Fixing the peritoneal dialysis catheter at open insertion cut displacement with no added complications

Design

Meta-analysis of comparative studies

Population

13 studies, 1,275 patients undergoing open PD catheter placement

Primary outcome

Catheter displacement and complications

Effect

Displacement OR 0.08 (0.04–0.16); operating time +4.2 minutes

Catheter migration is a common reason peritoneal dialysis fails early and patients move to haemodialysis. This meta-analysis, published on 16 October, pooled 13 studies comparing catheter fixation with no fixation during open surgical placement: 648 patients with fixation and 627 without.

Fixation reduced catheter displacement substantially (OR 0.08, 95% CI 0.04–0.16). There was no difference in catheter malfunction without displacement, omental wrapping, infection, bleeding, infusion pain or hernia, though some of these estimates are imprecise. Fixation added about four minutes to the operation.

Most included studies were from China, and the abstract does not specify how many were randomised, so selection and technique differences may contribute. The size of the effect on displacement is large enough that it is unlikely to be explained by bias alone. For units placing catheters by open technique, including many in India, it is a low-cost step to consider.

• When placing a peritoneal dialysis catheter by open surgery, consider fixing the intra-abdominal tip to reduce migration.
• Expect a few extra minutes of operating time, without evidence of more infection or hernia.
• In early drainage failure, check the catheter position on plain X-ray before other interventions.
• Constipation is a common, correctable cause of catheter dysfunction; treat it before repositioning.

Why it matters

Catheter displacement is a leading cause of early technique failure, and this simple step appears to prevent most of it.

Don't overread it

The pooled studies vary in design and come mostly from one country; this does not compare open with laparoscopic insertion.

The statistics, in plain English

An odds ratio of 0.08 means the odds of displacement were about 92% lower with fixation. Confidence intervals for rare complications such as bleeding (0.11–69.74) are very wide, so the study cannot rule out small differences in those.

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