1. EXPERIENCE WITH DIFFICULT CAPD CATHETER INSERTION Dr.Sunil Shroff Dept. of Urology & Transplantation, Sri Ramachandra Medical College & Research Institution, Chennai, India

2. CAPD- Implant SUCCESS OF CAPD Long Term Success of Continuous Ambulatory Peritoneal Dialysis depends on Successful CAPD Catheter Implantation

3. CAPD- Implant CAPD CATHETER IMPLANTATION Meticulous Surgical Technique to perform this simple procedure usually successful with minimum morbidity

4. CAPD- Implant RELATIVE CONTR-INDICATIONS TO CAPD CATHETER INSERTIONS Previous Abdominal Surgeries Incisional Hernias Obese Patients Repeated Peritonitis Repeated Catheter Malfunction Children – If catheter Size mismatch with catheter

5. CAPD- Implant DIFFICULT - CAPD CATHETER INSERTIONS Previous Abdominal Surgery (10) Repeated Peritonitis Episodes Requiring Removal and Re-insertion of Catheter (5) Catheter malfunction requiring Catheter Re-insertion (3) Associated Abdominal Hernias (3) Grossly Obese patients (2) Pediatric patients (3)

6. CAPD- Implant CAPD Catheter – Pre-op Drill Antibiotics – with Pre-Med Laxatives / Enemas / Suppository Betadine Scrub – Abdomen, Groin, Perineum – Half a dozen Times Shave – only if necessary and in operating Room Bladder – emptied before Implantation

7. CAPD- Implant RESULTS - DIFFICULT - CAPD CATHETER INSERTIONS Except on one occasion CAPD Catheter was succsessfully Implanted on all Patients

8. CAPD- Implant SECRET OF SUCCESS FOLLOWING BASIC SURGICAL PRINCIPLES METICULOUSLY FOR THIS PROCEDURE Pre-empting Difficulties A No Touch technique for CAPD catheter implantation Regional Anaesthesia for procedure

9. CAPD- Implant SECRET OF SUCCESS Keeping the Right Inventory of CAPD Catheters Combining Procedures if necessary e.g. – Hernia repair with Catheter Implantation Doing a Test Run of Inflow & Outflow of Fluid Before Closure of Abdomen

10. CAPD- Implant Catheter Inventory Oreopolous Catheter found to be the best catheter under difficult circumstances ( In only one instance in an obese patient this catheter failed ) Straight Catheters Should be used for Obese Patients Pediatric Catheters should be used (Avoid Trimming of adult Catheters) for children

11. CAPD- Implant Rescue CAPD catheter Oreopolous catheter – 1. Use Where Abdominal Adhesions Expected after surgery Previous Abdominal surgery Complex incisional Hernias to be concurrently repaired 2. Re-do CAPD catheters Implantation where Previous Catheter malfunction

12. CAPD- Implant DACRON CUFFS & OBESE PATIENTS For Obese Patients Standard Seperation Between Two Dacron Cuffs of CAPD catheters inadequate To Circumvent Problem Another Dacron Cuff added & placed 2.5cms from exit site

13. CAPD- Implant CAPD CATHETER INSERTIONS IN CHILDREN If Smaller Sized catheters not available for children? Ans. Use a High Insertion of catheter rather than trimming catheter. Otherwise will lose the holes in the catheter and this may lead to catheter malfunction

14. CAPD- Implant ROLE OF CYCLER In Difficult CAPD Implantation Cycler if available can be used to institute Low volume exchanges – early on after implantation ( We used Cycler within 3 days after implantation of catheter )

15. CAPD- Implant CONCLUSION For Difficult Surgical Group of patients the Surgical principles are generally similar Keeping a CAPD Catheter Inventory is helpful and increases chances of successful Implantation of Catheter Oreoplous catheter is a Good Rescue Catheter There are no real contra-indications to CAPD catheter Insertions