Should the "trocar and cannula" method be used for peritoneal catheter implantation?

Abstract

506 Peritoneal dialysis (PD) catheters are often described as the lifeline of end-stage renal failure patients receiving PD. There is no PD catheter that is definitely better than the conventional double-cuffed Tenckhoff catheter (1,2) and, in general, it is implantation technique rather than catheter design that determines the outcome of the catheter. To achieve good results, implantation must be performed by a competent, experienced, catheter insertion team. Initially, Tenckhoff catheters were implanted as a surgical procedure by surgeons using a mini-laparotomy technique. This is still the reference standard to which other implantation techniques should be compared. However, referral to surgeons may cause delay in initiating PD therapy, for both the waiting time to see a surgeon and the time required to arrange the operation afterward. The date of implantation is often not under the control of nephrologists and this may make timely implantation of a PD catheter an impossible dream. Some patients may be forced to remain on hemodialysis for months before PD catheters are implanted and they then may become reluctant to change modality to PD. Moreover, although it is a relatively minor surgery, the implantation operation requires dedication and attention to detail by the operator to yield good results. In many centers, such dedicated surgeons are not easily found, resulting in poor catheter outcomes. Therefore, nephrologists are often driven to take on catheter implantation themselves. The success of PD access procedures performed by nephrologists using various techniques has been well documented (3–7) and increases in PD utilization may result where catheter implantation by nephrologists is introduced (6,8). “Trocar and cannula” and Seldinger techniques are the usual catheter implantation methods employed by nephrologists. These procedures are relatively simple to perform, have a short learning period, and can be performed in a clean side-room. The trocar and cannula technique using the Tenckhoff trocar was the first method adopted by nephrologists for implantation of Tenckhoff catheters. With this technique, the trocar’s sharp pointed stylet is pushed through the linea alba into the lower abdomen. After entry into the peritoneal cavity, the stylet is removed and the Tenckhoff catheter is passed with a stiffening SHOULD THE “TROCAR AND CANNULA” METHOD BE USED FOR PERITONEAL CATHETER IMPLANTATION?