RU2177737C1 - Method for implanting catheter for carrying out peritoneal dialysis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves making surgical access to the abdominal cavity. The catheter with two fixing collars is placed in the inferior zone of the abdominal cavity. The fixing collars are coaxially set in the area of surgical cut on the external and internal side of the parietal peritoneum. The collars are attached to the peritoneum with separate interrupted sutures. EFFECT: avoided dialysis solution resorption from the abdominal cavity into the subcutaneous fat; increased contact area of the peritoneum with the dialysis solution.

Description

 The invention relates to medicine and can be used to ensure continuous outpatient dialysis in patients in the terminal stage of chronic renal failure, or acute peritoneal dialysis in patients with acute renal failure.

 A known method of implanting a catheter for peritoneal dialysis, including puncture installation by piercing the abdominal wall with a stylet. After removal of the stylet, the catheter is held by the abdominal wall (Indraprasit S. Continuos peritoneal dialysis in acute renal failure from severe falciparum malaria // Clin. Nephrol. - 1988. - Vol. 3. - P. 137-143).

 The disadvantage of this method is the risk of damage to internal organs, which can lead to complications, for example, perforation of the intestine and its mesentery, which often leads to peritonitis, intraperitoneal bleeding.

 A known method of implanting a catheter for peritoneal dialysis, including prompt access to the abdominal cavity and placing a catheter with two locking cuffs in the lower abdominal cavity (RF Patent 2141850, IPC A 61 M 25/04, publ. 1999).

 The disadvantage of this method is the lack of reliable sealing of the abdominal cavity, which does not allow peritoneal dialysis to begin immediately after the catheter is installed, due to the danger of a high-osmolar peritoneal dialysis solution flowing into the subcutaneous fat.

 The task set by the authors is to eliminate these shortcomings due to additional sealing of the abdominal cavity at the level of the parietal peritoneum in the area of catheter implantation, which allows you to start peritoneal dialysis immediately after implantation of the catheter into the abdominal cavity.

 For this, in the method of implanting a catheter for peritoneal dialysis, which includes quick access to the abdominal cavity and placing the catheter with two locking cuffs in the lower abdominal cavity, it is proposed to fix the cuffs coaxially in the surgical incision from the inside and outside of the parietal peritoneum and fix them separately interrupted sutures.

 This avoids the resorption of the dialysis solution from the abdominal cavity into the subcutaneous fat at the place where the peritoneal catheter passes through it, which increases the area of contact of the peritoneum with the dialysis solution and increases the clearance of toxic substrates.

 The method is as follows.

 Under local anesthesia, a microlaparotomy is performed, after opening the abdominal cavity in the pelvic cavity, the distal part of the catheter is installed on a metal stylet-conductor, the catheter is a silicone tube with a perforated abdominal end. After removal of the conductor, the distal dacron cuff is fixed from the inner surface of the parietal peritoneum with interrupted sutures (e.g., Prolen N 3-4) and, in addition to the place of the previous row of sutures, the second dacron cuff is tightly installed on the outside of the parietal peritoneum and is also sutured to the peritoneum similarly way. If there are indications, the cuffs are sewn together, for example, with separate interrupted sutures. To control the functional ability of the catheter, a "hydraulic test" is carried out - a trial infusion of the dialysis solution into the abdominal cavity is carried out. If the test is positive, the proximal end of the catheter is brought to the skin through a separate contrapertural puncture of the skin and the wound is sutured in layers.

 Example.

 Patient B., born in 1964 (East. Disease N3322, 2000).

 After receiving numerous injuries, he was admitted in serious condition to the intensive care unit. Diagnosis: closed craniocerebral trauma, concussion, multiple bruises of soft tissues of the face, hypothermia I st. blood pressure 60/40 mm RT. Art. acute renal failure, stage of oliguria.

 In the intensive care unit, the patient received appropriate intensive care, but the patient's condition remained serious, and the phenomena of uremia and hyperhydration progressed against the background of acute renal failure.

 Due to the need for temporary renal replacement therapy, the patient was transferred to the department of chronic hemodialysis and kidney transplantation. An operation was performed on an emergency basis: implantation of a peritoneal catheter according to the method described above.

 Upon admission, the patient's condition is severe, blood pressure 125/85 mm RT. Art. , central venous pressure of 12 cm of water. Art. , hemoglobin 110 g / l, total bilirubin 15 μmol / l, plasma creatinine 1000 μmol / l, plasma urea 31 mmol / l, plasma potassium 5.6 mmol / l, plasma sodium 127 mmol / l, diuresis 300 ml / day.

 On the 6th day, diuresis increased to 600 ml / day, a decrease in azotemia, on the 8th day, diuresis was 1,500 ml / day, the peritoneal dialysis program was discontinued.

 The patient was discharged in satisfactory condition for aftercare at the place of residence.

 The proposed method allows you to start renal replacement therapy at the earliest possible time, providing early restoration of urine output, reduces the patient’s hospital stay and rehabilitation, reduces the cost of treatment.

Claims (1)

 A method for implanting a catheter for peritoneal dialysis, comprising quick access to the abdominal cavity and placing a catheter with two locking cuffs in the lower abdominal cavity, characterized in that the locking cuffs are installed coaxially in the surgical incision from the inside and outside of the parietal peritoneum and are fixed separately to it interrupted sutures.