Letter to the Editor
Diagnosis of obstruction peritoneal catheter by fluoroscopic peritoneography
Diagnóstico de obstrucción de catéter peritoneal mediante peritoneografía fluoroscópica
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peritoneography" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "101" "paginaFinal" => "103" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Aránzazu Sastre, Jose González-Arregoces, Igor Romainoik, Santiago Mariño, Cristina Lucas, Elena Monfá, George Stefan, Benjamin de León, Mario Prieto, Ana Maria Fernández Martinez" "autores" => array:10 [ 0 => array:4 [ "nombre" => "Aránzazu" "apellidos" => "Sastre" "email" => array:1 [ 0 => "aranchasastre@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Jose" "apellidos" => "González-Arregoces" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Igor" "apellidos" => "Romainoik" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Santiago" "apellidos" => "Mariño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Cristina" "apellidos" => "Lucas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Elena" "apellidos" => "Monfá" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "George" "apellidos" => "Stefan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Benjamin" "apellidos" => "de León" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "Mario" "apellidos" => "Prieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "Ana Maria" "apellidos" => "Fernández Martinez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Complejo Asistencial Universitario de León, León, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiología, Complejo Asistencial Universitario de León, León, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico de obstrucción de catéter peritoneal mediante peritoneografía fluoroscópica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1266 "Ancho" => 1023 "Tamanyo" => 105729 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fluoroscopic peritoneography with contrast outflow through upper orifices and tail obstruction.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Infusion/drainage problems are defined as a slowed flow, hampered or prevented by causes related to the catheter itself and not to the functioning of the peritoneum as a dialysis membrane. The occurrence of these problems ranges between 5% and 20% and is often associated with the technique used fro the placement of the catheter. They are more common in cases of implantation by laparoscopy.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Let us look at the case of a patient suffering catheter flow problems who was diagnosed with partial catheter obstruction by fluoroscopic peritoneography and whose transfer to haemodialysis was avoided.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 17-year-old female with CKD secondary to IgA nephropathy, on an automated peritoneal dialysis (APD) program since April 2015 through a double-cuff silicon catheter and with a pigtail end implanted by open surgery. She had experienced no mechanical or infectious problems related to the technique, and maintained a residual diuresis of 1500<span class="elsevierStyleHsp" style=""></span>ml per day. She came to the unit complaining that she could not perform dialysis due to multiple concerns. She did not report constipation, although she had only one small bowel movement a day. An exchange was performed at the unit, in which infusion was very slow and drainage heavily obstructed. A <span class="elsevierStyleItalic">push</span> and <span class="elsevierStyleItalic">suck</span> maneuver was applied, checking the permeability of the catheter. The most common causes of infusion problems are catheter buckling and blockage of the catheter lumen/hole due to fibrin. And the causes of drainage problems are either of the two previously mentioned, plus poor catheter placement, obstruction due to omentum entrapment and constipation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> An abdominal X-ray was performed showing the distal end of the catheter displaced in the left iliac fossa and abundant gases and stool remains. For diagnosis, the simple X-ray identifies the position of the catheter in the abdominal cavity. Enemas and laxatives were prescribed and walking was recommended. Patient showed no volume problems or uremic symptoms. 48<span class="elsevierStyleHsp" style=""></span>h later the patient returned without any resolution of the problem. The abdominal X-ray was repeated which showed no changes in terms of the positioning of the catheter, and so the alpha maneuver was performed. Poorly placed catheters can be repositioned using a vascular guide wire (alpha maneuver).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> This can resolve some 50–80% of cases, although only 33% will achieve a permanent solution. The catheter was able to be moved down by around 3<span class="elsevierStyleHsp" style=""></span>cm, but the drainage problem persisted. Iodinated contrast medium (10<span class="elsevierStyleHsp" style=""></span>ml) was infused by catheter and fluoroscopy showed that it only came out through the proximal orifices of the catheter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In cases where diagnosis is difficult, performing a CT or MR peritoneography, or the less-used fluoroscopy, can diagnose virtually all of such types of complications, ruling out leakage.