Tunneled peritoneal catheters for the palliative therapy of malignant ascites

Objective:Malignant ascites presents difficult management issues in the palliative care population and results in distressing symptoms and recurrent hospital admissions.The palliative care services in Our Lady of Lourdes Hospital have been using radiologically guided tunneled peritoneal catheters for the palliative therapy of troublesome malignant ascites.We conducted a review of this management strategy.Methods:There were 10 catheters inserted in 9 patients between May 2007 and June 2011 in patients with malignant ascites.Results:There were no procedural related mortalities or major complications.Mean catheter life was 98.9 days.Post catheter re-hospitalization rate was 1.55 times per patient.Mean patient survival post insertion was 140 days.Eighty eight percent of patients achieved death at home.Conclusion:We conclude that this is a safe and useful strategy in the management of malignant ascites in a palliative care population.

Drainage of ascites in cirrhosis

For cirrhotic refractory ascites,diuretics combined with albumin and vasoactive drugs are the first-line choice for ascites management.However,their therapeutic effects are limited,and most refractory ascites do not respond to medication treat-ment,necessitating consideration of drainage or surgical interventions.Con-sequently,numerous drainage methods for cirrhotic ascites have emerged,including large-volume paracentesis,transjugular intrahepatic portosystemic shunt,peritoneovenous shunt,automated low-flow ascites pump,cell-free and concentrated ascites reinfusion therapy,and peritoneal catheter drainage.This review introduces the advantages and disadvantages of these methods in different aspects,as well as indications and contraindications for this disease.

Superiority of Laparoscopy in the Peritoneal Dialysis Catheter Reset Surgery

Peritoneal dialysis catheter surgery has been used in clinical treatment for nearly 40 years, and open surgery under local anesthesia is the conventional method. However, catheter displacement after open surgery is still the thorny issue during our clinical practice. Then the reset surgery is often required to be taken again. Nowadays, laparoscopic peritoneal dialysis catheter draws our attention due to its advantages of accurate positioning, smaller incision, and less pain, and its clinical application has been limited. While laparoscopic surgery is recognized, there are few relevant studies on whether there is difference during the catheter reset process between the two surgical approaches. In this study, we mainly discussed the rate of secondary catheter migration, the incidence of complications after catheter reset for two surgical approaches and the hospital stay as well as the total clinical cost for the two surgical approaches. In this study, we retrospectively analyzed 25 cases of end-stage renal disease, who received catheterization for peritoneal dialysis and regular peritoneal dialysis in our hospital from March 2010 to December 2013, and had a medical history of catheter migration. We collected the relevant clinical data for all patients. Fifteen patients selected laparoscopic catheter reset, and 10 patients selected the traditional surgical method for catheter reset by themselves. For all patients enrolled, we analyzed the incidence of secondary catheter migration and postoperative complications, hospitalization time, and total cost for different methods of reset. Through the studies above, we found that laparoscopic peritoneal dialysis catheter surgery offered accurate catheter location and a small incision that was easy to heal. Besides, the incidence of postoperative complications for the laparoscopic surgery was lower than that for traditional surgical approach for catheter reset. The average hospitalization time for laparoscopic surgery was shorter than that for the traditional surgical approach. The total cost of laparoscopic surgery was more than that of the traditional surgery. Therefore, the rational application of a laparoscopic peritoneal dialysis catheter and reset surgery can increase the success rate of peritoneal dialysis, reduce the complications, shorten hospitalization time of patients, and thus enhance patient＇s confidence to stick it out.

Bladder perforation injury after percutaneous peritoneal dialysis catheterization:A case report

BACKGROUND Insertion of a catheter into the bladder is a rare complication of peritoneal dialysis(PD),and is mainly related to surgical injury.This paper reports a case of bladder perforation that was caused by percutaneous PD catheterization.CASE SUMMARY A 64-year-old man underwent percutaneous PD catheterization for end-stage renal disease.On the second day after the operation,urgent urination and gross hematuria occurred.Urinalysis showed the presence of red and white blood cells.Empirical anti-infective treatment was given.On the third day after the operation,urgent urination occurred during PD perfusion.Ultrasound showed that the PD catheter was located in the bladder,and subsequent computed tomography(CT)showed that the PD catheter moved through the anterior wall into the bladder.The PD catheter was withdrawn from the bladder and catheterization was retained.Repeat CT on the fourth day after the operation showed that the PD catheter was removed from the bladder,but there was poor catheter function.The PD catheter was removed and the patient was changed to hemodialysis.CT cystography showed that the bladder healed well and the patient was discharged 14 d after the operation.CONCLUSION Bladder perforation injury should be considered and treated timeously in case of bladder irritation during and after percutaneous PD catheterization.The use of Doppler ultrasound and other related technologies may reduce the incidence of such complications.

Effective Laparoscopic Catheter Insertion Technique for Peritoneal Dialysis Using Specially Designed Trocar:22 Years Multi-Center Retrospective Study of 804 Patients

Introduction: Literature reveals several peritoneal dialysis laparoscopic catheter insertion techniques developed to improve long-term results for treatment chronic kidney failure with the technic of peritoneal dialysis. The purpose of the study is evaluation of developed and recommended minimally invasive laparoscopic technic for chronic peritoneal dialysis catheter placement using specially constructed trocar. Materials and Methods: Retrospective study included 804 patients in 10 departments of surgery. Surgical and non surgical complications related to PD catheter placement were analysed: bleeding, dialysate leak, early SSI, peritonitis, catheter tip migration, catheter obstruction, omental wrapping and visceral perforations. Available software (Microsoft? Excel for Windows 10, MedCalc, Mariakerke, Belgium) was used for statistical analysis (presented as percentages, mean ± SD or median). Conclusions: The presented technique with specially constructed trocar is a simple and effective procedure with fewer complications comparing to literature. The advantages of this method include long rectus sheath tunnel with the deep cuff placed pre-peritoneally, the small size of the entrance into the peritoneum and accurate position and control of catheter tip in the pelvis.

No special management for peritoneal catheter in ventriculo-peritoneal shunt is required

Objective To investigate the dynamic changes of peritoneal catheter of ventriculoperitoneal shunt (V-P shunt) prospectively,and to determine simple,effective disposal method of peritoneal catheter. Methods From Jan 2007 to Oct 2010,consecutive 40 patients with hydrocephalus were treated by V-P shunt. All

The effect of matrine against biofilm formation in Escherichia coli

Objective:To investigate the effect of matrine against biofilm formation of Escherichia coli(E.coli)in the early stage.Methods:Biofilms of E.coli(ATCC25922)was induced by using a peritoneal dialysis catheter in 96-well plates.After treatment with matrine for 24 h,the formation of biofilm on the catheters was observed by scanning electron microscope.The expressions of the flagellar gene(fliC)and motility genes(motA and motB)were determined by qPCR,and the protein expression of fliC was detected by western blotting.Results:The biofilm formation of E.coli was suppressed by different concentrations(less than the minimal inhibitory concentration)of matrine,and the mRNA levels of motA and motB as well as the mRNA and protein expression levels of fliC were decreased in a dose-dependent manner.Conclusion:Matrine could inhibit biofilm formation of E.coli via downregulating the expression of motA,motB and fliC.