V WIJERATNE1, K MCNAMARRA1, S May1
1Tamworth Hospital, Tamworth, Australia
Background: Many interventional Nephrologists will not place PD catheters in abdomens where there has been previous abdominal surgery.At Tamworth all patients wanting to do PD have catheters inserted by an interventional nephrologist apart from occasional patient who needs concurrent hernia surgery.
Aim: To describe successful insertion and use of PD catheters in higher risk patients as demonstrated by 3 patients who on initial assessment may have appeared not suitable for insertion of a PD catheter and/or successful PD. Focus on failed SPK patients given a comment from a senior transplant physician that they had not had success with CAPD in failed SPK.
The procedure uses real time ultrasound and a Seldinger technique placing a hydrophilic wire in the pelvis with Xray and then catheter insertion over the wire.Case 1 – 53 year old with ESRF due to T1DM had a SPK in 2005 with a pancreatectomy in same year. Had slowly progressive CKD. Was started on PD in Nov 2016. Catheter inserted without complications with no technical problems since. Remains on CAPD.
Case 2 – 37 year old female with ESRF secondary to Type 1 DM. Had a SPK in 2012. Developed acute rejection and started on CAPD Oct 2017. Catheter inserted without complications with no technical issues since. Remains on CAPD.
Case 3 – 65 year old male ESRF of uncertain cause. Previously had suffered a shot gun wound to the abdomen with multiple surgeries. PD catheter inserted without complications. Awaiting to start PD.
Conclusion – PD catheters can be successfully inserted by interventional nephrologist in patients with multiple abdominal scars using appropriate techniques.
Dr Viduranga Wijeratne is a Renal Advanced Trainee in Tamworth Rural Referral Hospital. He completed his BMed MD at UNSW and his basic physicians training at Concord Repatriation General Hospital.