Salvage of Malpositioned and Malfunctioning Peritoneal Dialysis Catheters by Manipulation with a Modified Malecot Introducer

Percutaneous peritoneal dialysis (PD) catheter manipulation successfully corrects displacement and contributes to catheter salvage. We describe a new device for the percutaneous treatment of malpositioned PD catheters, the modified Malecot introducer technique, which is an improvement over previous methods because its flexible consistency also allows the manipulation of swan-neck catheters. Twenty-one patients experienced catheter displacement managed by the new introducer: 12 males, average time in PD 13.7 +/- 23.2 months, six with "swan-neck'' catheter, seven obese, and six with previous abdominal surgery. Catheter manipulationwas technically successful in 19 of 21 cases (90.4%) by the end of the first week and in 15 cases (71.4%) at 1 month. An additional eight episodes of malposition occurred ranging from 10 to 300 days after the first manipulation. A second manipulation using the same introducer was performed and resulted in long-term patency in seven patients. No complications were reported. In the long-term follow-up, only one patient removed PD catheter for mechanical dysfunction. Overall survival of manipulated catheters was 32.7 +/- 23.4 months. Function at 1 month correlated with function by the first week (r = 0.513; p = 0.017) and the need of a second manipulation with age ( r = 0.494; p = 0.027) but not with obesity or previous abdominal surgery. We conclude that manipulation using the modified Malecot introducer is a simple and effective procedure for the correction of malpositioned PD catheters. It also represents a new alternative for the management of displaced "swan-neck'' catheters.