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John H Crabtree - One of the best experts on this subject based on the ideXlab platform.

  • Peritoneal Dialysis Catheter insertion
    Seminars in Nephrology, 2017
    Co-Authors: John H Crabtree, Kaiming Chow
    Abstract:

    The success of Peritoneal Dialysis as renal-replacement therapy depends on a well-functioning Peritoneal Catheter. Knowledge of best practices in Catheter insertion can minimize the risk of Catheter complications that lead to Peritoneal Dialysis failure. The Catheter placement procedure begins with preoperative assessment of the patient to determine the most appropriate Catheter type, insertion site, and exit site location. Preoperative preparation of the patient is an instrumental step in facilitating the performance of the procedure, avoiding untoward events, and promoting the desired outcome. Catheter insertion methods include percutaneous needle-guidewire with or without image guidance, open surgical dissection, peritoneoscopic procedure, and surgical laparoscopy. The insertion technique used often depends on the geographic availability of material resources and local provider expertise in placing Catheters. Independent of the Catheter implantation approach, adherence to a number of universal details is required to ensure the best opportunity for creating a successful long-term Peritoneal access. Finally, appropriate postoperative care and Catheter break-in enables a smooth transition to Dialysis therapy.

  • Operative Considerations for Peritoneal Dialysis Catheter
    Interventional Nephrology, 2013
    Co-Authors: Stephen R. Ash, Rajeev Narayan, Anil K. Agarwal, John H Crabtree
    Abstract:

    Peritoneal Dialysis is a very effective therapy in ESRD patients, especially when combined with some residual renal function. Peritonitis is the most common reason for transfer from Peritoneal Dialysis to other therapies, but Catheter failure is the next most common cause. The success of Peritoneal Dialysis Catheters is dependent upon the method of placement and the Catheter design chosen but more dependent upon the skill and experience of the physician placing the Catheter. This chapter reviews the types of Catheters available currently and recently, proper location of Catheter components, preoperative evaluation of the patient including ultrasound of the abdominal wall and peritoneum, overview of methods of placement, embedding of PD Catheters and exteriorization, Catheter repositioning, repair of periCatheter leaks and hernias, and Catheter removal.

  • Peritoneal Dialysis Catheter embedment surgical considerations expectations and complications
    American Journal of Surgery, 2013
    Co-Authors: John H Crabtree, Raoul J Burchette
    Abstract:

    Abstract Background Peritoneal Dialysis Catheter embedment consists of implanting the Catheter far in advance of anticipated need, with the external tubing buried under the skin. The Catheter is externalized when initiation of Dialysis is required. Details of the surgical procedure and management of associated complications are generally lacking. Methods A total of 84 Catheters including conventional and extended Catheters were embedded and externalized during the study period. Factors influencing duration of embedment, functionality upon externalization, and long-term outcomes were analyzed. Results Mean duration of embedment was 13.9 months (median 9.4; range .5 to 68.5). Immediate function was exhibited in 85.7% of Catheters. Employing laparoscopic revision, 98.8% of embedded Catheters were successfully used for Peritoneal Dialysis. Extended Catheters and duration of embedment were important determinants of Catheter functionality. Conclusions Catheters can be embedded for prolonged periods and still result in functional Dialysis access when needed. Complications are few and easily managed.

  • Selective performance of prophylactic omentopexy during laparoscopic implantation of Peritoneal Dialysis Catheters.
    Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2003
    Co-Authors: John H Crabtree, Arnold Fishman
    Abstract:

    Summary:Omental entrapment of the Peritoneal Dialysis Catheter remains a common cause of flow dysfunction. Prophylactic omentectomy during Catheter implantation is still followed with an incidence of flow obstruction as high as 10%. We describe indications and a technique for selective performance o

  • Laparoscopic implantation of swan neck presternal Peritoneal Dialysis Catheters.
    Journal of Laparoendoscopic & Advanced Surgical Techniques, 2003
    Co-Authors: John H Crabtree, Arnold Fishman
    Abstract:

    The swan neck presternal Peritoneal Dialysis Catheter provides an alternative location from which a Catheter can exit the skin when an abdominal site is not suitable. The exit site is in the upper anterior chest. The presternal Catheter was designed for patients who would not ordinarily be considered for Peritoneal Dialysis because of body habitus, presence of stomas, or urinary-fecal incontinence. In its original design, the Catheter can be implanted only by open dissection. We present a modification of the Catheter system and describe an operative technique in which the Catheter can be inserted laparoscopically. Eight patients underwent laparoscopic implantation of presternal Catheters by this technique. During follow-up ranging from 2.9 to 12.4 months (average, 5.3 months), no instances of Catheter dysfunction, leakage around the cannula, hernia, or loss secondary to infection occurred. We foresee greater use of the swan neck presternal Peritoneal Dialysis Catheter once surgeons become more familiar wi...

