Patients
• Repeated Peritonitis
• Repeated Catheter Malfunction
• Children If catheter Size mismatch with
  catheter

5
DIFFICULT - CAPD CATHETER INSERTIONS

• Previous Abdominal Surgery (10)
• Repeated Peritonitis Episodes Requiring Removal
  and Re-insertion of Catheter (5)
• Catheter malfunction requiring Catheter
  Re-insertion (3)
• Associated Abdominal Hernias (3)
• Grossly Obese patients (2)
• Pediatric patients (3)

6
CAPD Catheter Pre-op Drill

• Antibiotics with Pre-Med
• Laxatives / Enemas / Suppository
• Betadine Scrub Abdomen, Groin, Perineum Half
  a dozen Times
• Shave only if necessary and in operating Room
• Bladder emptied before Implantation

7
RESULTS - DIFFICULT - CAPD CATHETER INSERTIONS

• Except on one occasion CAPD Catheter was
  succsessfully Implanted on all Patients

8
SECRET OF SUCCESS

• FOLLOWING BASIC SURGICAL PRINCIPLES METICULOUSLY
  FOR THIS PROCEDURE
• Pre-empting Difficulties
• A No Touch technique for CAPD catheter
  implantation
• Regional Anaesthesia for procedure

9
SECRET OF SUCCESS

• Keeping the Right Inventory of CAPD Catheters
• Combining Procedures if necessary e.g. Hernia
  repair with Catheter Implantation
• Doing a Test Run of Inflow Outflow of Fluid
  Before Closure of Abdomen

10
Catheter Inventory

• Oreopolous Catheter found to be the best
  catheter under difficult circumstances
• ( In only one instance in an obese patient this
  catheter failed )
• Straight Catheters Should be used for Obese
  Patients
• Pediatric Catheters should be used (Avoid
  Trimming of adult Catheters) for children

11
Rescue CAPD catheter

• Oreopolous catheter
• 1. Use Where Abdominal Adhesions Expected after
  surgery
• Previous Abdominal surgery
• Complex incisional Hernias to be concurrently
  repaired
• 2. Re-do CAPD catheters Implantation where
  Previous Catheter malfunction

12
DACRON CUFFS OBESE PATIENTS

• For Obese Patients
• Standard Seperation Between Two Dacron Cuffs of
  CAPD catheters inadequate

• To Circumvent Problem
• Another Dacron Cuff added placed 2.5cms from
  exit site

13
CAPD CATHETER INSERTIONS IN CHILDREN

• If Smaller Sized catheters not available for
  children?

• Ans. Use a High Insertion of catheter rather
  than trimming catheter. Otherwise will lose the
  holes in the catheter and this may lead to
  catheter malfunction

14
ROLE OF CYCLER In Difficult CAPD Implantation

• Cycler if available can be used to institute Low
  volume exchanges early on after implantation
• ( We used Cycler within 3 days after implantation
  of catheter )

15
CONCLUSION

• For Difficult Surgical Group of patients the
  Surgical principles are generally similar
• Keeping a CAPD Catheter Inventory is helpful
  and increases chances of successful Implantation
  of Catheter
• Oreoplous catheter is a Good Rescue Catheter
• There are no real contra-indications to CAPD
  catheter Insertions