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">As for treatment, this depends on the case; constipation can be treated with a fiber-rich diet, laxatives or enemas. Nearly 50% of drainage difficulties are resolved using these methods. Where fibrin plugs or strands appear in the effluent, adding 200–500<span class="elsevierStyleHsp" style=""></span>U/l of heparin to the dialysis fluid is beneficial. Where the fibrin causes occlusion of the catheter lumen, as in the case in point, the instillation of 5000<span class="elsevierStyleHsp" style=""></span>U of urokinase may be adopted, which should be maintained for 1<span class="elsevierStyleHsp" style=""></span>h.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The catheter was sealed with urokinase, achieving acceptable infusion and drainage flows. Since this measure was effective, heparin was added to the subsequent changes at the dose mentioned, the prescription was changed to manual with CAPD and a regular use of laxatives was recommended. The patient was subsequently monitored as an outpatient by telephone. Since the flows improved over time, the patient resumed APD.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Most complications that cause catheter infusion and drainage problems which cannot be resolved with conservative methods can be approached using laparoscopy techniques: repositioning of poorly placed catheters and suture fixation, fibrin occlusion cleaning, clearing obstructions caused by omentum entrapment and omentectomy, or replacement with a self-locating catheter.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Prevention of these types of conditions requires proper catheter placement and avoiding causes of constipation.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sastre A, González-Arregoces J, Romainoik I, Mariño S, Lucas C, Monfá E, et al. Diagnóstico de obstrucción de catéter peritoneal mediante peritoneografía fluoroscópica. Nefrologia. 2017;37:101–103.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1266 "Ancho" => 1023 "Tamanyo" => 105729 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fluoroscopic peritoneography with contrast outflow through upper orifices and tail obstruction.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Actualización de protocolos en la práctica clínicas de diálisis peritoneal: año 2004" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 2 | 4 |
| 2024 October | 48 | 32 | 80 |
| 2024 September | 54 | 16 | 70 |
| 2024 August | 62 | 47 | 109 |
| 2024 July | 52 | 23 | 75 |
| 2024 June | 45 | 33 | 78 |
| 2024 May | 58 | 26 | 84 |
| 2024 April | 63 | 36 | 99 |
| 2024 March | 51 | 28 | 79 |
| 2024 February | 38 | 33 | 71 |
| 2024 January | 42 | 20 | 62 |
| 2023 December | 26 | 29 | 55 |
| 2023 November | 58 | 30 | 88 |
| 2023 October | 43 | 28 | 71 |
| 2023 September | 42 | 26 | 68 |
| 2023 August | 44 | 23 | 67 |
| 2023 July | 60 | 29 | 89 |
| 2023 June | 55 | 17 | 72 |
| 2023 May | 73 | 30 | 103 |
| 2023 April | 40 | 19 | 59 |
| 2023 March | 72 | 20 | 92 |
| 2023 February | 44 | 18 | 62 |
| 2023 January | 44 | 18 | 62 |
| 2022 December | 65 | 28 | 93 |
| 2022 November | 61 | 21 | 82 |
| 2022 October | 61 | 28 | 89 |
| 2022 September | 63 | 36 | 99 |
| 2022 August | 67 | 39 | 106 |
| 2022 July | 54 | 48 | 102 |
| 2022 June | 80 | 39 | 119 |
| 2022 May | 32 | 33 | 65 |
| 2022 April | 56 | 48 | 104 |
| 2022 March | 41 | 38 | 79 |
| 2022 February | 42 | 45 | 87 |
| 2022 January | 57 | 32 | 89 |
| 2021 December | 58 | 40 | 98 |
| 2021 November | 48 | 35 | 83 |
| 2021 October | 79 | 44 | 123 |
| 2021 September | 55 | 35 | 90 |
| 2021 August | 46 | 42 | 88 |
| 2021 July | 88 | 38 | 126 |
| 2021 June | 42 | 26 | 68 |
| 2021 May | 42 | 39 | 81 |
| 2021 April | 77 | 57 | 134 |
| 2021 March | 43 | 42 | 85 |
| 2021 February | 33 | 63 | 96 |
| 2021 January | 33 | 19 | 52 |
| 2020 December | 33 | 13 | 46 |
| 2020 November | 38 | 17 | 55 |
| 2020 October | 32 | 21 | 53 |
| 2020 September | 22 | 17 | 39 |
| 2020 August | 43 | 18 | 61 |
| 2020 July | 50 | 16 | 66 |
| 2020 June | 30 | 19 | 49 |
| 2020 May | 57 | 22 | 79 |
| 2020 April | 40 | 17 | 57 |
| 2020 March | 33 | 15 | 48 |
| 2020 February | 42 | 21 | 63 |
| 2020 January | 61 | 30 | 91 |
| 2019 December | 52 | 16 | 68 |
| 2019 November | 43 | 20 | 63 |
| 2019 October | 28 | 13 | 41 |
| 2019 September | 38 | 15 | 53 |
| 2019 August | 28 | 16 | 44 |
| 2019 July | 48 | 18 | 66 |
| 2019 June | 41 | 20 | 61 |
| 2019 May | 26 | 19 | 45 |
| 2019 April | 54 | 38 | 92 |
| 2019 March | 41 | 22 | 63 |
| 2019 February | 43 | 13 | 56 |
| 2019 January | 39 | 19 | 58 |
| 2018 December | 137 | 46 | 183 |
| 2018 November | 206 | 23 | 229 |
| 2018 October | 208 | 17 | 225 |
| 2018 September | 98 | 16 | 114 |
| 2018 August | 56 | 14 | 70 |
| 2018 July | 58 | 14 | 72 |
| 2018 June | 78 | 15 | 93 |
| 2018 May | 74 | 15 | 89 |
| 2018 April | 147 | 6 | 153 |
| 2018 March | 97 | 15 | 112 |
| 2018 February | 124 | 4 | 128 |
| 2018 January | 91 | 8 | 99 |
| 2017 December | 132 | 8 | 140 |
| 2017 November | 63 | 12 | 75 |
| 2017 October | 29 | 7 | 36 |
| 2017 September | 50 | 6 | 56 |
| 2017 August | 88 | 12 | 100 |
| 2017 July | 83 | 8 | 91 |
| 2017 June | 73 | 6 | 79 |
| 2017 May | 83 | 11 | 94 |
| 2017 April | 57 | 8 | 65 |
| 2017 March | 49 | 4 | 53 |
| 2017 February | 6 | 1 | 7 |
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