Thread by @renalpages

How does your unit remove #PD catheters no longer in use @askrenal

so it looks like the majority of folk u open surgical technique to remove #PD catheters - but is there any evidence to suggest that one technique is superior over the other?

there is small amount of literature out there - this paper is the latest link.springer.com/article/10.100…
concludes that PT is superior to OST in terms of blood loss, anesthetic use, operative pain score, and operating time without sacrificing safety and survival benefits

this is another paper showing PT is superior for a number of reasons #PD lchc.hebmu.edu.cn/EN/10.3969/j.i…

and another advocating the pull technique pubmed.ncbi.nlm.nih.gov/28360368/

so why do folk still use the open surgical technique? #PD

For a number of reasons
Many #PD tubes are removed as peritonitis is severe and in those circumstances open surgical technique preferred to ensure the infected cuff is removed
this paper highlights the perils of not removing infected cuffs
pubmed.ncbi.nlm.nih.gov/33349099/

secondly surgeons ( yes am not a surgeon but work with plenty) prefer to have the patient under GA in case they have to do a washout or find something unpleasant when they remove the infected tube #PD

If a patient is in pain; then the best way to remove the tube is to offer a GA - ensures the patient is comfortable ( and will consider #PD as a therapy again in the future)

so what is my local practice?
- if the tube is removed for non infection reasons then we use the PT
-For #peritonitis we use the OST to ensure all the cuffs are out
- many of the catheters we use are #weighted - these cannot be removed by PT so we use OST

Going forward, because of the advantages of PT, one should consider the way we remove #PD catheters as much as the way we insert them - this not only makes the service we offer to patients more holistic but also goes a long way in ensuring patients recommend PD to their peers /