Sustained Traction Technique is a Safe and Feasible Approach to Peritoneal Dialysis Catheter Removal: Experience of a Single Surgeon

Background: The use of Peritoneal Dialysis (PD) catheters is an attractive option for many patients who require dialysis. These PD catheters are most commonly placed with a standard minimally invasive technique. However, multiple techniques can be applied to remove these catheters. At our institution, under a single surgeon, we perform PD catheter removals in the operating room under mild to moderate sedation. Sustained traction is applied to the PD catheter until the catheter is released from the cuffs and easily slides off with both the superficial and deep cuffs left behind. In the event of catheter breakage, general anesthesia is induced and the PD catheter will then be removed in the usual open approach. The objective of this study was to determine if the pull technique can be safely employed for PD catheter removal with no increased complication rate. Methods: A case series study was performed at a community teaching hospital. Thirty-one patients underwent PD catheter removal from July 2017 to December 2021 for any indication. Ten patients had their PD catheter removed secondary to peritoneal dialysis-related infections (32%), 12 patients had their PD catheter removed due to mechanical failure. Postoperative infection rate and complication rate after removal of PD catheter using the sustained traction technique was measured. Results: There were no postoperative infections necessitating cuff removal due to a retained cuff after removing the PD catheter in our patient cohort. The mean time for catheter removal with the sustained traction technique was 4 minutes. Only one patient required general anesthesia and conversion to open removal technique due to catheter breakage as the patient had an extension tubing with additional connection (3%). Conclusion: Our series shows that the sustained traction technique can be safely employed for PD catheter removal under minimal sedation with no increased complication rate. Background: The use of Peritoneal Dialysis (PD) catheters is an attractive option for many patients who require dialysis. These PD catheters are most commonly placed with a standard minimally invasive technique. However, multiple techniques can be applied to remove these catheters. At our institution, under a single surgeon, we perform PD catheter removals in the operating room under mild to moderate sedation. Sustained traction is applied to the PD catheter until the catheter is released from the cuffs and easily slides off with both the superficial and deep cuffs left behind. In the event of catheter breakage, general anesthesia is induced and the PD catheter will then be removed in the usual open approach. The objective of this study was to determine if the pull technique can be safely employed for PD catheter removal with no increased complication rate. Methods: A case series study was performed at a community teaching hospital. Thirty-one patients underwent PD catheter removal from July 2017 to December 2021 for any indication. Ten patients had their PD catheter removed secondary to peritoneal dialysis-related infections (32%), 12 patients had their PD catheter removed due to mechanical failure. Postoperative infection rate and complication rate after removal of PD catheter using the sustained traction technique was measured. Results: There were no postoperative infections necessitating cuff removal due to a retained cuff after removing the PD catheter in our patient cohort. The mean time for catheter removal with the sustained traction technique was 4 minutes. Only one patient required general anesthesia and conversion to open removal technique due to catheter breakage as the patient had an extension tubing with additional connection (3%). Conclusion: Our series shows that the sustained traction technique can be safely employed for PD catheter removal under minimal sedation with no increased complication rate.