Comparison for four techniques of catheter insertion in patients undergoing continuous ambulatory peritoneal dialysis

Objective: To compare four different ways of implanting catheters for continuous ambulatory peritoneal dialysis (CAPD) in an effort to reduce the incidence of complications. Design: Retrospective study. Setting: Teaching hospital, Taiwan. Subjects: 166 Patients who had 180 catheters inserted between 1985 and 1993. Interventions: 49 Catheters were inserted through midline incisions (in 24 of which the catheter was fixed with an additional suture) and 131 were inserted through paramedian incisions (in 88 of which the catheter was fixed with an additional suture). Main outcome measures: Morbidity, particularly the incidence of migration of the catheter and incisional hernia. Results: 8/68 Catheters migrated in patients in whom no additional fixing suture had been used, compared with 2/112 in whom an additional suture had been used (p = 0.007). There were 4 incisional hernias in 49 midline, compared with 0/131 paramedian, incisions (p < 0.0001). Significantly more catheters had to be removed after midline than after paramedian incisions (35/49 compared with 56/131 (p = 0.008); chi square for independence 15.02, df 3, p = 0.0018). Conclusion: For the implantation of catheters for CAPD the paramedian incision is associated with significantly fewer complications than the midline incision and the incidence is even lower if the catheter is fixed to the lower peritoneum with an additional suture.