Master of Science
Epidemiology and Biostatistics
Fluoroscopic peritoneal dialysis catheter (FPDC) positioning has not been thoroughly evaluated. Using a retrospective cohort of adult patients who underwent FPDC insertion in London, Ontario (Feb 1, 2010 - Aug 1, 2017); we retrieved procedural radiographs measuring the level of intraabdominal radiocontrast to pubic symphysis (IRPS), and catheter tip to pubic symphysis (CTPS). The median (Q1-Q3) distance (millimeters) of IRPS was larger in females [35(25-44)] than males [28(19-37); P=0.001]; but this distance was not associated with variables: Age (years), BMI (Kg/m2), Race, PKD, abdominopelvic surgeries, in correlation/regression analyses. CTPS distance increased with BMI [(β; 95% Confidence Interval (CI); females: 0.79; 0.01,1.57; males: 1.08; 0.69,1.47)] and decreased with aging in males (-0.16; -0.29, -0.03). Predictors of early catheter dysfunction were assessed: CTPS, age, BMI, Race, ESKD, sex, break-in-period, abdominopelvic surgeries via backward-stepwise logistic regression, observing associations for higher BMI (Odds Ratio; 95% CI; 1.09; 1.01, 1.16), diabetic ESKD (0.39; 0.16, 0.93).
Summary for Lay Audience
Patients with kidney failure who choose peritoneal dialysis require a permanent catheter inserted into their abdomen. Ideally, the catheter tip is positioned in the deep pelvis so that it fills and drains dialysis fluid easily. The pubic bone of the pelvis located in the mid-groin currently serves as the landmark for the pelvic cavity, and catheter inserters reference it to decide where they should insert the catheter. X-ray guided catheter insertion uses a sequence of real-time x-rays and contrast dye injected into the abdomen to help the catheter inserters visualize the deep pelvis and then position the catheter tip; however, the X-ray approach has not been well studied. We designed a study to understand how the practices unique to x-ray guided catheter insertion relate to the pubic bone landmark approach and if they are predictive of future catheter flow problems which are severe enough to require another procedure to reposition the catheter. Using stored procedure x-rays from adults who underwent x-ray guided catheter insertion in London, Ontario between 2010-2017, we used computer software to measure: 1. The distance between the pubic bone and the level of contrast which is injected into the abdomen and pools in the deep pelvis, 2. The distance between the pubic bone and the bottom of the catheter tip. We found that the distance between the pubic bone and injected contrast was larger in females than males, likely reflecting anatomical differences in the female versus male pelvis. The distance between the pubic bone and the bottom of the catheter tip increased with increasing body mass index (a calculation that uses height and weight to estimate how much body fat someone has, with higher values indicating higher body fat). We also found that the distance between the pubic bone and the bottom of the catheter tip decreased with aging in males. Finally, the distance between the pubic bone and the bottom of the catheter tip was not predictive of developing severe catheter flow problems.
Clark, David, "Fluoroscopic Guided Peritoneal Dialysis Catheter Placement: An Analysis of Pelvic Catheter Positioning and Early Catheter Flow Dysfunction" (2023). Electronic Thesis and Dissertation Repository. 9690.
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