James R. Stallworth - One of the best experts on this subject based on the ideXlab platform.

Hongyi Lei - One of the best experts on this subject based on the ideXlab platform.

  • ultrasound guided unilateral transversus abdominis plane combined with rectus sheath block versus subarachnoid anesthesia in patients undergoing Peritoneal Dialysis Catheter surgery a randomized prospective controlled trial
    Journal of Pain Research, 2020
    Co-Authors: Wenjing Guo, Wei Zhao, Xiang Wang, Jie Zhou, Hongyi Lei
    Abstract:

    Background Peritoneal Dialysis Catheter placement can be performed under general anesthesia, local anesthesia or subarachnoid anesthesia (SA). Recently, studies have reported the successful placement of Peritoneal Dialysis Catheters using a transversus abdominis plane (TAP) block and rectus sheath (RS) block. This study compared the TAP + RS block with SA for patients undergoing Peritoneal Dialysis Catheter placement. Methods Sixty patients were randomly divided into two groups, with 30 receiving unilateral ultrasound-guided TAP + RS block anesthesia and 30 receiving SA. The demographic characteristics, anesthesia efficacy, indicators related to anesthesia or operation, hemodynamic index, postoperative pain numeric rating score (NRS), postoperative recovery indicators, complications related to anesthesia or surgery, and dosage of sedative or analgesic medication were analyzed. Results Anesthesia operation time was significantly shorter in the TAP + RS block group than in the SA group (P<0.001), while there was no significant difference in success rates (TAP + RS 93.33% [95% confidence interval, 95% CI, 83.9-102.8%] vs SA 100.00% [95% CI, 100-100%], P=0.472). Two patients in the TAP + RS group needed extra analgesia, although the dermatome pinprick sensation test gave negative results for all patients. Patients who received the TAP + RS block expressed significantly less pain on movement or at rest at 4 h and 8 h postoperative. Fewer patients needed rescue analgesia with tramadol in the postoperative period in the TAP + RS block group than in the SA group (P<0.05). The intraoperative MAP was more stable (P<0.05) in the TAP + RS group compared to the SA group. Conclusion The TAP + RS block is a safe, effective method for use as the principal anesthesia technique in PD Catheter placement. Compared to SA, it has the advantages of less influence on hemodynamics and a better postoperative analgesic effect.

A. Sakarcan - One of the best experts on this subject based on the ideXlab platform.

C. Thiel - One of the best experts on this subject based on the ideXlab platform.

  • Hernia repair and simultaneous continuous ambulatory Peritoneal Dialysis (CAPD) Catheter implantation: feasibility and outcome
    Hernia, 2019
    Co-Authors: P. Horvath, A. Königsrainer, T. Mühlbacher, K. Thiel, C. Thiel
    Abstract:

    Background Occurrence of abdominal wall hernias during and before Peritoneal Dialysis constitutes a pivotal role in treatment discontinuation, failure, and exclusion from this Dialysis method. We herein present a single-center experience regarding a one-stage surgical strategy, including hernia repair and simultaneous Peritoneal Dialysis Catheter implantation. Patients and methods Over a 4-year period, 123 patients underwent Peritoneal Dialysis Catheter implantation and 23 patients (19%) had concomitant abdominal wall hernias and were enrolled in this monocentric prospective study. Data collection included recurrent and new-onset hernias, surgical site infection, 1-year and 2-year Catheter survival. Results In 23 patients, 27 hernia repairs combined with Peritoneal Dialysis Catheter implantation were performed. Median age was 52 years (range, 30–85 years) and 18/23 (78%) patients were male. There were no recurrent hernias and no early surgical site infections. Daily flushing was regularly started on the 1st to 3rd postoperative day. Five patients (22%) developed hernias on other anatomical sites, which required hernia repair and perioperative discontinuation of Peritoneal Dialysis. After a median follow-up of 37 months (range, 28–87 months), 96% of all implanted Catheters were still working. Conclusion Hernia repair and simultaneous Peritoneal Dialysis Catheter implantation are associated with no recurrent hernias, an early start of Peritoneal Dialysis, a very low postoperative morbidity and very high 1-year and 2-year Catheter survival.