YEO W1,2, POTTER D2,3, NARAYANAN G3, ARAVINDAN A3, NANDAKOBAN H2,3, WONG J3
1South Western Sydney Clinical School, Sydney, Australia , 2University of New South Wales, Sydney , Australia , 3Renal Unit Liverpool Hospital, Sydney, Australia
Aim: To describe percutaneous peritoneal dialysis catheter (PPDC) insertion using ultrasound guided rectus sheath block (RSB) by nephrologists in an ambulatory setting.
Background: Analgesia for PPDC insertion concerns patients and proceduralist but is rarely described. RSB provides effective somatic analgesia for midline incisions. Our centre transitioned to oral premedication and Xylocaine 1% with Adrenaline 1:100000, as subcutaneous local anaesthesia (variable dose) and regional anaesthesia with RSB (fixed dose 10mls) for PPDC insertion in 2018.
Methods: A single centre retrospective review of PPDC insertions using RSB from January 2018 to April 2021. Patient, operator, procedural characteristics and post procedural outcomes including Kaplan-Meier survival were analysed with SPSS v.26.
Results: We identified 113 patients: 73% male, 58% Diabetic, median age 66 years (interquartile range(IQR)56-73), 87% pre-dialysis with median eGFR 8mls/min/1.73m2 (IQR=7-10). Most (95%) patients received formalized pre-procedure review: 37% had previous abdominal surgery, mean body mass index was 26.2kg/m2 (range=19-38) and median abdominal wall depth was 2.9cm (IQR=2.4-3.8). There were 64% same day discharges. Primary proceduralists were trainees in 34% cases. Median total Xylocaine with Adrenaline dose was 24.5mls (IQR=20-25). Insertion success was 99% with 96% flushing well post-procedure, 1 catheter failed <30 days. Acute start dialysis was commenced in 8 patients. Complications <30 days included: 2 cases of severe pain (1 due to mesenteric injury), 3 cases of bleeding and 1 catheter manipulation. Death and transplant censored primary catheter survival was 89% and 87% at 6 and 12 months respectively. The incidence of peritoneal dialysis peritonitis was 1 in 33 patient months.
Conclusions: PPDC insertion employing RSB performed by nephrologists and trainees in an ambulatory setting is simple and safe with good short and long-term outcomes.
Wai Weng is a 5th year medical student from University of New South Wales, currently based in Liverpool Hospital, Sydney. He has a strong interest in renal medicine.