Fluoroscopic manipulation of Tenckhoff catheters: outcome analysis.

UNLABELLED: Wire manipulation under fluoroscopic control can correct malposition of peritoneal catheters in a fast and safe manner. This study was performed to evaluate the success rate of wire manipulation and identify factors that may predict outcome.
MATERIAL AND METHODS: Data were prospectively collected between January 1, 1986 and June 30, 1996 among all patients with peritoneal catheter malfunction requiring manipulation at a single center. Manipulations were performed using a flexible guide wire under aseptic fluoroscopic control. All patients had flat plates of the abdomen pre and post manipulation and received antibiotics after the procedure. The direction of the subcutaneous tunnel at the point of entry into the peritoneal cavity was calculated from the X-rays by measuring the angle formed by the horizontal and the distal subcutaneous tunnel. Success was defined as adequate peritoneal catheter function at three months. The success rate was correlated with type of catheter, patient weight and the subcutaneous tunnel orientation.
RESULTS: 1250 Tenckhoff double-cuff peritoneal catheters were inserted and 69 (5.5%) were manipulated (59 straight and 10 curled). The median for time elapsed between peritoneal catheter insertion and wire manipulation was 18 days (range 1 day-5 years). The overall success rate was 60.9% (61% for straight and 60% for curled peritoneal catheters). The mean patient weight for successes was 71.4 +/- 12.4 and 84.0 +/- 17.2 kg for failures (p < 0.005). Subcutaneous tunnel orientation between 30 and 120 degrees was associated with the highest success and those beyond 120 degrees with the highest failure rate. No complications were observed.
CONCLUSIONS: Wire manipulation under fluoroscopic control of Tenckhoff peritoneal catheter in the treatment of malfunction is a safe and highly effective procedure. Obesity and cephalad orientation of the subcutaneous tunnel were associated with less favorable outcome.