#1089 Outcomes of medical and surgical peritoneal dialysis catheter insertion: a single centre experience

Abstract Background and Aims Medical insertion of peritoneal dialysis (PD) catheters has been common practice within the renal unit at University Hospitals Plymouth NHS Trust for over 25 years. Historically, uncomplicated patients with no previous abdominal surgery were suitable for Seldinger insertion whereas more complex patients required peritoneoscope insertion. Patients with a history of major abdominal surgery or those with a hernia were referred for surgical insertion of PD catheter. Following changes to EU medical device regulations, equipment production for the peritoneoscope ceased, resulting in a reduced ability to provide medical PD catheter insertions. With mounting pressures for surgical waiting times and increasing theatre demands, there has been a need to adapt practice and expand the criteria for medical insertions to maintain the PD service. The national drive to promote and increase access to home dialysis therapies (National Kidney Federation, 2024) has provided an opportunity to benchmark our practice and review our patient criteria for Seldinger insertion to ensure safe and effective practice. Method All renal units within the South West were contacted as a benchmarking exercise to establish current practice and identify patient selection for Seldinger insertion of PD catheters. UK Renal Registry data (26th Annual Report) was reviewed to understand the incidence of PD as choice of renal replacement therapy (RRT) in each of the units contacted allowing incidence of PD therapy to be compared to insertion method. Electronic and paper case notes were retrospectively reviewed for all patients who underwent PD catheter insertion from March 2021 to September 2024 (43 months). Data collected included demographic data, method of PD catheter insertion, complications and outcomes at two months and one year post insertion. Descriptive statistics were used to analyse the data. Coding of previous surgical history, complications and outcomes enabled themes to be established. Results The benchmarking exercise highlighted a limited number of units undertaking medical insertion of PD catheters (2/6). Practices in the units offering medical insertion were aligned, with similar criterion for both types of insertion. There appears to be a correlation between greater incidence of PD uptake in the units with access to medical insertion of PD catheters as opposed to units who solely offer surgical insertion. The review of patient case notes sampled one hundred patients. There was no difference in baseline demographic data for each technique. Complication rates were similar for each category of abdominal surgery in both medical and surgical techniques. Patients who had a failed medical insertion of PD catheter or those with a history of gastric/bowel surgery were routinely offered surgical insertion. Primary non-function, need for reposition/replacement, infection or drainage problems were similar between each method of insertion. A slightly higher rate of exit site leak was observed in surgical insertions in comparison to either of the medical insertion techniques. Importantly, there was no mortality associated with the procedure itself for any type of insertion. A larger number of medically inserted PD catheters were functional at two months than those surgically inserted. At one year, more patients remained on PD following a medically inserted catheter as opposed to those inserted surgically. Conclusion Historically, there have been concerns over undertaking Seldinger insertion of PD catheters in patients with previous abdominal surgery. Yet, we have observed similar complication rates amongst each insertion method, along with more patients remaining on PD following a medical insertion. In this cohort, Seldinger insertions appear to be safe and effective in patients with a range of surgical histories. Although this is a single centre review, with a small sample size, this audit supports the broadening of local criteria for medical insertion of PD catheters. This may allow for timelier insertion; increasing ease of access to home therapies and lower waiting times for tube insertion.