Dissertação
Implante de cateter de diálise peritoneal: técnica de Seldinger e técnica cirúrgica, resultados no Hospital Universitário de Santa Maria
Fecha
2015-03-17Registro en:
PANSARD, Rafael Boeira. IMPLANT OF PERITONEAL DIALYSIS CATHETER: SELDINGER TECHNIQUE AND SURGICAL TECHNIQUE, RESULTS AT HUSM. 2015. 39 f. Dissertação (Mestrado em Medicina) - Universidade Federal de Santa Maria, Santa Maria, 2015.
Autor
Pansard, Rafael Boeira
Institución
Resumen
Peritoneal dialysis (PD) is a well-established modality of renal replacement
therapy, which has as a principle for its proper function the guaranteed access to the
peritoneal cavity. PD catheter implant technique should be safe, as well as provide
minimal inconvenience to the patient, agility for the service, and few complications. At
the University Hospital of Santa Maria (HUSM; Santa Maria, RS, Brazil), the
catheters were inserted by laparotomy since the 1980s. It is been desired by the
Nephrology department an alternative to facilitate the procedure, leading to greater
agility and greater autonomy of the service. This study aimed to analyze the results
obtained by professionals trained to implant peritoneal catheters with the Seldinger
technique, recently implemented, and those obtained with the standard surgical
technique. The samples were obtained from medical records of patients with endstage
chronic kidney disease at the Nephrology department of HUSM with peritoneal
dialysis indication (n=104). The demographic profile of the patients was evaluated, as
well as the presence of infection and / or bleeding in the surgical wound, the first
infusion and the 30-day functionality of the catheters, and the survival rate one and
two years after implant. Data for each peritoneal catheter insertion mode were
expressed as frequencies and then compared by chi-square, Fisher exact or Mann
Whitey tests, with a 5% significance level. The profile of the two groups had similar
characteristics in relation to gender, age, history of diabetes mellitus and arterial
hypertension. The functionality of the implant at first infusion was also similar for both
groups (83.9%for Seldinger vs. 79% for surgery). When evaluated the functionality in
30 days, the Seldinger technique demonstrated a higher success rate (76.7%) than
the surgical technique (43.6%) (P-value=0,002). Regarding the presence of infection
and / or bleeding in the outside wound, the percentage was similar for both groups
(14.8% for Seldinger vs. 16.9% for surgical). The survival rate of the catheters at 1
and 2 years was also similar for both groups (37% and 14.8% for Seldinger, 23.7%
and 20.6% for surgery, respectively). Given these results, it can be concluded that
the implant of peritoneal catheters by Seldinger technique is a qualified alternative
that allows greater agility to the service since it is an ambulatory procedure, can be
performed by nephrologists and involves less patient management; having similar
functionality to surgical implant according to the experience reported at HUSM.