Nuffield Department of Surgery John Radcliffe Hospital Headington Oxford UK Email: chris.darby{at}orh.nhs.uk
Sir,
We are writing as a follow up to our previously published article [1] describing the pull technique for removing Tenckhoff peritoneal dialysis catheters as a day case procedure, not requiring a general anaesthetic. We have been routinely using this technique in the Oxford Transplant Centre successfully for the last 3 years and now perform it exclusively on the ward. We would like to provide a warning regarding a catheter that snapped whilst being pulled out, by not following the described technique. However, it did remain attached to the inner cuff anchored to the abdominal wall and was removed safely under a local anaesthetic, as had been predicted theoretically in the original paper.
A 67-year-old male, with end-stage renal failure on ambulatory peritoneal dialysis with chronic obstructive pulmonary disease and a history of myocardial infarction in the last 3 months, had the catheter pulled on the ward. The outer cuff was surrounded by granulation tissue and as described in the original paper, was dissected out under a local anaesthetic to be removed with the catheter. The catheter was grasped by a Spencer Wells forceps and during the pull it snapped at the point of clamping. The patient subsequently underwent a wound exploration under local anaesthesia and as predicted the catheter was fixed to the anterior abdominal wall anchored by the inner cuff. The cuff along with the catheter was removed successfully and the patient discharged home the same day.
This case illustrates the importance of a steady pull technique applied by hand only. Grasping the catheter by an instrument has the definite risk of fracturing the catheter. Pulling by hand spreads the load more evenly and provides feed back as to the degree of traction being applied. Continued use of the pull technique in our and other units, which have taken up the technique since the original publication, is supported by its low complication rate, economic advantages and patient acceptability.
Conflict of interest statement. None declared.
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