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Pull Technique is a Safe and Feasible Approach to Peritoneal Dialysis Catheter Removal - Experience of a Single Surgeon
Sue Ting Lim1, Vikram S. Bhatt1, Jennifer Sayers2, John Alexander Palesty1
1General Surgery, Saint Mary's Hospital, Waterbury, Connecticut, United States, 2Saba University School of Medicine, Dutch Caribbean, Netherlands

Objective. To demonstrate the safety and feasibility of adopting the pull technique in peritoneal dialysis (PD) catheter removal.

Design. A descriptive study of a case series

Setting. Community teaching hospital

Patients. Thirty-one patients underwent PD catheter removal from July 2017 to December 2021 for various indications. Ten patients had their PD catheter removed secondary to peritoneal dialysis-related infections (32%), 12 patients had their PD catheter removed due to mechanical failure. The remaining nine patients transitioned to hemodialysis due to personal preference. PD catheter placement and removal interval is ten days to 58 months.

Interventions. All patients consented to PD catheter removal using the pull technique, with a possible laparoscopic or open approach in the event of catheter breakage. In our practice, we performed the PD catheter removal in the operating room under procedural sedation, setting up for general anesthesia in preparation for a possible open approach. Sustained traction is applied to the PD catheter until the catheter is released from the cuffs. PD catheter will easily slide off once it is released from the cuff. Both the superficial and deep cuffs are left behind with the pull technique. In the event of catheter breakage, general anesthesia is induced, and the PD catheter will then be removed in the usual open approach by cuff dissection.

Main Outcome Measures. Postoperative infection rate after removal of PD catheter using the pull technique. Secondary outcomes are complication rate and operating room time.

Results. There were no postoperative infections associated with retained cuff after removing the PD catheter, which necessitated cuff removal in our patient cohort. One patient had cellulitis around the catheter site that was treated with a course of oral antibiotics. The mean time for catheter removal with the pull technique is 4 minutes. Only one patient required general anesthesia and conversion to open removal technique due to catheter breakage as the patient had an extension tubing with an additional connection (3%). Post PD catheter removal, 26 patients (84%) were required to transition to hemodialysis.

Conclusions. Patients with end-stage renal disease often have multiple comorbidities and are at higher risk for bleeding and wound complications associated with surgery. Our series shows that the pull technique can be safely employed for PD catheter removal under minimal sedation with no increased complication rate, mitigating any possible complications associated with general anesthesia.


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